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Reproductive Biomedicine Online Feb 2024What are the different characteristics of vaginal microbial composition between patients with endometrial polypoid lesions and controls?
RESEARCH QUESTION
What are the different characteristics of vaginal microbial composition between patients with endometrial polypoid lesions and controls?
DESIGN
This cohort study compared the pre-operative microbial compositions of vaginal samples in a cohort of 703 women with endometrial polypoid lesions [293 and 410 women diagnosed and not diagnosed with polyps pathologically (polyps group and not-polyps group, respectively] and 703 women in the control group. Bacterial abundance, diversity, differential taxa and microbial network structure were assessed using 16S rRNA gene sequencing. Predictive algorithms were used to determine the functional pathways of vaginal microbiota within the cohort.
RESULTS
The control group exhibited higher relative abundance of Lactobacillus crispatus in comparison with the polypoid lesions group (P = 0.0427). Beta diversity of vaginal microbiota differed significantly between the groups (P < 0.05). Comparing the polyps group with the not-polyps group, Leptotrichia spp. and Cutibacterium spp. were more abundant in the polyps group, and Fannyhessea spp., Acinetobacter spp. and Achromobacter spp. were more abundant in the not-polyps group. The control group exhibited higher abundance of Bifidobacterium spp., Achromobacter spp. and Escherichia/Shigella spp. (false discovery rate < 0.05). Furthermore, the polyps group and not-polyps group displayed more complex co-occurrence networks compared with the control group.
CONCLUSIONS
The results of this study provide compelling evidence supporting associations between vaginal microbiota and endometrial polypoid lesions, highlighting the potential relationship between a well-balanced vaginal microbial ecosystem and a healthy intrauterine environment.
Topics: Female; Humans; Cross-Sectional Studies; Cohort Studies; RNA, Ribosomal, 16S; Microbiota; Reproduction; Vagina
PubMed: 38101145
DOI: 10.1016/j.rbmo.2023.103602 -
Journal of Pediatric and Adolescent... Jun 2018Sacrococcygeal teratoma accounts for the most common solid tumor in neonates. Because of improved technology, 50%-70% of cases can be diagnosed antenatally during...
BACKGROUND
Sacrococcygeal teratoma accounts for the most common solid tumor in neonates. Because of improved technology, 50%-70% of cases can be diagnosed antenatally during routine ultrasound screenings. If not diagnosed antenatally, clinical findings at birth are distinct in most cases including a palpable or visible mass.
CASE
We report an unusual case of a 1-year-old girl who presented with persistent vaginal discharge leading to diagnosis of a mucosal polypoid lesion of the vagina, ultimately revealing a hidden sacrococcygeal teratoma.
SUMMARY AND CONCLUSION
We suggest thorough investigation of all infants who present with purulent discharge and recurrent vaginal mass; sacrococcygeal teratoma should routinely be considered as a differential diagnosis.
Topics: Colposcopy; Diagnosis, Differential; Female; Humans; Infant; Magnetic Resonance Imaging; Polyps; Sacrococcygeal Region; Teratoma; Vagina; Vaginal Discharge; Vaginal Neoplasms
PubMed: 29269272
DOI: 10.1016/j.jpag.2017.12.004 -
The American Journal of Surgical... Nov 2022Embryonal rhabdomyosarcoma of the uterine cervix (cERMS) is rare and frequently associated with DICER1 mutations. We report 94 tumors that arose in patients aged 7 to 59...
