Pathology

Benign Tumors and Tumor-like Lesions

Objectives:

After completing this tutorial the student will be able to:

• list benign tumors and tumor-like lesions of the vulva
• describe their clinical features
• describe/recognize histologic features
• state clinical behavior/treatment

1. Fibroepithelial polyp (acrochordon; skin or cutaneous tag)

• Clinical presentation

A fibroepithelial polyp is a flesh-colored, hyper- or hypo-pigmented, soft, pedunculated or sessile mass that involves the hair-bearing skin of the vulva. It ranges in size from 1mm to 3 cm.

• Histology.

  Microscopically the lesion appears as a connective tissue stalk with blood vessels and loose collagen covered by keratinized stratified squamous epithelium, which may be thrown into multiple folds.

• Clinical behavior

It is benign and has no malignant potential. It may bleed from trauma. Large lesions may present cosmetic problems.

2. Hidradenoma papilliferum

This is a benign neoplasm of apocrine sweat gland origin.

• Clinical presentation

A hidradenoma papilliferum forms a small subcutaneous, dome-shaped mass less than 2 cm in size. It presents most commonly on the labia majora but may also occur on the labia minora and interlabial sulci. Very occasionally, it may involve the apocrine glands of the nipple areola or the perianal region. The tumor is not found before puberty and is virtually only seen in Caucasian women.

• Histology

Microscopically, the lesion is well circumscribed and composed of a cystic space into which projects a papillary structure with delicate fibrovascular branching stalks and numerous tubules and acini lined by inner cuboidal or columnar epithelium with an outer compressed layer of myoepithelial cells.

Low power view showing cystic space into which project complex papillary structure.

High power view showing papillary fronds, tubules and acini, and the two-celled wall.

• Clinical behavior

Benign but can be confused clinically with malignant tumor because of its propensity to ulcerate.

3. Ectopic breast tissue

Occurrence of breast tissue in the vulva is considered to be ectopic. This occurs as an extension of breast tissue in the "milk line".

• Clinical behavior.

The lesion has a variable presentation ranging from small isolated glands or nodules, which are first noticed during pregnancy due to enlargement, to large bilateral masses.

• Histology

The histological appearances are identical to mammary tissue in breasts. The spectrum of changes seen in breast tissue, including fibrocystic and lactational changes may be present.

• Clinical behavior

Benign. On rare occasions adenocarcinoma may develop.

• Treatment.

  Local excision.