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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 2  |  Page : 265-266
Villous adenoma: A rare tumor of vaginal vault


1 Prakash Diagnostic Laboratory, Mysore, Karnataka, India
2 JSS Medical College, Mysore, Karnataka, India
3 2359/3, 10th cross, Basaveshwara Road, Mysore, Karnataka, India

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   Abstract 

Villous adenomas are extremely rare tumors in the vagina and are indistinguishable from their colonic counterparts. These are considered as enteric type neoplasms of lower female genital tract arising from cloacal remnants. The significance of this lesion lies in the fact that it has to be distinguished from metastatic adenocarcinoma from other sites. We present a case of villous adenoma of vaginal vault, a rare site of presentation in a 30-year-old female.

Keywords: Cloacal remnants, vagina, vault, villous adenoma

How to cite this article:
Shivaprakash H N, Jayashree K, Girish M. Villous adenoma: A rare tumor of vaginal vault. Indian J Pathol Microbiol 2008;51:265-6

How to cite this URL:
Shivaprakash H N, Jayashree K, Girish M. Villous adenoma: A rare tumor of vaginal vault. Indian J Pathol Microbiol [serial online] 2008 [cited 2014 Dec 29];51:265-6. Available from: http://www.ijpmonline.org/text.asp?2008/51/2/265/41684



   Introduction Top


Villous adenomas tend to occur in older persons, most commonly in the rectum and rectosigmoid colon, but they may be located elsewhere. [1] Two cases of villous adenomas of the uterine cervix associated with underlying invasive carcinoma have been reported. [2] Villous adenomas are extremely rare in the vagina. [3] These rare tumors in the vagina can be readily recognized for they are indistinguishable from their colonic counterparts. The presenting symptoms include vaginal discharge, vaginal itching or dysfunctional uterine bleeding. [4] Though a very rare tumor, awareness of the lesion is important, as it must be distinguished from metastatic adenocarcinoma from other sites. [5]


   Case History Top


A 30-year-old female, who had undergone hysterectomy 2 years back for dysfunctional uterine bleeding, presented a history of intermittent bleeding per vagina of 2 months duration. Clinical examination revealed a polypoidal mass of 1.5 cm × 1.5 cm over the vaginal vault. The mass was friable and would bleed to touch. Ultrasonographic study of the abdomen and pelvis was found to be normal. A clinical diagnosis of vault granuloma was made and the mass was excised.

Pathological findings

Macroscopically, the specimen consisted of two irregular grey brown firm bits of tissue. The larger bit measured 1 cm × 1 cm × 0.5 cm, while the smaller bit measured 1 cm × 0.5 cm × 0.5 cm. Cut sections of both the masses were grey brown. The entire tissue was taken for processing.

Microscopically, the sections showed polypoid structures thrown into multiple papillary projections having a complex branching pattern [Figure 1]. The lining epithelium was composed of tall columnar cells with surface ciliation and had moderate to abundant cytoplasm, round regular nuclei [Figure 2]. There were no abnormal mitotic figures, necrosis or stromal invasion. The underlying oedematous fibro-vascular core displayed dilated and congested vessels with focal areas of mixed inflammatory cell infiltrate.


   Discussion Top


Villous adenomas are extremely rare in the vagina. [3] The first case of a villous adenoma of endodermal derivation involving the rectovaginal septum presenting as a polypoidal tumor in a 72-year-old woman has been reported in 1987. [6] The present case is a 30-year-old female presenting with a polypoidal lesion on the vaginal vault. It has been postulated that the adenoma traversed a tract of developmental origin within the rectovaginal septum. [6] Out of the three enteric neoplasms described by Fox et al. , the tubulovillous adenoma of vagina was identical to similar lesion found in large intestine. They suggested that the enteric tumors of vagina were more probable to develop from cloacal remnants. [7] Burton also supports that villous adenomas of vagina are derived from cloacal remnants. [4]

Clinically, villous adenomas of vagina present with vaginal discharge, vaginal itching or dysfunctional uterine bleeding. [4] The present case was a post-hysterectomized patient with a history of intermittent bleeding per vagina. A case of tubulovillous adenoma located outside the vaginal introitus near the urethra presented with intermittent vaginal spotting. [3]

Morphologically, the tubulovillous adenoma has a fibromuscular core. The villi and the tubules are lined by intestinal type of epithelium consisting of columnar cells with a brush border but lack Paneth cells and goblet cells. [4] A case of vaginal adenocarcinoma of intestinal type arising from an adenoma was initially interpreted as a metastatic deposit from a colonic adenocarcinoma. As the clinical investigations showed no evidence of a primary gastrointestinal lesion, the case was reviewed. The morphology, histochemical and differential cytokeratin profile led to the lesion being reinterpreted as a primary intestinal type of adenocarcinoma of the vagina arising from a tubular adenoma. [5] The present case is one such rare entity, which on microscopy showed only villous component without any tubular component. This is in contrast to many reports that describe both tubular and villous components.


   Conclusion Top


Villous adenomas of the vagina are extremely rare. It has been postulated that they are derived from the cloacal remnants along a tract within the rectovaginal septum.

Adenocarcinomas are known to arise from these pre-existing adenomas. It is thus essential for an extensive microscopic study of villous adenomas of the vagina to look for any evidence of malignancy like cellular atypia, nuclear pleomorphism, abnormal mitotic figures, necrosis or stromal invasion.

 
   References Top

1.Liu C, Crawford JM. The gastrointestinal tract. In : Kumar V, Abbas AK, Fausto N, editors. Robbins and cotran pathologic basis of disease. 7 th ed. Philadelphia: Saunders; 2004. p. 860.  Back to cited text no. 1    
2.Michael H, Sutton G, Hull MT, Roth LM. Villous adenoma of the uterine cervix associated with invasive adenocarcinoma: A histologic, ultrastructural and immunohistochemical study. Int J Gynecol Pathol 1986;5:163-9.  Back to cited text no. 2  [PUBMED]  
3.Lee SE, Park NH, Park IA, Kang SB, Lee HP. Tubulovillous adenoma of the vagina. Gynecol Oncol 2005;96:556-8.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Burton JL, Wells M. Tumors of the female genital tract. In : Fletcher C, editor. Diagnostic histopathology of tumors. 2 nd ed. London: Harcourt Publishers Limited; 2000. p. 707.  Back to cited text no. 4    
5.Mudhar HS, Smith JH, Tidy J. Primary vaginal adenocarcinoma of intestinal type arising from an adenoma: Case report and Review of literature. Int J Gynecol Pathol 2001;20:204-9.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Ciano PS, Antoniolo DA, Critchlow J, Burke L, Goldman H. Villous adenoma presenting as a vaginal polyp in a rectovaginal polyp. Hum Pathol 1987;18:863-6.  Back to cited text no. 6    
7.Fox H, Wells M, Harris M. Enteric tumors of the lower female genital tract: A report of three cases. Histopathology 1988;12:167-76.  Back to cited text no. 7    

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Correspondence Address:
H N Shivaprakash
Prakash Diagnostic Laboratory, 2775/C, Narayana Shastry Road, Chamundipuram, Mysore - 570 004, Karnataka
India
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DOI: 10.4103/0377-4929.41684

PMID: 18603704

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    Figures

  [Figure 1], [Figure 2]

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    Abstract
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    Case History
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