Cellular pseudosarcomatous fibroepithelial stromal polyp of the vagina during pregnancy: a lesion that is overdiagnosed as a malignant tumor

Recurrent fibroepithelial vaginal polyp in a 2-year-old girl: a case report and review of the literature

Introduction and importance

Fibroepithelial vaginal polyps (FEPV) are rare mucosal polypoid lesions primarily found in adult women. However, FEPV in paediatric patients, especially beyond the neonatal period, is exceedingly uncommon. Documenting cases improves diagnosis and management. FEPV can mimic malignancy, posing challenges for interpretation. Early detection, treatment, and follow-up are crucial for optimal outcomes.

Case presentation

The authors present the case of a 2-year-old girl with a recurrent FEPV. The patient had a painless, reddish, smooth, soft, rubbery polypoid vaginal mass measuring 2.3 × 1.5 cm. Physical examination revealed no concurrent systemic issues. Surgical excision of the polyps confirmed them as fibroepithelial polyps. Despite previous excisions, the polyps recurred within a month. The patient's postoperative recovery was uneventful, and subsequent follow-up showed no recurrence.

Clinical discussion

FEPV presents as mucosal polypoid lesions with a connective tissue core covered by benign squamous epithelium. It is rare before menarche and after menopause. Although the pathophysiology remains unclear, hormonal factors and local injuries may contribute. FEPV is usually asymptomatic but may cause pressure, obstruction, bleeding, or discharge. Differential diagnosis includes vaginal connective tissue malignancies. The diagnosis was confirmed by surgical excision and histopathology. Complete excision is crucial for preventing recurrence.

Conclusion

This case report highlights recurrent FEPV in a 2-year-old girl. Despite previous excisions, polyps recurred, emphasizing the need for complete excision. Documenting cases will enhance our understanding. Further research is needed to elucidate the pathogenesis of paediatric FEPV. Early detection, treatment, and follow-up are essential for optimal management.

Fibroepithelial Polyp of the Vagina With Torsion: A Difficult Diagnosis Based on Clinical and Morphological Findings of the Vaginal Lesion

Vaginal fibroepithelial polyps are rare benign tumors of the mucosa of the anterior vaginal wall. In extremely rare cases, they may originate from the posterior vaginal wall or be complicated by torsion. Our case concerns a 63-year-old patient who presented to the gynecology outpatient clinic of the General Hospital of Trikala with minor vaginal bleeding. On vaginal examination, a large pedunculated painless hemorrhagic polypoid mass was noticed, originating from the posterior vaginal wall. A torsion of the pedunculated vaginal tumor was suspected, leading to its surgical excision with clear resection margins. Due to extensive tissue necrosis, accurate histological identification of the vaginal neoplasm was not possible. Histological examination excluded vaginal malignancy. Based predominantly on the clinical and morphological features of the vaginal lesion, a diagnosis of vaginal fibroepithelial polyp with torsion was made, acknowledging its limitations. The patient was discharged from the clinic the same afternoon following the surgery. Three months later, no recurrence of the lesion in the vaginal wall was noted. Following the case presentation, this paper provides a brief literature review of this rare entity, focusing on the diagnostic and therapeutic approaches.

Embryonal rhabdomyosarcoma of the uterine cervix in an adult female

Embryonal rhabdomyosarcoma (RMS) of the female genital tract is an uncommon malignancy, presenting mainly in the pediatric and adolescent populations, primarily affecting the first two decades of life. This malignancy presentation in adulthood is rare and is seldom seen. The incidence of this tumor affecting adult females is approximately 0.4 - 1%, with the common site being the vagina. This tumor infrequently involves the cervix. RMS has a poor survival rate and once diagnosed, it requires aggressive management by radical surgery accompanied by chemoradiation. We present a case of an anaplastic variant of embryonal RMS of the uterine cervix presenting as a cervical polyp in a 36-year-old female who complained of dyspareunia and post-coital bleeding.

Giant hypopharyngeal fibroepithelial polyp: A case report and literature review

Hypopharyngeal fibroepithelial polyp is a rare entity. It could extend along the esophagus, leading to dysphagia. In rare cases, this polyp could present as airway compromise due to occlusion of the inlet of the larynx. The treatment of choice is surgical resection. Accurate defining of the origin of such polyp is mandatory in order to achieve complete resection and avoid recurrence. Although hypopharyngeal FEP is rare, physicians must keep this in mind when a patient presents dysphagia or airway compromise. In the current case, we present a rare case of giant hypopharyngeal FEP originating from the right pyriform sinus detected in a Caucasian female. The patient threw up the polyp after severe vomiting. This case should be the fourth and largest case of hypopharyngeal FEP reported in the literature.

A vaginal fibroepithelial stromal polyp: a case report with magnetic resonance images

A fibroepithelial stromal polyp is a benign soft tissue tumour that can occur in the vagina, vulva and uterine cervix. Magnetic resonance imaging (MRI) findings have been reported in patients with vulvar fibroepithelial stromal polyps, not in those with vaginal polyps. We present MRI findings of vaginal fibroepithelial stromal polyp in a postmenopausal female. A 1 to 2 cm firm vaginal mass arising from the left side of the vaginal wall with hypointense signal changes on T1W MRI was identified. A well-defined vaginal mass (1 cm diameter) was detected with inhomogeneous signal intensity on T2W images. However, a major portion had high signal intensity on diffusion-weighted images. A benign vaginal lesion with oedematous changes or myxoid degeneration was suspected. Vaginal resection was performed, and fibroepithelial stromal polyp was pathologically diagnosed. MRI may be a useful non-invasive modality for preoperatively diagnosing vaginal fibroepithelial stromal polyps.