Embryonal rhabdomyosarcoma of the uterine cervix (cERMS) is rare and frequently associated with DICER1 mutations. We report 94 tumors that arose in patients aged 7 to 59 (median=23) years and presented with vaginal bleeding (52), protruding vaginal mass (17), cervical polyp (8), or expelled tumor fragments per vagina (5). Nine had DICER1 syndrome, 8 of whom had other syndromic manifestations including ovarian Sertoli-Leydig cell tumor (7), multinodular goiter (3), pleuropulmonary blastoma (2), pineoblastoma (1), and osteosarcoma (1). Syndromic patients were younger than nonsyndromic patients (16 vs. 24 y). Tumor size ranged from 2 to 24 (median=4.5) cm. Ninety-two tumors were polypoid, most being grape-like (77 of 92). They were characterized by aggregates of primitive cells, almost always exhibiting a cambium layer, within a variably myxoedematous stroma and were hypocellular (63), moderately cellular (22), or hypercellular (9). Entrapped glands, typically scant, were present in 84 tumors. Primitive hyperchromatic ovoid to spindled cells with minimal cytoplasm predominated but differentiated rhabdomyoblasts with abundant eosinophilic cytoplasm (having cross-striations in 30) were seen in 83 tumors; they were often sparse but predominated in three. Nine tumors showed areas of intersecting fascicles and 4 zones with densely cellular (solid) growth. Cartilage was present in 38. Anaplasia was seen in 15 tumors, as was necrosis. Mitotic activity ranged from 1 to 58/10 high-power fields (median=8). The varied microscopic features resulted in a spectrum of differential diagnostic considerations, mainly typical and cellular forms of fibroepithelial polyps, Mullerian adenosarcoma, and other sarcomas. Follow-up was available for 79 patients ranging from 6 to 492 (median=90) months. Treatment information was available in 62 and included polypectomy in 6 patients (2 also received chemotherapy), limited resection in 26 (14 also received chemotherapy), hysterectomy in 29 (15 with adjuvant chemotherapy), and biopsies only in 1 (with chemotherapy). Staging was possible in 56 tumors; according to the "uterine sarcoma" system (tumor size and extent) they were: stage I (10/56; could not be further subclassified as size not available), IA (22/56), IB (18/56), IIA (2/56), IIB 3/56), IIIC (1/56). According to the "adenosarcoma" system (depth of invasion and extent) they were: stage IA (26/56), IB (14/56), IC (10/56), IIA (2/56), IIB (3/56), IIIC (1/56). Eight patients had local recurrence following incomplete excision (10%). Eleven of 79 patients had extrauterine recurrences (14%) and 9 died of disease (11%). Older age was associated with extrauterine recurrence (median 44 vs. 22; P =0.002) and decreased disease-specific survival (median 44 vs. 22; P =0.02). For patients with tumors initially confined to the cervix, the adenosarcoma staging system was superior to the uterine sarcoma staging system for predicting survival ( P =0.02). Three patients with DICER1 syndrome who underwent fertility-preserving surgery developed a second primary cERMS 7, 7, and 12 years after their primary tumor. All 9 patients with DICER1 syndrome had tumors confined to the cervix and none died of disease. This study highlights the intriguing clinical aspects of cERMS including its long-known tendency to occur in the young but also more recently appreciated association with DICER1 syndrome. Establishing the diagnosis may still be difficult because of the hazard of sampling a neoplasm which in areas may appear remarkably bland and also because of its potential confusion with other neoplasms. This study indicates that this tumor has a good prognosis at this site and in selected cases a conservative surgical approach is a realistic consideration.
Topics: Adenosarcoma; Cervix Uteri; DEAD-box RNA Helicases; Diagnosis, Differential; Female; Humans; Neoplastic Syndromes, Hereditary; Prognosis; Rhabdomyosarcoma, Embryonal; Ribonuclease III; Uterine Cervical Neoplasms; Uterine Neoplasms
PubMed: 35941719
DOI: 10.1097/PAS.0000000000001933 -
Cureus Feb 2024Vaginal 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...
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.
PubMed: 38558656
DOI: 10.7759/cureus.55157 -
Iranian Journal of Pathology 2021Fibroepithelial polyps of the vagina (FEPV) are rare entities which normally manifest as one or more painless polyps sometimes with symptoms such as bleeding, vaginal...
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.
PubMed: 34567198
DOI: 10.30699/IJP.2021.522689.2566 -
Journal of the American Veterinary... Dec 2023To describe the clinical presentation, diagnostic imaging findings, surgical technique, histopathological diagnosis, and postoperative outcome in 3 cats with extensive...
OBJECTIVE
To describe the clinical presentation, diagnostic imaging findings, surgical technique, histopathological diagnosis, and postoperative outcome in 3 cats with extensive vaginal masses.
ANIMALS
Medical records of cats diagnosed with vaginal masses that had a bilateral pubic and ischial osteotomy and vaginectomy between 2004 and 2022 were retrospectively reviewed. Three cats met the inclusion criteria.
