Twisted aggressive angiomyxoma of the vulva presenting as an emergency with severe pain and impending gangrene

A woman in her mid-30s, a construction worker, came to the emergency department with excruciating pain and bleeding from a twisted vulval tumour. She had the tumour, which grew insidiously over 2 months. The blackening of the skin over the tumour occurred over 24 hours. She denies having manipulated