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Angiomyxoma are rare myxoid cells tumours that occur predominantly in women in the fourth decade. They are classified as the less aggressive superficial and the deeper aggressive variety commonly called aggressive angimyxomas. We report a rare perineal aggressive angiomyxoma in a 79-year-old male presenting with a painless perineo-scrotal mass. Radiological investigations confirmed a lobulated well-defined mass separate from the testicles and histology following wide local excision confirmed aggressive angiomyxoma. He remains recurrence free at 4 years of surveillance which is the among longest reported follow-up for perineal angiomyxoma. [ABSTRACT FROM AUTHOR]