Vulva, vagina & female urethra
Nontumor
Fibroepithelial (stromal) polyp


Topic Completed: 18 December 2020

Minor changes: 1 February 2021

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PubMed Search: Fibroepithelial polyp vagina

Albert Alhatem, M.D.
Debra S. Heller, M.D.
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Cite this page: Alhatem A, Heller D. S. Fibroepithelial (stromal) polyp. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/vaginafibroepithelial.html. Accessed April 15th, 2021.
Definition / general
  • Benign mesenchymal mass characterized by a polypoid proliferation of the stroma with overlying squamous epithelium
  • Originally described by Norris and Taylor in 1966 (Cancer 1966;19:227)
Essential features
  • Common benign polypoid proliferation of the stroma with overlying squamous epithelium
  • Hormonally related and affects women, mostly of reproductive age
  • The key to diagnosis is the characteristic stellate and multinucleated stromal cells
  • May raise concern of a sarcoma due to the stromal cellularity
  • Complete surgical resection is curative or otherwise it can recur
Terminology
  • Formerly known as pseudosarcoma botryoides (not recommended)
ICD coding
  • ICD-10: N84.3 - polyp of vulva
Epidemiology
  • Common
  • Reproductive age women, often during pregnancy or in postmenopausal women taking hormone replacement therapy
Sites
Pathophysiology
  • Reactive hyperplastic process arising from the distinctive specialized subepithelial stromal cells of the lower female genital tract (Histopathology 2000;36:97)
  • Some of these stromal cells exhibit hormonal responsiveness and immunoreactivity to estrogen and progesterone receptors (Am J Perinatol 1991;8:236)
  • Due to hormone induced hyperplasia of loose subepithelial connective tissue or end stage of granulation tissue (J Clin Pathol 1992;45:235)
Clinical features
  • Usually asymptomatic
  • Occasionally can cause bleeding, discharge and general discomfort
Diagnosis
  • Morphology is the key to diagnosis
Radiology description
  • Imaging is rarely done but the typical findings are (Jpn J Radiol 2010;28:609):
    • Polypoid stromal proliferation
    • Hyper and hypointense areas
    • Covering surface epithelium
    • Central fibrovascular core
    • No focal or diffusion restriction
    • No pelvic lymph node enlargement
Radiology images

Images hosted on other servers:
Labium major mass Labium major mass Labium major mass

Labium majora mass

Labium major polyp

Labium majora polyp

Prognostic factors
  • Benign, may recur during pregnancy, often regresses following delivery
Case reports
Treatment
Clinical images

Contributed by Hope Haefner, M.D.
Vulvar polyp

Vulvar polyp

Gross description
  • Polypoid, multilobulated or pedunculated mass usually < 5 cm
  • Giant polyps (15 - 20 cm) are rare; likely arise from proliferation of mesenchymal cells within the hormonally sensitive subepithelial stromal layer and have been reported in association with chronic lymphedema (Gynecol Oncol 2005;98:168)
Gross images

Images hosted on other servers:
Labia majora mass Labia majora mass

Labia majora mass

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Albert Alhatem, M.D. and Debra S. Heller, M.D.
Stroma reaching the epithelium

Stroma reaching the epithelium

Hypocellular stromal form

Hypocellular stromal form

Hypercellular stromal form

Hypercellular stromal form

Stellate cells Stellate cells

Stellate cells

Multinucleated cells

Multinucleated cells

Virtual slides

Images hosted on other servers:
Fibroepithelial stromal polyp of vulva

Fibroepithelial stromal polyp of vulva

Polyp with overlying squamous hyperplasia

Polyp with overlying squamous hyperplasia

Polyp with negative p16 reactive squamous hyperplasia

Polyp with negative
p16 reactive
squamous
hyperplasia

Positive stains
Sample pathology report
  • Vulva, lesion, excision:
    • Fibroepithelial stromal polyp
Differential diagnosis
  • Aggressive angiomyxoma:
    • Deep location
    • Large size (> 10 cm)
    • Infiltrative borders
    • Lack of hypercellular areas
    • Presence of uniformly distributed blood vessels throughout the tumor
    • Rearrangements of the high mobility group AT-hook 2 (HMGA2) gene (chromosome 12q15)
    • Immunohistochemistry: strong nuclear reactivity for HMGA2
  • Angiomyofibroblastoma:
    • Subcutaneous rather than a polypoid mass
    • Stromal cells are:
      • Epithelioid with abundant eosinophilic cytoplasm
      • Cluster around blood vessels
    • Abundant thin walled blood vessels
    • Mean age: fifth decade of life
    • Mast cells within the stroma
    • Epithelioid and spindle cells are myofibroblastic in origin
    • Immunohistochemistry: positive for desmin with coexpression of BCL2 and CD99
  • Cellular angiofibroma:
    • Well circumscribed
    • Moderately cellular stroma
    • Intersecting short fascicles of bland spindle cells
    • Numerous medium sized blood vessels often with thick hyalinized walls
    • Immunohistochemistry: weak to absent staining with desmin and SMA and variably positive for CD34
    • Loss of 13q14 (FOX1A1) (similar to spindle cell lipoma and extramammary myofibroblastoma)
  • Superficial angiomyxoma:
    • Superficial location
    • Multinodular growth pattern in a myxoid stroma
    • Thin blood vessels
    • Neutrophils in the stroma
    • Lack of stellate stromal cells
    • Mostly found in the head and neck and rarely in the vulva
    • Multiple extragenital superficial angiomyxomas are strongly associated with Carney complex
  • Prepubertal vulvar fibroma:
    • Stroma is edematous and hypocellular without atypia
    • Thick walled blood vessels
    • Entrapped adipose tissue and nerve bundles
    • Immunohistochemistry:
  • Botryoid rhabdomyosarcoma:
    • Usually under 5 years of age
    • Cambium layer
    • Invasion
    • Rapid growth
    • Cross striations
Board review style question #1

    A 25 year old woman presented with a vulvar mass, measuring 3.0 cm in diameter. The lesion was excised and the H&E image is shown. Which of the following is the most likely diagnosis?

  1. Superficial angiomyxoma
  2. Cellular angiofibroma
  3. Fibroepithelial stromal polyp
  4. Angiomyofibroblastoma
  5. Acrochordon of vulva
Board review style answer #1
C. Fibroepithelial stromal polyp

Comment Here

Reference: Fibroepithelial (stromal) polyp
Board review style question #2
    Which of the following morphologic features is characteristic of fibroepithelial stromal polyps?

  1. Uniformly distributed blood vessels
  2. Thin blood vessels
  3. Thick walled blood vessels
  4. Stellate cells around the blood vessels
  5. Abundant thin walled blood vessels
Board review style answer #2
D. Stellate cells around the blood vessels

Comment Here

Reference: Fibroepithelial (stromal) polyp
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