2 November 2012 - Case #256
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
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.
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?
Diagnosis: Hymenal polyp, gastrointestinal type
Immunohistochemistry:
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.
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
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.
Website news:
(1) We are reorganizing our Books pages to fix some formatting errors and provide a cleaner look. Some small categories will be merged into other categories. We are eliminating the "discount" page, because Amazon.com changes prices daily and we cannot keep this page current. We will be adding images of book covers over the next several months.
(2) We are combining what were 3 parts of the Soft Tissue chapter into one. Its Table of Contents contains most topics, and at the top of the page, there is a link to the remaining topics.
(3) We have updated these chapters: Appendix-based on a review by Jaleh Mansouri, M.D.; Stomach-based on a review by Elliot Weisenberg, M.D.; Soft Tissue-Fibrohistiocytic tumors-based on a review by Vijay Shankar, M.D. We have also recently updated these topics in our Stains and CD Markers chapters: Factor XIIIa, hCG, HMB45, HPV, LMO2, MUM1, Uroplakin III, Vimentin.
Visit and follow our Blog to see recent updates to the website.
(1) We are reorganizing our Books pages to fix some formatting errors and provide a cleaner look. Some small categories will be merged into other categories. We are eliminating the "discount" page, because Amazon.com changes prices daily and we cannot keep this page current. We will be adding images of book covers over the next several months.
(2) We are combining what were 3 parts of the Soft Tissue chapter into one. Its Table of Contents contains most topics, and at the top of the page, there is a link to the remaining topics.
(3) We have updated these chapters: Appendix-based on a review by Jaleh Mansouri, M.D.; Stomach-based on a review by Elliot Weisenberg, M.D.; Soft Tissue-Fibrohistiocytic tumors-based on a review by Vijay Shankar, M.D. We have also recently updated these topics in our Stains and CD Markers chapters: Factor XIIIa, hCG, HMB45, HPV, LMO2, MUM1, Uroplakin III, Vimentin.
Visit and follow our Blog to see recent updates to the website.
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
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 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.
