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Ceskoslovenska Patologie Apr 2008We report a case of an 86-year-old female with a tubulo-squamous polyp of the vagina. Grossly, the polyp measured 2 x 1.5 x 1 cm. Histologically, it was composed of...
We report a case of an 86-year-old female with a tubulo-squamous polyp of the vagina. Grossly, the polyp measured 2 x 1.5 x 1 cm. Histologically, it was composed of well-circumscribed nests of squamous cells with bland nuclei. Some of the squamous nests showed central spaces filled with necrotic debris. Small tubules were present at the periphery of some of the nests, and there were a few tubules unassociated with the squamous nests. Furthermore, several larger mucinous glands, some with apparent squamous metaplasia, were present. The stroma was fibrous and rather hypocellular. Surface of the polyp was covered by intact squamous epithelium, which was not connected with the underlying lesion. The recently described tubulo-squamous vaginal polyp represents a distinctive entity. To the best of our knowledge, only one study describing a series of ten cases has been reported in the literature to date.
Topics: Aged, 80 and over; Biopsy; Female; Humans; Polyps; Vaginal Neoplasms
PubMed: 18819327
DOI: No ID Found -
International Journal of Gynecological... Nov 2009Tubulo-squamous polyp is a recently described and apparently benign lesion that most frequently involves the upper vagina of postmenopausal patients. Histologically, it...
Tubulo-squamous polyp is a recently described and apparently benign lesion that most frequently involves the upper vagina of postmenopausal patients. Histologically, it is characterized by the presence of cysts, squamous epithelial nests, and small tubular structures that are surrounded by a hypocellular fibrous stroma. Some lesions show focal immunoreactivity for prostatic acid phosphatise and/or prostate-specific antigen raising the possibility of derivation from Skene's glands. In this report, an additional case of tubulo-squamous polyp is presented in which there was prominent basaloid epithelial differentiation, mainly in the form of elongated cords of cells around the peripheral and deep aspect of the lesion. This feature has not been recorded previously in tubulo-squamous polyp and potentially could create diagnostic difficulty with other lesions such as basal cell/adenoid basal carcinoma or small-cell neuroendocrine carcinoma.
Topics: Aged; Cell Differentiation; Female; Humans; Immunohistochemistry; Polyps; Vaginal Neoplasms
PubMed: 19851205
DOI: 10.1097/PGP.0b013e3181a9cd86 -
Histopathology Feb 1992Twenty benign vaginal polyps from 18 patients, together with sections from normal vaginal epithelium, were studied histologically, histochemically using elastic van... (Comparative Study)
Comparative Study
Twenty benign vaginal polyps from 18 patients, together with sections from normal vaginal epithelium, were studied histologically, histochemically using elastic van Gieson stain and immunohistochemically using monoclonal antibodies against vimentin, desmin and actin. The striking finding was the similarity, both histologically and immunohistochemically, of the stroma of vaginal polyps to that of the loose subepithelial layer found in normal vagina. The important difference was the marked degeneration of the elastic tissue, increased number of stellate and giant fibroblasts and subepithelial condensation of fibroblasts in the polyps. These findings support the hypothesis that vaginal polyps may represent a reactive hyperplasia of the loose subepithelial zone of the vaginal wall.
Topics: Adult; Aged; Epithelial Cells; Female; Histocytochemistry; Humans; Immunoenzyme Techniques; Middle Aged; Polyps; Vagina; Vaginal Neoplasms
PubMed: 1302457
DOI: 10.1111/j.1365-2559.1992.tb00944.x -
Annals of Medicine and Surgery (2012) Apr 2024Fibroepithelial vaginal polyps (FEPV) are rare mucosal polypoid lesions primarily found in adult women. However, FEPV in paediatric patients, especially beyond the...
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.
PubMed: 38576976
DOI: 10.1097/MS9.0000000000001836 -
Obstetrics and Gynecology Nov 2010To systematically review and summarize the medical literature regarding the association of menopausal status, uterine bleeding, and polyp size and risk of malignancy... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically review and summarize the medical literature regarding the association of menopausal status, uterine bleeding, and polyp size and risk of malignancy among women undergoing polyp resection.
