Pararectal aggressive angiomyxoma with bilateral ovarian endometriomas cysts: a rare case report

Background Aggressive Angiomyxoma (AAM) is a rare mesenchymal tumor characterized by local invasiveness and a high recurrence rate, often arising in the pelvis and perineum. Case presentation We report a 49-year-old woman presenting with a long-standing pelvic mass. Imaging suggested bilateral ovarian endometriomas and a deep pelvic lesion suspicious for AAM. The patient underwent total hysterectomy, bilateral adnexectomy, and complete resection of a pararectal mass via a pure transabdominal laparotomy, without any perineal incision or manipulation. Histopathology and immunohistochemistry confirmed pararectal Aggressive Angiomyxoma coexisting with bilateral ovarian endometriotic cysts. Conclusion This rare combination highlights the importance of MRI in preoperative diagnosis and the challenges of surgical management for deep pelvic AAM. Complete resection and long-term follow-up are essential to reduce recurrence.