Primary vaginal leiomyosarcoma: A case report with complete morphological, immunohistochemical and ultrastructural study.

OBJECTIVE: Primary vaginal leiomyosarcomas (LMS) are rare, easily recurrent tumours with an unknown etiology; the prognosis is poor and there is no consensus guideline on their management. CASE REPORT: A nodular, 25 × 23 x 28 mm-mass, infiltrating the urethra, was found in a 58-year-old woman. A biopsy showed a LMS of the vagina that was positive for vimentin, alpha-smooth muscle actin, caldesmon, desmin, p16 and p53. An anterior pelvic exenteration was performed. The sample was fixed and prepared for light microscopy, transmission and scanning electron microscopy, confirming the diagnosis of LMS. CONCLUSIONS: Best outcomes occur when the tumour is small, localized, and can be removed surgically with wide, clear margins, as in this case. As there are different kinds of malignant mesenchymal tumours, biopsy followed by immunohistochemistry and electron microscopy still represents a good diagnostic choice and surgical resection is generally the gold standard in these cases.

Vaginal bleeding as primary presentation of renal cell carcinoma.

Vaginal metastases from renal cell carcinoma has been recorded as extremely rare. We present a patient with vaginal bleeding as primary manifestation of renal cell carcinoma. A 40-year-old woman presented to a local private clinic with intermittent vaginal bleeding for approximately one month. Gynecological examination revealed a mass on the vaginal wall at approximately 8 o'clock. She underwent dilation and curettage (D&C) and mass excision. Microscopic histopathology and immunohistochemical stains showed vaginal metastases of clear cell RCC. The patient was referred to our urology clinic. Magnetic Resonance Imaging (MRI) of abdomen and pelvic showed a well-defined solid mass lesion measuring 16 × 12 × 11 cm in left kidney. Patient underwent left side radical nephrectomy through a left subcostal intraperitoneal incision. Histopathological results and metastasis workup confirmed the diagnosis of RCC with solitary metastatic vaginal lesion. After radical nephrectomy, she was treated with Sunitinib. No local relapse or distant metastasis was recognized 5 months after radical nephrectomy. In conclusion, the incidence of RCC metastasis to the vagina is extremely rare; but, in cases of vaginal bleeding or lesions we have to keep in mind the possibility of metastatic RCC.

Mixed tumors of the vagina. A clinicopathological analysis of eight cases.

Eight mixed tumors of the vagina are described. Seven of them were situated in or near the hymenal ring. All but one were well-circumscribed masses unconnected to the surface epithelium. They were composed of small stromal-type cells usually containing islands of mature squamous cells and glands lined by mucinous epithelium. Their histogenesis is not clear. Follow-up of 2--9 years in seven of the cases has revealed no evidence of recurrence or metastases after local excision.

Paravaginal wolffian duct (mesonephros) adenocarcinoma: a light and electron microscopic study.

This is a report of an adenocarcinoma of mesonephric origin studied by light microscopy, electron microscopy, and immunocytochemistry. Unlike previous reports, our lesion was located paravaginally and not in the leaves of the broad ligament or in the cervix. The light microscopic features are similar to those of previous cases in the literature. Although not specific, the ultrastructural features of the tumor are similar to those of mesonephric structures and different from those of müllerian structures. The diagnosis always should be considered when a tumor occurs at the site where mesonephric remnants may be found and after exclusion of a carcinoma of other pelvic organs or a metastasis from a primary neoplasm elsewhere.

Glandular dysplasia in diethylstilbestrol-associated vaginal adenosis. A case report and review of the literature.

A case of diethylstilbestrol-associated vaginal adenosis in which dysplastic glands were identified and examined by light and electron microscopy is reported. Transitions between normal and dysplastic glands were documented in subserial sections. These alterations may characterize an intermediate phase in the development of clear-cell adenocarcinoma of the vagina.

Xanthogranulomatous pseudotumor of the vagina: evidence of a local response to an unusual bacterium (mucoid Escherichia coli).

Utilization of nonconventional bacterial strains and electron microscopy occasionally may aid in the recognition of unusual microorganisms which fail to be demonstrated by more conventional bacterial stains. We report an unusual case of recurrent vaginal polyps, initially thought by physical examination to represent a malignant neoplasm and histologically to represent a granular cell tumor. The lesions were comprised microscopically of sheets of large, polygonal, histiocytic-like cells with abundant eosinophilic granular cytoplasm. With the Dieterle silver stain, the cytoplasm of these cells contained large numbers of intracellular rod-shaped bacilliform bodies thought to be microorganisms. These organisms stained not at all or very poorly with more conventional bacterial stains, such as Gram and Giemsa stains. Electron microscopy was employed to confirm the presence of intra- and extracellular bacilliform bodies and the absence of large numbers of cytosegresomes, the latter characteristically seen in typical granular cell tumors. Cultures of tissue from the biopsy documented a pure strain of a mucoid form of Escherichia coli. We were unable to identify any prior report describing a similar recurrent inflammatory vaginal lesion in which mucoid E. coli was demonstrated. We discuss possible pathogenesis of this case, and relate it to morphologically similar diseases, such as Whipple's disease and malakoplakia, in which there appears to be defective clearance of bacteria from a variety of tissues.

