Recurrent vulval fibroids—an unusual indication for selective oestrogen receptor modulators (SERMs)

facilitate biopsies and resection (Craven et al., 1992). Prognosis depends on tumour size and the number of mitoses per 10 high-power fields (HPF). Ten-year survival rates of 92% have been documented in patients with tumours of less than 6.5 cm diameter (Enzinger and Smith, 1976), while the survival decreases to 29% in cases with more than four mitoses per HPF (Pandy et al., 1997). With regard to haemangiopericytomas affecting gynaecological sites, uterine HPCs are the most frequently reported and to date, 64 such cases have been published (Guercio et al., 1992). In contrast, vulval haemangiopericytoma are extremely rare and only eight cases have been reported so far in the international literature (De Sousa and Lash, 1960; Reymond et al., 1972; Mariani et al., 1998). The main issue in the management of this case is the extent of surgical excision considered as adequate. The recommended primary therapeutic approach usually involves wide excision of the tumour and radical vulvectomy has been advocated in highly malignant cases (Pandy et al., 1997). However, the patient made an informed choice to decline further excision of the surrounding vulval tissue. This may be justified, as no malignant features were noted on histology, but nevertheless the uncertain malignant potential of this tumour and its incomplete excision margins made prognosis in this case difficult to estimate. The authors have not found such a situation being reported previously in the literature. The patient is currently under 6-monthly review in the gynaecology clinic. References Craven J.P., Quigley T.M. , Bolen J.W. and Raker E.J. (1992) Current management and clinical outcome of haemangiopericytoma. American Journal of Surgery, 163, 490 – 493. De Sousa L. and Lash A. (1960) Haemangiopericytoma of the vulva. American Journal of Obstetrics and Gynecology, 78, 295. Enzinger F.M. and Smith B.H. (1976) Haemangiopericytoma. An analysis of 106 cases. Human Pathology, 7, 61 – 82. Guercio E. , Siliquini G.P., Aimone V. , Ghiringhello B. , Mutti F. and Rolfo A. (1982) Hemangiopericytoma of the vulva. Minerva Ginecologica, 34, 451 – 460. Howard J.W. and Davies P.L. (1956) Retroperitoneal haemangiopericytoma associated with hypoglycaemia and masculinization. Delaware Medical Journal, 31, 186 – 192. Mariani L. , Ricci Benevolo M. and Ricci P. (1998) Vulvar haemangiopericytoma. Case report. Journal of Experimental and Clinical Cancer Research, 17, 87 – 90. McMaster M. , Soule E. and Ivins J. (1975) Hemangiopericytoma: a clinical pathological study and long term follow up of 60 patients. Cancer, 36, 2232 – 2244. Nemes Z. (1992) Differentiation markers in haemangiopericytoma. Cancer, 69, 133 – 140. Pandy M. , Kothari K. and Patel D. (1997) Haemangiopericytoma: current status, diagnosis and management. European Journal of Surgical Oncology, 23, 282 – 285. Reymond R. , Hazra T. , Edlow D. and Bawab M. (1972) Haemangiopericytoma of the vulva with metastasis to bone 14 years later. British Journal of Radiology, 45, 765 – 768. Stout A.P. and Murray M.R. (1942) Haemangiopericytoma. A vascular tumour featuring Zimmerman’s pericytes. Annals of Surgery, 116, 26 – 33. Wong P.P. and Ysgoda A. (1987) Chemotherapy of malignant haemangiopericytoma. Cancer, 41, 1256 – 1260.