14 May 2009 – Case of the Week #146
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Thanks to Dr C. N. Srinivas, MIOT Hospitals, Chennai (India) for contributing this case. To contribute a Case of the Week, email NatPernick@Hotmail.com with the clinical history, your diagnosis and diagnostic microscopic images in JPG, GIF or TIFF format (send as attachments, we will shrink if necessary). Please include any other images (gross, immunostains, etc.) that may be helpful or interesting. We will write the discussion (unless you want to), list you as the contributor, and send you $35 (US dollars) by check or PayPal for your time after we send out the case. Please only send cases with high quality images and a known diagnosis that is somewhat unusual (or a case with unusual features).
Case of the Week #146
A 51 year old woman presented with a 3 month history of vaginal mucoid discharge and a recent history of chronic diarrhea. CBC revealed mild anemia. Chemistries were normal. Local and colposcopic examinations revealed a fleshy polyp at the posterior fouchette, while ultrasound, anal and colonoscopic examinations detected no abnormalities.
The vaginal polyp measured 3 x 2 cm with a 5 cm stalk, with a slippery mucoid surface. It was completely removed, step sectioned, and submitted.
What is your diagnosis?
Microscopic sections show a tubulovillous adenoma of colonic type. There was stromal inflammation with strips of squamous and endocervical epithelium, in addition to squamous metaplasia of colonic glands. There were no dysplastic changes.
In the anorectal region, adenomas may resemble inflammatory cloacogenic polyps (Histopathology 2008;53:91, Hum Pathol 1987;18:1120). In the vagina, the main differential diagnosis is primary or metastatic adenocarcinoma, which can be identified by examining the entire mass and taking step sections as needed.
Nat Pernick, M.D., President
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