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.

Blue nevi of the Müllerian tract: case series and review of the literature.

BACKGROUND: Blue nevi are rare in the cervix and vagina. Melanocytes are not normally found in these sites and have been hypothesized to arise either from the Schwann cells of stromal nerves or from melanocytic precursors which have aberrantly migrated from the neural crest to rest in the Müllerian stroma. Because of their rarity (3 previous cases in the literature), vaginal blue nevi have not previously been studied with immunohistochemical and ultrastructural analysis. DESIGN: We describe 3 cases of blue nevus occurring in the Müllerian tract, 1 in the vagina and 2 in the endocervix. RESULTS: The vaginal lesion was seen during routine examination of a 40-year-old woman. The endocervical blue nevi were incidental findings in hysterectomies performed for leiomyomata and endometrial serous carcinoma in women aged 44 and 57 years, respectively. All 3 cases showed loose aggregates of cytologically benign, pigmented, dendritic spindle cells in the superficial stroma. They were immunoreactive for S100 and melan-A, but not HMB45. Ultrastructural analysis revealed numerous melanosomes, with no Schwannian features identified. Compared with the endocervical lesions, the vaginal nevus cells were more heavily pigmented, and on electron microscopy, a greater proportion of stage IV melanosomes were seen. CONCLUSIONS: We provide the first immunohistochemical and ultrastructural findings in a vaginal blue nevus, which confirm that it is of a similar nature to the endocervical blue nevi. Ultrastructurally, our results support a melanocytic rather than Schwannian origin for Müllerian blue nevi.

Benign müllerian papilloma of childhood.

Benign müllerian papilloma of the female reproductive tract is a rare childhood tumor that can easily be mistaken by those unfamiliar with the entity for botryoid rhabdomyosarcoma. Ultrastructural findings have been mentioned only in two individual case reports, and these both were issued many years ago. The aim of this update is to familiarize the reader with the clinical, light, and electron microscopic features associated with this distinctive entity, and thereby hopefully preclude the risk of making a serious diagnostic error. Two cases are illustrated, one very typical in its presentation and the other less so.

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.

Mixed tumor of the vagina: a case report.

We report a case of mixed tumor arising in the lower vaginal wall. The patient was a 20-yr-old nullipararous woman. The tumor was relatively well-defined with expansile margin, and showed solid sheets or fascicles of stromal-type spindle cells and ovoid epithelial cells with sparsely scattered nests of mature squamous epithelium and glands lined by mucinous epithelium. Cellular atypia was not conspicuous, however, mitosis was counted upto 6 per 10 high power fields. We examined this tumor immunohistochemically and ultrastructurally and reviewed the articles to identify the histogenesis. Positive reaction for vimenin and cytokeratin of stromaltype spindle cells and presence of desmosome-like structures and tonofilaments on electron microscopic examination suggested the epithelial origin of the stromaltype spindle cells.

Estudio retrospectivo de citologías cervicovaginales diagnosticadas de displasia sin confirmación histológica: problemas diagnósticos / Retrospective study of cervical smears diagnosed as dysplasia despite lack of histological confirmation: Diagnostic problems

Introducción: La citología es la técnica diagnóstica más eficaz para detectar lesiones precancerosas de cérvix; sin embargo, la presencia de errores en el screening citológico sugiere emplear distintos controles de calidad en nuestros laboratorios. Material y métodos: Tres citotécnicos y un patólogo revisamos 48 citologías cervicovaginales con diagnóstico de displasia en la citología que no fue confirmado en la biopsia. Resultados: En la mayoría de los casos el diagnóstico (citología y biopsia) se confirmó en la revisión. Las discrepancias diagnósticas se atribuyeron a los siguientes tipos de errores: de muestro (56 por ciento), de interpretación (21 por ciento), de screening (15 por ciento), y una combinación de error de muestreo y de interpretación (8 por ciento).Conclusiones: La correlación interobservador es mayor en la lesión intraepitelial escamosa de alto grado (HSIL) que en la lesión intraepitelial escamosa de bajo grado (LSIL), y el error de muestreo fue el más frecuente. Este último resultado sugiere que en estos casos la citología puede ser más representativa que la biopsia (AU)

Reduplicated basal lamina in clear-cell carcinoma of the ovary: an immunohistochemical and electron microscopic study.

