title: Inverted Y incision and trans-sacral approach in retroperitoneal aggressive angiomyxoma: a case report.
abstract: BACKGROUND
  Aggressive angiomyxoma is a rare myxedematous mesenchymal tumor that mainly occurs in the female pelvis and perineum. The principle of treatment for aggressive angiomyxoma is surgical excision. The tumor can be removed by local excision alone when it occurs locally on the perineum. However, it cannot be completely excised by a perineal approach alone when it passes through the perineum and pelvic bone to extend into the retroperitoneal space.
  
  
  METHODS
  A 34-year-old Asian woman presented with a rapidly growing left perineal mass and swelling in the left gluteal region. The swelling was associated with a mild, dull pain in the left gluteal region. In the present case of bulky aggressive angiomyxoma extending to the perineum and retroperitoneal space, the authors made an inverted Y incision through the buttock, removed the coccyx and lower portion of the sacrum, and excised the retroperitoneal mass and perineal lesion through a perineal approach.
  
  
  CONCLUSIONS
  The inverted Y incision and trans-sacral approach can provide easy access to deep retroperitoneal aggressive angiomyxoma and reduce damage to neighboring organs.
authors.affiliation: Gynecologic Cancer Center, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea. ysleeknuh@yahoo.co.kr.
authors.forename: Dae Gy
authors.initials: DG
authors.lastname: Hong
authors.forename: Gun Oh
authors.initials: GO
authors.lastname: Chong
authors.forename: Young Lae
authors.initials: YL
authors.lastname: Cho
authors.forename: Il Soo
authors.initials: IS
authors.lastname: Park
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
authors.forename: Yoon Soon
authors.initials: YS
authors.lastname: Lee