DATA SOURCES
We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing the risk of malignancy for patients undergoing polypectomy. Key word searches were performed using the words "endometrial polyp," "malignancy," "ultrasound," "saline sonohysterography," "hysteroscopy," and "histopathology."
METHODS OF STUDY SELECTION
We evaluated abstracted data and performed quantitative analyses in observational studies assessing the effects of menopausal status, vaginal bleeding, and polyp size on the risk of malignancy in patients undergoing polyp resection (n=1,552). For each study with binary outcomes, relative risks with 95% confidence intervals (CIs) were calculated. Estimates of relative risk were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Sensitivity analyses were performed to determine the effects of individual studies on the overall effect estimates. Publication bias was assessed using Egger test.
TABULATION, INTEGRATION, AND RESULTS
Seventeen studies met inclusion criteria for this review. Among women found to have endometrial polyps, the prevalence of premalignant or malignant polyps was 5.42% (214 of 3,946) in postmenopausal women compared with 1.7% (68 of 3,997) in reproductive-aged women (relative risk 3.86; 95% CI 2.92-5.11). The prevalence of endometrial neoplasia within polyps in women with symptomatic bleeding was 4.15% (195 of 4,697) compared with 2.16% (85 of 3,941) for those without bleeding (relative risk 1.97; 95% CI 1.24-3.14). Among symptomatic postmenopausal women with endometrial polyps, 4.47% (88 of 1,968) had a malignant polyp in comparison to 1.51% (25 of 1,654) asymptomatic postmenopausal women (relative risk 3.36; 95% CI 1.45-7.80).
CONCLUSION
Based on data from observational studies, both symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps are associated with an increased risk of endometrial malignancy.
Topics: Endometrial Neoplasms; Female; Humans; Menopause; Polyps; Precancerous Conditions; Risk Factors; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 20966706
DOI: 10.1097/AOG.0b013e3181f74864 -
BMJ Case Reports Mar 2018Fibroepithelial stromal polyps are mesenchymal lesions occurring typically in reproductive age women with a predilection for the vulvo-vaginal region. Malignancy may...
Fibroepithelial stromal polyps are mesenchymal lesions occurring typically in reproductive age women with a predilection for the vulvo-vaginal region. Malignancy may mimic this polyp in morphology, rendering further investigations including detailed histopathology mandatory. Histologically its characteristic features are stellate and multinucleate stromal cells identified near the epithelial-stromal interface. This case report discusses incidental finding of largest fibroepithelial polyp presented in a 31-year-old nulliparous woman. She was initially admitted with sepsis and detailed physical examination revealed a right-sided infected pedunculated labial mass measuring 20×21 cm. After initial resuscitation for sepsis, she was further investigated for the mass. Transabdominal ultrasound was essentially normal apart from a small fibroid 3×2 cm in the anterior wall of the uterus. The vulval mass was removed under local and regional anaesthesia and was confirmed to be a giant fibroepithelial stromal polyp on histopathology. The woman recovered well and was followed up until 1 year.
Topics: Adult; Female; Humans; Polyps; Sepsis; Treatment Outcome; Ultrasonography; Vulvar Diseases
PubMed: 29574427
DOI: 10.1136/bcr-2017-222789 -
Archives of Gynecology and Obstetrics Oct 2007The current management of patients with cervical polyps may include different approaches and protocols, such as a simply removal of the polyp in most cases at an office... (Review)
Review
The current management of patients with cervical polyps may include different approaches and protocols, such as a simply removal of the polyp in most cases at an office setting, surgical dilatation and curettage, electrosurgical excision or hysteroscopic polypectomy. Exploration of the cervical canal and uterine cavity by hysteroscopy determines the exact origin of the polyp pedicle (cervical or endometrial) and if there is any concurrent endometrial pathology. The majority of cervical polyps are asymptomatic, and their incidence is increasing with age. Symptomatic cervical polyps may cause intermenstrual bleeding, postcoital bleeding, heavy menses, postmenopausal bleeding and vaginal discharge. Cervical polyps may be detected by routine gynaecological examination, colposcopy, filling defects on hysterosalpingogram, gynaecological ultrasound (abdominal, transvaginal or sonohysterography) or endometrial biopsy. The location, number, and size of cervical polyps are best determined with diagnostic hysteroscopy. In the past, simple twisting or avulsion of the polyp or blind curettage was the standard surgical treatment of choice. However, this treatment often leaves residual polyp fragments in the cervical canal. Difficulty may also occur in differentiating endocervical from endometrial lesions. In addition, up to 25% of patients who have cervical polyp, have also a coexisting endometrial polyp, so there is a need for evaluation of the endometrial cavity. It is important to note the usefulness of hysteroscopy to manage a patient with a cervical polyp, especially when she presents abnormal uterine bleeding, in order to make an accurate diagnosis and offer appropriate treatment.
