Submit Manuscript | http://medcraveonline.com Abbreviations: CAF, cellular angiofibroma; WDL, well-di- fferentiated liposarcoma; SMA, smooth muscle actin; ER, estrogen receptor; PR, progesterone receptor Introduction Cellular angiofibroma is a benign soft tissue neoplasm that occurs almost exclusively in the vulvovaginal region of women or in the inguinal–scrotal region of men. CAF is characterized by bland spindle cells and prominent small to medium-sized vessels with mural hyalinization. Rarely, cellular angiofibromas have been reported to show atypical or sarcomatous features, including foci resembling undifferentiated pleomorphic sarcoma, and pleomorphic liposarcoma. 1,2 Case report A 60 year-old man presented with a one month history of a non- tender, painless, and growing lesion in the inguinoscrotal area that progressively became painful before he presented to medical attention. On clinical examination, a trans-illuminating scrotal mass is found in the scrotum that does not appear to be attached to the epididymis or the testicle. A scrotal ultrasound revealed a solid, heterogeneous and hypervascular 2.5cm extra testicular mass in the left lower testicular pole. A scrotal exploration was undertaken with excision of the mass. Grossly, the lesion measured 3x2x1.5cm, was gray-tan, firm, well circumscribed, and attached to the spermatic cord. Cut surface of the mass was pink-tan and firm to solid in consistency. Microscopically, the lesion was well circumscribed (Figure 1) and there were predominately spindle-shaped cells in an edematous and lightly fibrous stroma interspersed with chronic inflammatory cells consisting of lymphocytes with some plasma cells and occasional mast cells. There were numerous thick-walled blood vessels, many with wall hyalinization (Figures 2 & 3). These findings are typical of cellular angiofibroma, but there were also scattered cells with cytological atypia and abundant intralesional adipose tissue with focal fat necrosis (Figures 1 & 4). These additional findings raised concern for a well-differentiated liposarcoma, and the case was referred to the Joint Pathology Center, the reference laboratory for Veterans Affairs medical Centers, for consultation. The consultant performed immunohistochemical stains for CD34, desmin, and estrogen receptor, which were positive, and MDM-2, which was negative. This immunoprofile, along with the light microscopic appearance supported the diagnosis of cellular angiofibroma with focal cytologic atypia over well-differentiated liposarcoma. Figure 1 Cellular Angiofibroma showing abundant intralesional adipose tissue and chronic inflammatory cells. Note that the lesion is well-circumscribed. (H&E X40). Figure 2 Cellular Angiofibroma with numerous thick-walled blood vessels, many with wall hyalinization (H&E X40). Adv Cytol Pathol. 2016;1(1):10‒13 10 © 2016 Kassaby et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Cellular angiofibroma of the inguinoscrotal region with cytologic atypia and abundant adipose tissue simulating liposarcoma: a case report Volume 1 Issue 1 - 2016 Sarah S Kassaby, 1 M Azam, 2 M Salah Shurbaji 1 1 Department of Pathology, East Tennessee State University, USA 2 Pathology and Laboratory Medicine Service, JH Quillen Veterans Affairs Medical Center, USA Correspondence: Sarah S Kassaby MD, Department of Pathology, East Tennessee State University, PO Box: 70568, Johnson City, TN 37614, USA, Email KASSABY@mail.etsu.edu Received: September 23, 2016 | Published: December 22, 2016 Abstract Cellular angiofibroma (CAF) is a rare benign mesenchymal neoplasm of the vulvovaginal or inguinoscrotal regions. We report a case of CAF with abundant intralesional fat and focal cytological atypia that raised the possibility of liposarcoma. We review the literature and discuss the significance of these findings and the differential diagnosis of CAF. Keywords: angiofibroma, differential diagnosis, sarcoma, spermatic cord Advances in Cytology & Pathology Case Report Open Access