Recurrent Atypical Myxoid Fibroepithelial Polyp Associated with Vulvar Crohn's Disease

Abstract

Fibroepithelial polyps of the lower female genital tract are common lesions that can rarely exhibit atypical features including increased and atypical mitoses, bizarre nuclei, and hypercellularity, a combination of findings that may suggest malignancy. Five recurrent cases have been published to date, two of which were in pregnant females; the other three followed incomplete excisions. Our case is that of a 25-year-old female with Crohn's disease who developed multiple recurrences of polypoid and domed lesions of the labium minus following surgical excision. Histologic findings in the initial and recurrent lesions were consistent with atypical myxoid fibroepithelial polyps with underlying vulvar Crohn's disease. The lesions subsequently improved with standard Crohn's treatment including 5-amino-salicylic acid (Pentasa) and prednisone. The present case represents the only example of this entity associated with Crohn's disease, and it is the only reported recurrent case not associated with pregnancy, tamoxifen administration, or positive excision margins. The clinical, microscopic, and immunohistochemical findings of this case suggest that atypical fibroepithelial polyps of the lower female genital tract, cutaneous pleomorphic fibroma, and lesions such as fibroepithelial polyps of the anus may represent variants of the same atypical reparative process.

Localized lymphedema (elephantiasis): a case series and review of the literature

“…Histopathologically, lymphedema is a fibroinflammatory process 7,8 . Typically, elephantiasis diffusely involves the body part affected by lymphedema (legs more than arms and genitalia episodically); 8 exceptionally, lymphedema involves circumscribed region of skin producing a solitary, large polyp, 9–29 indurated (solid) plaque, 30–68 papillomatous plaque, 69–80 pendulous swelling 81–90 or large, sarcoma‐like mass 91–115 . Herein, we report the clinicopathologic findings of a consecutive series of 24 cases of localized lymphedema (elephantiasis) and review the literature on this phenomenon.…”

Pedunculated hemangiopericytoma‐like tumor: peculiar fibroepithelial polyp or fibrous histiocytoma variant

“…The epidemiologic information collected includes patient age, sex and anatomic location. Similar to the FEP, PHLFH appears to have a predilection for the intertriginous areas of the body, as the three lesions were found in the axilla and neck regions 1,2 . A bodily fold propensity further suggests a possible etiologic relationship to friction or thermal energy.…”

“…A myriad of benign, intermediate and malignant entities may present with features simulating PHLFH (Table 2). Grossly, it is pedunculated and polypoid, showing overlap with FEP, basal cell carcinomas in the basal cell nevus syndrome, pleomorphic fibroma and pseudosarcomatous polyp 1,2,12,18 . Histopathologically, PHLFH possesses the silhouette of a FEP at scanning magnification; completely surfaced and enclosed by squamous epithelium devoid of adnexae.…”

“…The dermis discloses a spindled cell population with dilated blood vessels similar to PHLFH. Incongruent with PHLFH are the presence of scattered hyperchromatic nuclei, multinucleation, mitoses and a myxoid background; features typical of pseudosarcomatous polyp 2 . Grossly, GCF is described as gray, gelatinous, firm, fibrous, pink and watery 19 .…”

“…The most common identity of these cutaneous lesions is the fibroepithelial polyp (FEP) or acrochordon. These benign tumors of late adulthood are considered to be an unsightly nuisance that may undergo torsion and secondary inflammation, typically presenting in the bodily fold areas of the axilla, groin or neck 1,2 . Although reports of a putative association with diabetes mellitus, abnormal lipid profiles, colonic polyps, acromegaly and human papillomavirus (HPV) infection exist, obesity and advancing age appear to be the most common associations 3–10 .…”