Topics: Female; Humans; Hysteroscopy; Polyps; Uterine Cervical Neoplasms
PubMed: 17653740
DOI: 10.1007/s00404-007-0417-2 -
Journal of Lower Genital Tract Disease Jul 2011To establish pathology frequencies for polyps in the vagina and cervix and to identify determinants of vaginal polyps and premalignant-malignant cervico-vaginal polyps.
OBJECTIVE
To establish pathology frequencies for polyps in the vagina and cervix and to identify determinants of vaginal polyps and premalignant-malignant cervico-vaginal polyps.
MATERIALS AND METHODS
The pathology reports of all cervico-vaginal polyps examined for 6 years at a single institution were classified, and frequencies were calculated. In 2 separate case-control studies, clinical and pathological variables of vaginal cases were compared with cervical controls, and premalignant-malignant cases were compared with benign controls. Differences in variables that were abstracted from patients' chart and pathology reviews were tested for significance.
RESULTS
There were 4,402 polyps; 4,340 cervical (98.6%), 62 vaginal (1.4%), 4,268 benign (97.0%), 62 premalignant-malignant (1.4%) (CIN, endometrial hyperplasia, and carcinoma), and 72 unsatisfactory (1.6%). Age was a significant determinant of vaginal and premalignant-malignant polyps, and polyp size and number were significant determinants of vaginal polyps. Vaginal polyps were 3 times more frequent among women 40 years and younger and twice as frequent among those 60 years and older (p < .001). Premalignant-malignant polyps were twice as frequent among women 40 years and younger (p = .04), and malignant polyps were 6 times more frequent in those 60 years and older, which approached statistical significance (p = .09). Multiple polyps were 2 times more frequent (p = .04) and greater than 2 cm was 4 times (p = .01) more frequent among vaginal polyps.
CONCLUSIONS
Vaginal polyps and premalignant-malignant cervico-vaginal polyps are rare. Vaginal polyps are larger and multiple and cervico-vaginal polyps in younger and older women are at greater risk of premalignant-malignant changes.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Alberta; Case-Control Studies; Cervix Uteri; Female; Humans; Middle Aged; Neoplasms, Glandular and Epithelial; Polyps; Precancerous Conditions; Risk Factors; Uterine Cervical Neoplasms; Vagina; Young Adult
PubMed: 21427606
DOI: 10.1097/LGT.0b013e31820b7e0f -
Fertility and Sterility May 2021To demonstrate an outpatient vaginoscopic technique for treating multiple vaginal polyps.
OBJECTIVE
To demonstrate an outpatient vaginoscopic technique for treating multiple vaginal polyps.
DESIGN
Demonstration of surgical technique using slides, pictures, and video.
SETTING
Private hospital.
PATIENT(S)
Thirty-two-year-old nulligravid woman presenting to the gynecology clinic with one episode of intermenstrual bleeding, regular menstrual cycles with normal flow, and no history of dysmenorrhoea or dyspareunia. The genital local examination was normal, and speculum examination showed multiple vaginal lesions like polyps in the proximal posterior two-thirds and right lateral vaginal walls. Her transvaginal ultrasound read a normal uterus with a right ovarian simple cyst.