An Unusual Presentation of Giant Fibroepithelial Polyp of the Vagina

Fibroepithelial polyps of the vagina (FEPV) are rare entities which normally manifest as one or more painless polyps sometimes with symptoms such as bleeding, vaginal discharge, and discomfort regarding the size of the mass. Despite their benign nature, they can be confused with other vaginal tumors due to their abnormal histology. In this report, we present a case of a 44-year-old woman with a giant pedunculated and symptomatic polyp of the vagina with anterior vaginal wall prolapse. The treatment method included a simple local excision of the polyp and anterior vaginal compartment repair. Histopathological examination revealed a polypoid lesion covered by squamous epithelium containing a central fibrovascular core without atypia. The patient experienced an uneventful postoperative recovery, with no complication, which implies that surgery is the most effective modality for managing such tumors.

Mesenchymal lesions of the vulva

Mesenchymal lesions of the vulva include site-specific entities limited to the lower genital tract, as well as a range of non-site-specific tumors that are more common at extragenital sites. Site-specific lesions include fibroepithelial stromal polyp, cellular angiofibroma, angiomyofibroblastoma, and aggressive angiomyxoma. Non-site-specific tumors that may occur in the vulva include those of smooth muscle, skeletal muscle, vascular, neural, adipocytic, and uncertain differentiation. This review discusses both site-specific and non-site-specific vulvar mesenchymal lesions including non-neoplastic proliferations, benign neoplasms, locally aggressive neoplasms with a predilection for local recurrence, neoplasms of indeterminate biologic potential, and frankly malignant neoplasms with a high risk of distant metastasis and death. Accurate diagnosis is essential for proper management, and is facilitated by correlation with clinical findings and targeted application of immunohistochemical and molecular studies.

An Unusually Large Fibroepithelial Polyp of Uterine Cervix: Case Report and Review of Literature

BACKGROUND:

Fibroepithelial cervical polyps (FEPs) are benign growths protruding from the inner surface of the cervix. They are typically asymptomatic, but a very small minority can undergo malignant change. Giant cervical polyps with a size greater than 4 cm are rare entities with only 23 reported cases in the literature. Cervical polyps develop as a result of focal hyperplasia of the columnar epithelium of the endocervix.

CASE PRESENTATION:

We present the case of a giant fibroepithelial polyp measuring approximately 11 x 6 x 4 cm which was protruding from the anterior lip of the uterine cervix in a 51-year-old woman who clinically presented vaginal bleeding. She was nulligravida and doesn’t have a child. The speculum examination revealed a soft, mobile, painless irregular cerebriform mass on the cervix, protruding through the vagina. The polyp was excised using a scalpel, and the pedicle was sutured using the Vicryl 1-0 under short-term intravenous anaesthesia. Histopathological examination revealed a polypoidal tumour mass composed of cellular fibrovascular stroma covered with stratified squamous epithelium. Three months after the initial surgery, there was no recurrence seen.

CONCLUSION:

Cervical giant polyps are rare entities and occur mostly in perimenopausal women. Transvaginal polypectomy, as performed for this patient followed by histopathological examination is an adequate procedure for these lesions.

Giant Fibroepithelial Stromal Polyp of the Vulva: Diffusion-Weighted and Conventional Magnetic Resonance Imaging Features and Pathologic Correlation

BACKGROUND

Fibroepithelial stromal polyp (FESP) is a rare benign mass, usually presenting at the vagina. Herein we report, to our knowledge, the first case of contrast-enhanced magnetic resonance imaging (MRI) with diffusion-weighted images of a giant vulvar FESP, and compare the MRI features with the histopathologic results.

CASE

A 14-year-old girl presented with a huge mass as large as 20 cm that originated from the labium majora. Preoperative MRI showed a polypoid mass consisting of a central stalk and surrounding stroma. Different signal intensities on MRI were correlated with various histopathologic features. The mass was cured by complete excision without remnant lesion.

SUMMARY AND CONCLUSION

Contrast-enhanced MRI with diffusion-weighted images can help us differentiate FESP from other vulvovaginal stromal tumors with a complete evaluation of the external and internal structures and the depth of invasion.

Pseudosarcomatous Vaginal Polyp

BACKGROUND

Although rare, pregnant women can present with fibroepithelial polyps of the vagina. Most likely hormonally related, these polyps have been described in various locations of the lower female genital tract. They can be mistaken for malignant lesions due to hypercellularity and cytologic atypia.

CASE

We describe the case of a 31-year-old woman who presented with a polyp of the vagina during a postpartum visit.

RESULTS

Atypical cells were seen in hypercellular areas of the stroma of the polyp.

CONCLUSION

A pitfall to avoid is classifying these benign lesions as malignant based on atypical histopathology.