Vaginal Cellular Angiofibroma with Heavy Bleeding: A Case Report

Cellular angiofibroma is a rare mesenchymal tumor that most commonly presents as an asymptomatic well-circumscribed mass in the vulva. Very few cases have been found in the vagina and even fewer presented with vaginal bleeding. A 54-year-old female presented to the emergency department with five months of vaginal bleeding and symptomatic anemia requiring blood transfusion. Upon physical examination, she was found to have a firm 4 cm posterior vaginal mass, distinctly distal to the cervix. The mass was resected and diagnosed as a vaginal cellular angiofibroma on pathologic evaluation. The patient did well post-operatively with recommended follow-up every six months. The common differential diagnosis for a bleeding vaginal mass includes leiomyoma, angiofibroblastoma, aggressive angiomyxoma, squamous cell carcinoma, and adenocarcinoma. In this case, cellular angiofibroma presented as a vaginal mass with heavy bleeding leading to severe anemia. Early involvement of gynecologic oncology can help to optimize patients’ evaluation and management.