Paravaginal female adnexal tumor of probable wolffian origin.

Female adnexal tumor of wolffian origin (FATPWO) is a lesion that predominantly occurs in the broad ligament. Its occurrence in the right paravaginal area is rare; only one other case has been reported to occur at this site. The authors report a case of paravaginal FATPWO in a 20-year-old woman that recurred twice during a 5-year period. The microscopic and ultrastructural features of this lesion were identical to other cases of FATPWO reported in the literature. This tumor must be recognized, especially at this site, so that it is not confused with vaginal adenocarcinoma related to diethylstilbestrol exposure in utero.

Immunohistochemical and electron microscopic findings in benign fibroepithelial vaginal polyps.

Eleven classic benign "fibroepithelial polyps" of the vagina were examined using a panel of immunocytochemical agents. Two were also examined electron microscopically. In all cases the stellate and multinucleate stromal cells characteristic of these lesions stained strongly for desmin, indicating muscle intermediate filament production. In common with uterine fibroleiomyomata, numerous mast cells were also often seen. Myoglobin staining was negative. Electron microscopical examination confirmed that the stromal cells contained abundant thin filaments with focal densities and also showed the ultrastructural features usually associated with myofibroblasts. It is concluded that these tumours would be better designated polypoid myofibroblastomas in view of the above findings.

Vaginal glomus tumor: case presentation and ultrastructural findings.

Vaginal glomus tumors are exceptionally rare, and have not been reported in the literature. A case of vaginal glomus tumor is described. Light and electron microscopic views are presented. The differential diagnosis and surgical approach are discussed.

Vaginal hemangiopericytoma: a histopathologic and ultrastructural evaluation.

The hemangiopericytoma is an uncommon stromovascular neoplasm that arises from the pericyte of Zimmerman. Since their original description in the female genital tract in 1954, the majority of these lesions have been of uterine origin. Presented is a clinicopathologic description of a hemangiopericytoma arising in the vagina and occupying the rectovaginal septum. Light and electron microscopic characterization is rendered. Current understanding of these lesions is reviewed and therapeutic options are discussed.

Pseudosarcoma botyroides in pregnancy: report of a case with ultrastructural observations.

A case of pseudosarcoma botryoides of the vagina diagnosed in advanced pregnancy is described. The cellular characteristics (atypical cells and abnormal mitoses) suggested malignancy, but ultrastructural studies demonstrated the fibroblastic nature of the cells, thus confirming the diagnosis of pseudosarcoma. Local excision and subsequent cesarean section was the method of treatment. Three years later, another pregnancy was terminated by repeat cesarean section and uncontrollable hemorrhage requiring emergency hysterectomy. The histologic study of the bleeding area revealed very edematous areas and lacunaelike endothelium-lined vessels. No cellular abnormalities were observed.

The morphology of the earliest invasive cell in low genital tract epidermoid neoplasia.

The light and electron microscopic characteristics of the distinct eosinophilic microinvasive cell in the lower genital tract epidermoid neoplasia are described. The eosinophilic quality of the invasive cell is associated with an accumulation of contractive protein seen at the ultrastructural level. The presence of these differentiated cells near the basement membrane should be viewed with more concern as they contain the cytoplasmic machinery with which to invade.

Establishment and characterization of human vaginal malignant melanoma xenotransplants.

Human vaginal malignant melanoma represents rare gynecological malignancies of poor prognosis. We have established a melanoma tumor line in nude mice, designated Mela-1, and have examined the histological and biological characteristics of this tumor. The Mela-1 tumor has preserved the histological, histochemical and biological characteristics of malignant melanoma even after 20 passages. Tumor cells are of epitheloid shape varying in size. An ultrastructural study revealed that the tumor cells were characterized by the presence of cells with deeply indented nuclei, and both types of melanosomes, eumelanosomes and pheomelanosomes, in various stages of maturation with vesiculo-globular bodies in the cytoplasm. Melanin analysis of the tumor indicated the Mela-1 tumor to be pheomelanic. Immunohistochemical examinations revealed that the Mela-1 cells were stained positively by melanoma-associated antibody (NKI/C3) and by antibodies for S-100 protein and vimentin, and negatively for keratin and CEA. The levels of AFP, CA125 and CEA in sera of tumor-bearing mice were within normal range. The 5-S-cysteinyldopa level in sera of tumor-bearing mice correlated well with the size of the tumor. Chromosomal analysis showed the human karyotype with great heterogeneity and a modal number of 102 chromosomes. Thus the Mela-1 tumor will be useful in establishing the biological characteristics in the search for an effective treatment of human malignant melanoma of the vagina.

Benign vaginal rhabdomyoma.

A case of benign polypoid vaginal rhabdomyoma occurring in a 52-year-old female is described. The characteristic histological features were interlacing bands of striated muscle cells with prominent cross and longitudinal striations, with surrounding loose collagenous stroma, within which were many dilated vascular spaces. Electron microscopy confirmed the striated muscle origin of these cells. The pathogenesis is possibly a localized area of abnormal mesenchymal differentiation.

