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2 November 2012 - Case of the Week #256

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Thanks to Dr. Shahrzad Ehdaivand, Brown University, Rhode Island (USA), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.


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Case of the Week #256

Clinical History:

A 23 year old woman with vaginal discomfort had a vaginal polyp at the introitus, which was excised.

Micro images:

       

What is your diagnosis?































Diagnosis:

Hymenal polyp, gastrointestinal type

Discussion:

Immunohistochemistry:


Left to right: CDX2, CK7, CK20

The polyp contains intestinal type epithelium, but no atypia or mitotic figures. Based on its location, it may be designated as a hymenal polyp. Other terms for this or related entities include cloacogenic neoplasia (Crum: Diagnostic Gynecologic and Obstetric Pathology, 2nd edition), and villous or tubulovillous adenoma (Acta Obstet Gynecol Scand 1991;70:161, Histopathology 1988;12:167). However, these terms may not be appropriate in this case, because no dysplastic changes were present. The differential diagnosis also includes a fibroepithelial polyp with GI differentiation. However, stromal polyps have a central fibrovascular core with edematous or hypocellular stroma, and variable atypical stromal cells, features not present in this case.

The pathogenesis of enteric epithelium in the lower female genital tract is unknown. Since the lower vagina is derived from the urogenital tract, enteric epithelium could develop from metaplasia of cloacal remnants (Gynecol Oncol 2005;96:556). Typically, followup is recommended for GI adenomas, but as no dysplasia was present in this patient, the appropriate followup is unclear.

Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com