Septic presentation of a giant fibroepithelial polyp of the vulva

Abstract

Fibroepithelial stromal polyps are mesenchymal lesions occurring typically in reproductive age women with a predilection for the vulvo-vaginal region. Malignancy may mimic this polyp in morphology, rendering further investigations including detailed histopathology mandatory. Histologically its characteristic features are stellate and multinucleate stromal cells identified near the epithelial-stromal interface. This case report discusses incidental finding of largest fibroepithelial polyp presented in a 31-year-old nulliparous woman. She was initially admitted with sepsis and detailed physical examination revealed a right-sided infected pedunculated labial mass measuring 20×21 cm. After initial resuscitation for sepsis, she was further investigated for the mass. Transabdominal ultrasound was essentially normal apart from a small fibroid 3×2 cm in the anterior wall of the uterus. The vulval mass was removed under local and regional anaesthesia and was confirmed to be a giant fibroepithelial stromal polyp on histopathology. The woman recovered well and was followed up until 1 year.

Multiple Vulvar Giant Fibroepithelial Polyps: A Rare Case Occurrence

“…Initially, fibroepithelial polyp was described by Norris and Taylor in 1966. The first case of vulvar fibroepithelial polyp was described by Ostor et al in 1988 [ 7 , 8 ] Fibroepithelial polyps rarely arises in the vulva and cervix of reproductive-age women [ 9 ]. The most common clinical presentation of fibroepithelial polyp is a painless mass [ 6 ].…”

“…Although the risk of malignancy and recurrence are very low, malignancy must be excluded by tissue biopsy. Botryoid embryonal rhabdomyosarcoma is the main differential diagnosis, and differentiated sarcomas from a fibroepithelial stromal polyp may be difficult [ 9 ]. A distinguishing microscopic feature would be the presence of stellate and multinucleate stromal cells, not found in sarcomas [ 9 ].…”

“…Botryoid embryonal rhabdomyosarcoma is the main differential diagnosis, and differentiated sarcomas from a fibroepithelial stromal polyp may be difficult [ 9 ]. A distinguishing microscopic feature would be the presence of stellate and multinucleate stromal cells, not found in sarcomas [ 9 ]. Other differential diagnoses include leiomyomas, superficial angiomyxoma, perineuroma, and neurofibromas mimic fibro epithelial polyp [ 14 ].…”

“…In the present case, definitive diagnosis was confirmed on the basis of histopathological examination. Histologically, the most characteristic feature of this polyp is the presence of stellate and multinucleate stromal cells at the epithelial-stromal interface [ 9 ]. In this case, the microscopic evaluation of the lesion revealed that the epithelial surface was keratinized and hyperplastic.…”

“…Ideal treatment for this lesion is complete excision and long-term follow-up to detect recurrence at the earliest. Although fibroepithelial polyps are benign skin tumors, they tend to regrow if not totally excised [ 9 ]. They can be treated with cryotherapy or cauterization when their size is in millimeters, while surgical excision is required for large fibroepithelial polyps [ 15 ].…”