Papillary tumour of the vagina resembling transitional cell carcinoma.

A case of a peculiar papillary neoplasia of the vagina resembling a urothelial tumour is presented. Four vaginal tumours were excised from a 76-year-old woman. Five years before this patient had undergone a uretero-nephrectomy for a non-invasive papillary transitional cell carcinoma of the renal pelvis. The four vaginal tumours demonstrated gross and microscopic similarities to low-grade papillary transitional cell carcinoma of the urinary tract. This observation indicates that multicentric, non-invasive, papillary tumours may affect the whole uro-genital area. The vaginal wall was not overlaid by a normal squamous epithelium, but by a peculiar "transitional-like" epithelium. Variegated endocrine cells were documented within this lining, using immunohistochemical and ultrastructural techniques. The eventuality of a histogenetic link between the tumour and the adjacent epithelial lining remains unresolved.

Small-cell carcinoma of the vagina. A clinicopathologic study.

We report a case of small-cell carcinoma of the vagina in a women whose entire uterus, cervix, both fallopian tubes, and both ovaries had been removed 22 years previously. She presented with diffuse submucosal disease of the distal vagina with a possible soft-tissue component extending beyond the end of the vaginal vault. Extensive microscopic and immunohistochemical assessment established the diagnosis; treatment was initiated with chemotherapy, followed by local radiotherapy. To our knowledge, this is the first fully characterized case of its kind. We discuss the aggressive local behavior and the characteristics of gynecologic small-cell tumors in general.

Presence of human papillomavirus in verrucous carcinoma (Ackerman) of the vagina. Immunocytochemical, ultrastructural, and DNA hybridization studies.

Human papillomavirus (HPV) genomes were identified in two cases of verrucous carcinoma of the vagina, using Southern blot DNA hybridization under low-stringency conditions. Type (group) 6 HPV DNA (HPV-6) was identified, using molecularly cloned HPV-1 through HPV-6 DNA probes under high-stringency conditions in both cases. In addition, DNA extract in one case hybridized with HPV-1, HPV-3, and HPV-4 DNA probes. No HPV structural proteins were demonstrated in either case by immunocytochemical tests, using HPV antibodies. In one case viruslike intranuclear particles were observed by transmission electron microscopy. These two cases suggest a strong associative relationship between HPV and verrucous carcinoma (Ackerman) of the lower part of the genital tract.

Vaginal müllerian stromal sarcoma. A case report.

Primary malignancies of the vagina are among those encountered most rarely in the female reproductive tract. Even more rare are primary vaginal sarcomas. The fourth case of vaginal müllerian stromal sarcoma is reported on here.

Primary adenocarcinoma of the vagina. A case report with light and electron microscopic study.

A case of primary adenocarcinoma of the vagina in a 46 year old woman is reported. The light and electron microscopic studies are highly suggestive of a Müllerian origin. The ultrastructural features are discussed in relation to clear cell adenocarcinoma of the vagina, establishing the differences between them.

Thin-layer cytology findings of small cell carcinoma of the lower female genital tract. Review of three cases with molecular analysis.

OBJECTIVE: To describe the thin-layer cytology findings of small cell carcinoma of the low female genital tract, with histologic correlation and human papillomavirus (HPV) genotyping. STUDY DESIGN: The authors reviewed the clinical findings, thin-layer cytology and histologic features of small cell carcinoma of the lower female genital tract (cervix or vagina) occurring in three postmenopausal Chinese women at Pamela Youde Nethersole Eastern Hospital, Hong Kong, over a four-year period, from January 1998 to December 2001. Molecular techniques for HPV screening and genotyping using the polymerase chain reaction and restriction fragment length polymorphism were employed on the cytologic specimens. RESULTS: The thin-layer preparations were of moderate to high cellularity. There were loose aggregates of or isolated small round cells with a high nuclear/cytoplasmic ratio, thin but irregular nuclear membrane, hyperchromatic nuclei, inconspicuous nucleoli and scanty cytoplasm. Tumor cell cannibalism was commonly found. Small groups of tumor cells with nuclear molding were noted. There was also obvious tumor diathesis in the background. The necrotic debris was admixed with isolated small round cells, apoptotic bodies and nuclear dust. Associated koilocytosis or squamous intraepithelial lesions were not seen. Histologic examination of the tumor biopsies showed classic features of small cell carcinoma associated with squashing artifacts and vascularized stroma. Molecular analysis revealed the presence of HPV DNA (either type 18 or 16) in all the three liquid-based cytology samples. CONCLUSION: While the cytomorphologic features of small cell carcinoma of the cervix or vagina in thin-layer preparations are slightly different from those in conventional smears, due mainly to the absence of smearing effect, recognition of the subtle but characteristic appearance can enhance the accuracy of the cytologic diagnosis. The association between HPV and primary small cell carcinoma of the lower female genital tract was confirmed by this study.