Tubulo-squamous Vaginal Polyp With Basaloid Epithelial Differentiation:

Large Cyst of Skene Gland: A Rare Perineum Mass

Objective  In this report we present a rare case of a large cyst of Skene gland in a female patient with a palpable vaginal mass persisting for at least 2 years. Case Report  A 67-year-old female admitted to the department of urology due to the presence of "a vaginal mass" for the past 2 years. A cyst of Skene's duct was suspected based on clinical manifestation and findings of magnetic resonance imaging showing an extensive cyst formation in the upper vaginal area and anterior to the urethra. Based on these findings, a decision for surgical removement of the cyst was made. The cyst was incised, drained, and marsupialized. The postoperative recovery was uneventful, and the patient was discharged on the second postoperative day. Conclusion  High clinical suspicion is important to reach this rare diagnosis. Partial excision and marsupialization of the cyst is a simple procedure with low morbidity, without recurrence, and excellent results.

Skene's Gland Derivatives in the Female Genital Tract and Cervical Adenoid Basal Carcinoma are Consistently Positive With Prostatic Marker NKX3.1

Cervical ectopic prostatic tissue and vaginal tubulosquamous polyp are rare lesions which exhibit variable, and often focal, immunohistochemical expression with traditional prostatic markers [prostate-specific antigen and prostatic acid phosphatase (PSAP)]. These lesions are thought to arise from periurethral Skene's glands, the female equivalent of prostatic glands in the male. Adenoid basal carcinoma is a rare and indolent cervical neoplasm. Expression of the prostatic marker NKX3.1 in ectopic prostatic tissue and tubulosquamous polyp has been reported but no studies have examined immunoreactivity with this marker in adenoid basal carcinoma. We stained 19 cases [adenoid basal carcinoma (n=6), cervical ectopic prostatic tissue (n=11), and vaginal tubulosquamous polyp (n=3); 1 case contained both adenoid basal carcinoma and ectopic prostatic tissue] with NKX3.1. In all cases, the glandular component of these lesions exhibited diffuse nuclear immunoreactivity while normal endocervical glands were negative. Prostate-specific antigen was positive in 4 of 9 and 0 of 3 cases of ectopic prostatic tissue and tubulosquamous polyp, respectively, while PSAP was positive in 3 of 4 and 2 of 2 cases of ectopic prostatic tissue and tubulosquamous polyp respectively; 3 of 5 cases of adenoid basal carcinoma tested were focally positive with PSAP and all 5 were negative with prostate-specific antigen. While the specificity of NKX3.1 should be investigated in future studies, positivity with this marker may be useful in diagnosing these uncommon lesions. NKX3.1 appears a more sensitive marker of ectopic prostatic tissue and tubulosquamous polyp than traditional prostatic markers and positive staining provides further support that these lesions exhibit "prostatic" differentiation and are of Skene's gland origin. NKX3.1 and PSAP positivity in adenoid basal carcinoma raises the possibility of an association with benign glandular lesions exhibiting prostatic differentiation and we critically discuss the possible association.

Uterine cervical tubulosquamous polyp resembling a penis

This case report describes a tubulosquamous polyp resembling a penis in the uterine cervix. A 34-yr-old, gravida 0, para 0, woman showed an 18 × 8 × 5 mm polypoid lesion in the uterine ectocervix. The polyp had a penis-like appearance; the tip looked like glans penis and the middle portion resembled the shaft of the penis. Its surface was covered by squamous epithelium, and tissues resembling those of a urethra, corpus spongiosum penis, and external orifice urethra were observed. Foreskin-like tissues were also observed, although a corpus cavernosum penis was not seen. Skene glands and Cowper glands were also observed. Immunohistochemically, Skene glands and the urethra-like epithelium were focally positive for prostate-specific antigen and/or prostatic acid proteins. Histologically and immunohistochemically, the polypoid lesion overlapped with a tubulosquamous polyp of the vagina and ectopic prostatic tissue of the uterine cervix and encompassed these lesions in the lower female genital tract. The most likely theory of histogenesis is a developmental anomaly and misplacement of Skene glands.

[Tubulosquamous vaginal polyp. Case report with respect to histogenesis]

Tubulosquamous vaginal polyp is a rare form of lesion. It is thought to derive from displaced paraurethral Skene's gland which is the female equivalent of the prostate gland in men. We report on a case of tubulosquamous vaginal polyp in a 77-year-old female patient. Histological examination showed prominent epithelial nests in a spindle cell-rich stroma. The nests were predominantly squamous in type with small tubules at the periphery of the island. Using immunohistochemistry the tubules were found to be positive for CK7, prostate-specific acidic phosphatase (PAP) and androgen receptor (AR) but negative for CK 5/6 and prostate-specific antigen (PSA). The solid parts were positive for CK5/6 and most interestingly, also expressed AR but not CK7, PAP or PSA. The stroma also showed strong staining for AR but not for the other markers applied. To our knowledge this is the first report on AR expression in this benign polyp. Our findings confirm the view that tubulosquamous polyp of the vagina is derived from paraurethral Skene's gland.