CLINICAL PRESENTATION
Histopathological diagnosis included T-cell-rich B-cell lymphoma (n = 1), mycetoma (1), and vaginal polyp (1). Diagnostic imaging included CT (n = 2) and MRI (1), and tumor length/width/height percentages in relation to the pelvic dimensions were 53% X 62% X 63% (case 1), 50% X 100% X 60% (case 2), and 150% X 120% X 120% (case 3). A bilateral pubic and ischial osteotomy was performed in all 3 cases.
RESULTS
All 3 cases developed mild pelvic-limb splaying postoperatively; all resolved within 8 weeks, and 2 cases fully resolved within 14 days. Two of the 3 cases presented with mild stranguria postoperatively, which resolved fully in both cases.
CLINICAL RELEVANCE
Vaginal neoplasia, either malignant or benign, is infrequently reported in cats in the veterinary literature. Bilateral pubic and ischial osteotomy for resection of vaginal masses in cats is a successful surgical approach, offering good exposure for resection of large vaginal masses, with minimal postoperative complications.
Topics: Female; Cats; Animals; Retrospective Studies; Ischium; Postoperative Complications; Vaginal Neoplasms; Osteotomy; Cat Diseases
PubMed: 37619616
DOI: 10.2460/javma.23.05.0260 -
World Journal of Clinical Cases Sep 2022Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin, occurring predominantly in children and adolescents, but extremely rare in adults and the...
BACKGROUND
Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin, occurring predominantly in children and adolescents, but extremely rare in adults and the data regarding its treatment are sparse. Here, we would like to share our experience in the treatment of a locally advanced primary embryonal rhabdomyosarcoma of cervix in a 39-year-old female.
CASE SUMMARY
The patient was admitted with symptoms of intermenstrual bleeding and postcoital bleeding for six months. Physical examination revealed a friable, polyp-like mass (5 cm × 5 cm) in her cervix protruding into the vagina, while the uterus was mobile and normal-sized. Colposcopy-directed biopsy was performed, and a pathological diagnosis of embryonal rhabdomyosarcoma was made. Magnetic resonance imaging of the pelvis showed that the cervical volume was significantly increased, with a hypointense and hyperintense soft tissue mass on the right side, invading the cervical stroma; the mass was 5 cm × 5 cm with a clear boundary and confined to the cervix; there were no obvious findings indicating tumor invasion in the vaginal wall, parametrium, or pelvic wall; no enlarged lymph nodes were observed in the pelvic cavity. Based on our findings, the tumor was classified as stage IA according to the intergroup rhabdomyosarcoma studies criteria and IB3 stage according to The International Federation of Gynecology and Obstetrics 2018. The patient underwent two courses of neoadjuvant chemotherapy and a partial remission was achieved. Subsequently, she underwent laparoscopic radical hysterectomy, bilateral salpingo-oophrectomy and pelvic lymph node dissection and there were no risk factors revealed by postoperative pathological examination. Adjuvant chemotherapy was performed after surgery. The patient was disease-free until the last follow-up, 49 mo after completing the entire treatment.
CONCLUSION
Our experience suggests that neoadjuvant vincristine, dactinomycin, and cyclophosphamide chemotherapy followed by radical surgery and adjuvant chemotherapy might be reasonable therapeutic option for bulky cervical rhabdomyosarcoma in adults without fertility desire. Since large-scale studies on such rare conditions are rather impossible, further case reports and systematic reviews could help optimize the treatment of primary, bulky cervical rhabdomyosarcoma in adults.
PubMed: 36159439
DOI: 10.12998/wjcc.v10.i26.9454 -
Journal of the Belgian Society of... Jul 2016To investigate the feasibility of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating endometrial...
PURPOSE
To investigate the feasibility of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating endometrial cancer from benign endometrial lesions in postmenopausal patients with vaginal bleeding and endometrial thickening and to predict the depth of myometrial invasion in endometrial cancer.
MATERIALS AND METHODS
Postmenopausal patients with vaginal bleeding and endometrial thickening were enrolled in this prospective study. T2-weighted, pre- and postcontrast T1-weighted and diffusion-weighted images were obtained. The ADC values of all the patients with endometrial pathologies were recorded. The staging accuracies of DWI and postcontrast T1-weighted images in the assessment of myometrial invasion were evaluated in histopathologically proven endometrial cancer patients.
