Pathology Thread

III. Benign Tumors and Tumor-like Conditions

Objectives:

After completing this tutorial the student will be able to:

• list benign tumors and tumor-like conditions of the vagina
• describe their clinical features
• describe/recognize histologic features
• state clinical behavior

1. Squamous papilloma

Clinical appearance

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.

Histology

Microscopically, the lesion is composed of a single fibrovascular core with a squamous epithelial lining. Koilocytes are absent.

Clinical behavior

It is benign.

2. Fibroepithelial polyp

Clinical presentation.

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.

Histology

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.

Clinical behavior

This is a benign lesion.

1. Fallopian tube prolapse

Clinical presentation

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 as carcinoma.

Histology

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.

Clinical behavior

The lesion is benign.

2. Candidiasis (Moniliasis)

The fungus Candida albicans causes this very common infection.

Clinical presentation

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.

Histology.

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 pseudohyphae.

Pap smear showing branched and budding Candida albicans.

3. Trichomoniasis

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.

Clinical presentation

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.

Histology

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.