III. Benign Tumors and Tumor-like Conditions
After completing this tutorial the student will be
- list benign tumors and tumor-like conditions of the
- describe their clinical features
- describe/recognize histologic features
- state clinical behavior
- Squamous papilloma
Squamous papillomas of the vagina may be single but frequently are multiple,
small (<2 mm) papillary lesions. They most commonly occur near the hymenal
ring and are usually asymptomatic. The lesions may be clinically confused
with condyloma acuminatum. The papilloma is not related to HPV infection and
neither is it sexually transmitted.
Microscopically, the lesion is composed of a single fibrovascular core with
a squamous epithelial lining. Koilocytes are absent.
It is benign.
- Fibroepithelial polyp
This is a polypoid growth that is found in the lower third of the vagina
and is usually asymptomatic. It ranges in size from 0.5 to 4 cm.
The lesion is seen microscopically as an edematous connective tissue stalk
covered by stratified squamous epithelium.
Note connective stroma containing blood vessels and covered by normal-looking
stratified squamous epithelium.
This is a benign lesion.
- Fallopian tube prolapse
Prolapse of the fallopian tube is a complication of vaginal or abdominal
hysterectomy. Patients present with abdominal pain, vaginal discharge or bleeding.
A red, granular mass is present at the vaginal apex, which may be misdiagnosed
A complex pattern of tubular, glandular and papillary structures are seen
on histological examination and may be misdiagnosed as carcinoma. Typical
fallopian tube morphologic features may be difficult to identify due to distortion.
Associated inflammation is often present.
Low power view showing complex pattern of tubules, glands and papillary structures.
Higher power view showing papillary fronds and inflammation.
The lesion is benign.
- Candidiasis (Moniliasis)
The fungus Candida albicans causes this very common infection.
The disease presents with pruritus, a thick white vaginal discharge. The
vaginal is sometimes only mildly reddened. There may be patches of white membrane
or severe inflammation with edema and ulcers.
Colonies of the fungus are present on the surface and extend into the epithelium
but not into the underlying tissues. Mild edema and chronic inflammatory cells
are present. If ulceration develops fungi are seen in the base of the ulcers
with marked acute inflammation. Cytological smears show yeast forms and branching
Pap smear showing branched and budding Candida albicans.
Trichomoniasis is caused by the unicellular flagellated protozoan, Trichomonas
vaginalis. It is sexually transmitted. The disease involves not only the vagina
but also lower urinary tract.
Most infections are asymptomatic and pass unnoticed. Occasionally, a copious,
thin, frothy, yellow green to gray offensive discharge is produced. There
may be vulvar itching or burning or dyspareunia.
The stroma of the vaginal wall may show an inflammatory infiltrate of lymphocytes
and plasma cells. The organisms are not seen in biopsies because they do not
invade the vaginal wall. Diagnosis is made by examination of a saline wet
preparation in which the motile trophozoites are seen. The organism can also
be found in Pap-stained vaginal smears.
Pap smear showing trophozoites of T. vaginalis.