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2 November 2012 - Case #256

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Thanks to Dr. Shahrzad Ehdaivand, Brown University, Rhode Island (USA), 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.

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Case #256

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

Microscopic images:

What is your diagnosis?

Click here for diagnosis and discussion:

Diagnosis: Hymenal polyp, gastrointestinal type


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 and villous or tubulovillous adenoma (Crum: Diagnostic Gynecologic and Obstetric Pathology, 2nd Edition, 2011, 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.

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