14 May 2009 Case of the Week #146


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Attend the

27th Annual Summer Update in Clinical Immunology,

Microbiology and Infectious Diseases


July 13-17, 2009

Snow King Resort

Jackson, Wyoming (USA)



This review and update is intended to improve knowledge about the pathogenesis and clinical manifestations of infectious diseases, immunological mechanisms of disease and disease prevention, appropriate approaches to the diagnosis of infections and immunologic disorders, and utilization of the clinical microbiology and immunology laboratory including selection and interpretation of results.


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(1) Are you looking for pathology related books?  We do the work of finding the books and organizing them for you.  Visit our Books pages (click here), which have 900+ pathology related books sorted by specialty, with separate listings for WHO books.  We update regularly.


(2) Thanks to Angel Fernandez-Flores, MD, PhD, Hospital El Bierzo and Clinica Ponferrada, Spain, for contributing images recently posted in the Skin-Melanocytic Tumors chapter, including blue nevus, cellular blue nevus, dysplastic nevus, lentigo melanoma, melanoma-general and nodular melanoma.


(3) The Breast-Malignant chapter was recently reviewed by Dr. Daniel Visscher, University of Michigan.



Thanks to Dr C. N. Srinivas, MIOT Hospitals, Chennai (India) for contributing this case.  This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto.


Case of the Week #146


Clinical History


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.


Micro images: #1; #2; #3; #4


What is your diagnosis?



























Tubulovillous adenoma of the vagina




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.


Vaginal enteric-type tumors are very rare, and are thought to arise from cloacal remnants (Histopathology 1988;12:167, IJPM 2008;51:265).


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.


Excision of the adenoma is curative, although follow up is recommended to detect recurrence (Gynecol Oncol 2005;96:556) and possible malignant transformation (IJGC 2006;16:1461).




Nat Pernick, M.D., President

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