A Vulvar Fibroepithelial Stromal Polyp Appearing in Infancy

Mesodermal mesenchymal polyp; wide introitus in young female

INTRODUCTION AND IMPORTANCE

Mesodermal mesenchymal polyps (Fibroepithelial stromal polyps) are mesenchymal embryological structures that remain and grow to be an apparent polyp-like lesion in females of reproductive age. We present this case of mesodermal mesenchymal polyp in a young female arising at the hymenal ring of the vagina making the introitus very wide. We highlighted in our case the importance of recognizing mesenchymal lesions and their differential diagnosis to provide the patients with optimal care.

CASE PRESENTATION

A 24-years-old single female presented with a painless vaginal mass since birth, that increased in size after puberty. Upon examination, she was found to have an irregular smooth mass with around 4 × 4 cm of it protruding outside the vagina and easily reducible disfiguring and making the introitus wide. After performing Magnetic resonance imaging (MRI), findings were Suggestive of a Vulvovaginal mesenchymal tumor likely aggressive angiomyxoma. The patient underwent surgical vaginal mass excision, with hymenal repair, posterior and anterior vaginal wall reconstruction. The final diagnosis confirmed by tissue pathology was mesodermal mesenchymal polyp.

CLINICAL DISCUSSION

Fibroepithelial polyps of the vagina (FEPV) is a rare benign neoplasm and most commonly asymptomatic apart from painless mass protruding or disfiguring the sensitive area. The variety of mesenchymal lesions that occur at the vulvovaginal region can be very challenging histopathologically and surgically due to their rarity and lack literature.

CONCLUSION

Fibroepithelial polyps of the vagina (FEPV) remain an infrequent entity of pathologies affecting the female urogenital tract. We reported a rare case of concomitant FEPV and wide introitus affecting a young woman physically and psychologically. Therefore, preoperative clinical assessment and surgical approach along with psychological support is critical to provide the patient with the best outcome.

Genital soft tissue tumors

Mesenchymal neoplasms of the vulvovaginal and inguinoscrotal regions are among the most diagnostically challenging specimens in the pathology laboratory owing largely to their unique intersection between general soft tissue tumors and relatively genital-specific mesenchymal tumors. Genital stromal tumors are a unique subset of soft tissue tumors encountered at this location, and this group includes fibroepithelial stromal polyp, superficial (cervicovaginal) myofibroblastoma, cellular angiofibroma, mammary-type myofibroblastoma, angiomyofibroblastoma and aggressive angiomyxoma. Aside from the striking morphologic and immunophenotypic similarity that is seen with these entities, there is evidence that a subset of genital stromal tumors may be linked genetically. This review will focus on simplifying this group of tumors and provide the pathologist or dermatopathologist with practical management information. Smooth muscle tumors of the external genitalia will also be discussed.

Fibroepithelial polyp of the external auditory canal: a case report and a literature review

This paper reports the first case of fibroepithelial polyp arising independently of the external auditory canal. A 16-year-old female patient presented to our clinic for aural fullness of the left side. Physical examination revealed a papillomatous tumor at the posterior wall of the inlet of the left external auditory canal. After biopsy, which yielded a diagnosis of benign papilloma, the patient underwent tumor excision. Final diagnosis was fibroepithelial polyp. One week after resection, aural fullness had resolved. Fibroepithelial polyp is a benign lesion and occurs mainly in the skin, ureteropelvic system, and genitals. In the head and neck area, there are reports on fibroepithelial polyp of the tongue, piriform fossa, inferior nasal turbinate, and tonsil, in addition to the skin, but none on independent fibroepithelial polyp of the external auditory canal. Excision of fibroepithelial polyp of the external auditory canal is advisable, especially in the presence of any symptoms, and should be preceded by confirmation of nonmalignancy by biopsy, if possible.