INTERVENTION(S)
The surgeon performed an outpatient operative vaginoscopy using a 5-mm continuous flow office hysteroscope with a 2.9-mm rod lens optical system and a 5F working channel. Distension of the vagina was achieved with a normal saline solution, and an intrauterine pressure of 50 to 60 mm Hg was maintained by an irrigation and aspiration electronic pump. An inspection of the vaginal walls, fornices, and the external cervical os (Fig. 1) revealed 10 vaginal lesions like polyps in the proximal two-thirds of the posterior and right lateral vaginal wall. The vaginal lesions (Fig. 2) varied in size from 0.5 cm to 4 cm. An excisional biopsy was performed and the sample sent for histopathologic evaluation. The vaginal lesions <2 cm in length were excised by cutting the base with scissors or using a bipolar vaporization electrode, which was connected to an electrocautery unit by a bipolar high-frequency cord. Vaginal lesions >2 cm were excised with the TruClear 5C Hysteroscopic Tissue Removal System (HTRS) with a zero-degree scope using the 2.9-mm incisor with a 5-mm cutting window at one end attached to a reusable handpiece with two connectors-one to the motor unit and second to the suction bottle with a collection bag. The overall diameter of TruClear 5C is 5.7 mm, and the optic size is 0.8 mm. The same irrigation pump is compatible with HTRS, and the pressure was increased to 150 mm Hg to maintain vaginal distension. Three factors influenced our decision to use the HTRS intraoperatively: the number and size of the vaginal lesions and the surgical time in the outpatient setting. A mechanical system that works on the principle of excising and aspirating tissue, the HTRS incisor has a rotatory action with the excising window placed against the most distal part of the vaginal lesions. The cutting action is controlled via a foot pedal attached to a motor control with 800 rotations per minute. The handpiece remains stationary while the polyp is excised and aspirated through the window into the collection bag. Minimal bleeding occurred and stopped spontaneously. The institutional ethics committee exempted this case report from review, and we obtained informed written consent from the patient.
MAIN OUTCOME MEASURE(S)
All vaginal lesions excised in an outpatient setting via vaginoscopy technique without anesthesia.
RESULT(S)
The operative time with the Bettocchi hysteroscope was 14 minutes, and HTRS was 6 minutes. The patient did not complain of pain but did describe minimal discomfort, rated on the visual analog scale as 2 (where ≥5 is severe pain). She was discharged 1 hour later. The histopathology was reported as vaginal endometriosis (ectopic presentation of endometriosis is rare, accounting for 0.02% of cases). After surgery, she was started on cyclical oral contraceptive pills (OCP) in the combination of 30 mg of ethinyl estradiol + 2 mg of dienogest because she desired to delay pregnancy by 1 year. She remained asymptomatic for 6 months. These contraceptive hormones are available in the form of oral pills, vaginal rings, and transdermal patches, and a physician can provide OCP continuously or cyclically. Continuous OCP is more efficacious for control of dysmenorrhoea, but cyclical OCP is preferred because it is affordable, tolerable, effective, produces no unpredictable bleeding, and slows the progression of the disease. (A cohort study found the contraceptive vaginal ring to be more effective for symptom-control in rectovaginal endometriosis with higher patient satisfaction than the transdermal patch; vaginal rings or transdermal patches are not available in some countries.) CONCLUSION(S): Vaginoscopy allows a more in-depth visualization of the vagina with complete inspection and removal of all polyps. Vaginoscopy is feasible in the outpatient setting and allows a comfortable, ergonomic position for the surgeon. Vaginoscopy or no-touch technique avoids the use of a speculum or tenaculum and results in minimal pain during the outpatient procedure.
Topics: Adult; Ambulatory Care; Diagnosis, Differential; Endometriosis; Female; Humans; Hysteroscopy; Laparoscopy; Outpatients; Polyps; Vaginal Diseases; Vaginal Neoplasms
PubMed: 33589138
DOI: 10.1016/j.fertnstert.2020.11.021 -
Der Pathologe Mar 2012Tubulosquamous 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...
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.
Topics: Aged; Biomarkers, Tumor; Colposcopy; Epithelium; Female; Follow-Up Studies; Humans; Polyps; Receptors, Androgen; Vagina; Vaginal Diseases
PubMed: 22350170
DOI: 10.1007/s00292-012-1566-z