Tumours ranged from 1 to 6.5 cm (median 2.0 cm) in size. Many were polypoidal (n=10). They were soft to rubbery with a glistening mucoid or fleshy cut surface.
They were located in the lamina propria and domed the overlying epithelium, from which they were separated by a band of myxoid or oedematous stroma. The tumours were not encapsulated but were well demarcated. They were composed of a uniform population of spindled or stellate cells in a finely collagenous matrix with myxoid or oedematous foci. Cellularity varied from moderate to high. A few multinucleate cells were present. Mitotic activity was up to 2 per 50 HPF. There was a sieve-like pattern of spindled cells encircling small nodules of collagen. Two cases showed a focal storiform pattern. The cells did not show concentration around vessels. There were no cases showing necrosis. Mast cells were were in all cases and some showed scattered lymphocytes (n=9).
|
|
mesodermal (fibroepithelial) stromal polyp: superficial, in vulvovaginal subepithelial stroma.
The pseudosarcomatous variant with high cellularity, atypia and mitoses pose diagnostic difficulty. It is commonly associated with pregnancy. There is no native stroma separating the lesion form the epithelium. The architecture is chaotic. There are markedly atypical cells , including bizarre multinucleate giant cells. Mitotic activity may be up to 30 per 50 HPF. Atypical mitoses are present. Desmin expression is weaker and smooth muscle actin expression stronger.
aggressive angiomyxoma: young women, large bulky mass in the deep pelvicoperitoneal region, histologically bland but local infiltrative growth. Bundles of cells with myoid features commonly sen n proximity to vessels and nerves. Lesser degree of desmin and CD34 expression.
angiomyofibroblastoma of the vulva: peri and postmenopausal women, subcutaneous, well circumscribed, composed of plump spindled and epithelioid cells which proliferate around vessels,
cellular angiofibroma: angiomyofibroblastoma / spindle cell lipoma overlap tumour; middle aged women, vulva and inguinal region, small, well circumscribed, spindle cells form fascicles, adipocytes are present.
superficial angiomyxoma / cutaneous myxoma; wide anatomical distribution, including vulva and inguinal region but not vagina or cervix, small lesion in young women, has more myxoid material, variable expression of S-100 but negative for desmin and steroid receptors.
mixed tumour of the vagina (spindle cell epithelioma); younger women, often hymenal, cytologically bland spindle cells which may show a sieve-like pattern, but includes a squamous or glandular component. Both the epithelial and the spindle cell components are positive for cytokeratins.
endometrial stromal tumour, metastatic or occasionally primary in the vagina or cervix; higher cellularity, more atypia, arteriolar-like vessels, focal smooth muscle or sex cord stromal differentiation, presence of lipid-laden macrophages, lack marked desmin staining.
solitary fibrous tumour; rare in female genital tract, more pronounced collagenisation, haemangiopericytomatous pattern, more marked CD34 positivity but negative for desmin.
This page last revised 8.11.2001.