RESULTS
Fifty-two patients (mean age: 57 ± 10, range: 41-79) were enrolled in the study. Thirty-eight of the lesions were benign (27 as hyperplasia and endometritis; 11 as polyps). Fourteen of the 52 endometrial lesions were pathologically proven as cancers and underwent hysterectomy, and all the specimens were reported as endometrioid adenocarcinomas. The mean ADC value (10 mm/second) of cancer (0.88 ± 0.10) was significantly lower than that of benign lesions (1.78 ± 0.27, p = 0,001). There was no significant difference between ADC values of endometrial tissue in patients with FIGO stage 1A (0.87 ± 0.11, n = 9) and FIGO stage 1B (0.91 ± 0.07, n = 5). The staging accuracy was 92.9 per cent (13/14) for DWI and 85.7 per cent (12/14) for postcontrast T1-weighted images.
CONCLUSION
ADC values allow benign endometrial lesions to be differentiated from endometrial cancer in postmenopausal patients but do not correlate with the depth of myometrial invasion and histological tumor grading.
PubMed: 30038987
DOI: 10.5334/jbr-btr.1118 -
Journal of Pediatric Urology Dec 2020Vaginal lesions are rare and of various types in children. Clinical presentation is generally undifferenciated. Histological examination is fundamental to ascertain the...
BACKGROUND
Vaginal lesions are rare and of various types in children. Clinical presentation is generally undifferenciated. Histological examination is fundamental to ascertain the nature of the lesion. Regarding tumoral lesions, histological subtypes encountered are radically different from those seen in adults, dominated by stromal benign lesions.
OBJECTIVE
The aim of this retrospective study was to describe characteristics and pathological aspects of pediatric vaginal lesions, diagnosed in a single pediatric experienced center.
STUDY DESIGN
A database analysis was performed on all vaginal samples of patients under 18 years old received in a pediatric-specialized pathology laboratory of an academic hospital, over a 26-year period.
RESULTS
Among 36 vaginal tissue samples reported, a total of 15 tumoral or pseudotumoral processes was recorded. Primitive malignant tumors included embryonal rhabdomyosarcoma (n = 3) and germ-cell tumors, yolk-sac type (n = 2). Benign tumoral or pseudotumoral processes included inflammatory stromal polyps (n = 8), epidermic cyst (n = 1), and benign Müllerian papilloma (n = 1).
DISCUSSION
Over 15 primitive vaginal tumors, 1/3 was malignant with embryonal rhabdomyosarcoma being the most common. The remaining 2/3 specimens were benign, with stromal inflammatory lesions being the most commonly observed. Fibro-epithelial polyp is a debated entity, which covers a wide histological spectrum, with varying inflammation and stromal cellularity, raising sometimes the question of the differential diagnosis with rhabdomyosarcoma. Stromal cells morphology along with their immunohistochemical profile suggest their reactive myofibroblastic nature. Pseudotumoral inflammatory lesions display very similar histological findings with these entities. A common pathogenesis beginning with an inflammatory process, potentially accelerated by chronic traumatic factors, could be discussed.
CONCLUSION
We confirmed the rarity and the diversity of vaginal lesions in children. Vaginoscopy and biopsy sample should be systematic, given the non-specific presentation of tumoral processes. Myogenin immunostain must be systematic in case of vaginal polypoid mass, in order to rule out malignancy.
Topics: Adolescent; Adult; Child; Female; Humans; Neoplasms, Germ Cell and Embryonal; Retrospective Studies; Rhabdomyosarcoma; Vaginal Neoplasms
PubMed: 32980262
DOI: 10.1016/j.jpurol.2020.09.010 -
Clinical Case Reports Jun 2021The differential diagnosis of a sudden protrusion of a large vaginal mass includes a uterine or vaginal vault prolapse, a pedunculated uterine leiomyoma or...
The differential diagnosis of a sudden protrusion of a large vaginal mass includes a uterine or vaginal vault prolapse, a pedunculated uterine leiomyoma or leiomyosarcoma, a uterine stromal tumor or a giant polyp.
PubMed: 34136245
DOI: 10.1002/ccr3.4319