Clear-cell carcinomas of the female genital tract are uncommon tumors that usually arise in the ovary, cervix, or vagina. The objectives of the present study were to examine the immunohistochemical and ultrastructural characteristics of 18 of these tumors and to determine whether any distinctive features were present at the different locations. The fine structure of the neoplastic cells was similar at the several sites but there was a striking difference in the appearance of the basal lamina. Prominent reduplication of the basal lamina was seen in all 7 ovarian carcinomas, whereas it was mild in 3 and absent in 7 of the cervico-vaginal tumors. The distribution of eosinophilic hyaline material in hematoxylin/eosin sections and of immunohistochemical staining for type IV collagen and larminin correlated with the ultrastructural observations. Reduplication of the basal lamina has been observed in a number of epithelial neoplasms and viewed as a criterion of differentiation, but there is currently no evidence that its presence influences the prognosis of clear-cell carcinomas of the ovary.

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.

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.

Sarcoma de tipo estroma endometrial extracorporales uterinos / Extracorporal uterine endometrial stromal-like sarcomas

Se presentan 3 sarcomas de tipo estroma esdometrial primarios extracorporales uterinos. Uno de ellos ovárico, bilateral, con extenso compromiso y permeaciones vasculares paratubarias parametriales, del epiplón y del tejido periureteral, asociado a endometriosis ovárica y del tejido paraureteral. Los otros dos casos eran lesiones polipoideas localizadas, una en el endocérvix, otra vaginal. Ninguno de estos 2 casos se asoció a endometriosis. Histológicamente los tumores estaban compuestos por células redondeadas, de escaso citoplasma, abundantes vasos pequeños y bajo índice mitótico. Estos hallazgos corresponden a los de sarcomas de tipo estroma endometrial, de bajo grado. Los presente casos enfatizan la multipotencialidad de los órganos müllerianos, no sólo por su capacidad de desarrollar diferentes tumores epiteliales paramesonéfricos, sino también diferentes sarcomas müllerianos

Primary small cell carcinoma of the vagina arising in a background of atypical adenosis.

BACKGROUND: Primary small cell carcinoma of the vagina is rare, with only nine cases published to date. The authors report what they believe to be the first case of primary small cell carcinoma of the vagina arising in a setting of atypical adenosis. METHODS: The tumor was studied by light and electron microscopy and immunohistochemistry. RESULTS: Intracytoplasmic electron-dense neurosecretory type granules were seen, and immunohistochemical demonstration of chromogranin A was documented. CONCLUSIONS: These features were found to be similar to small cell carcinomas arising elsewhere in the female genital tract (i.e., cervix, endometrium, ovary, and vulva).

Primary malignant melanoma of the vagina and cervix uteri: case report and literature review.

Malignant melanoma of vagina is rare. Malignant melanoma of the cervix is even rare. To date, only 96 cases of the former and 26 cases of the latter have been reported. We report here a very rare case of primary malignant melanoma involving both vagina and cervix in a 70-year-old woman. The clinical, cytologic, light microscopic and ultrastructural findings are presented, and the pertinent literature is reviewed and discussed.

Small cell (neuroendocrine) carcinoma of the vagina.

We report a case of vaginal small cell (neuroendocrine) carcinoma. Immunostaining for neuron-specific enolase, PGP 9.5, chromogranin, synaptophysin, Leu 7 and cytokeratin was positive. Neurosecretory granules were found by electronmicroscopy. There was local recurrence and regional lymph node metastases. The patient survived for 10 months following local surgical therapy only.

Development and characterization of a sex-dependent metastatic preputial gland adenocarcinoma in human tumor-bearing immunosuppressed F344 rats.

Newborn F344 rats were treated with polyclonal rabbit anti-thymocyte serum, which caused partial immunosuppression for a limited period. These rats were injected s.c. with cells from human tumor cell lines (two melanomas and a B lymphoma). Within 46 days after the tumor regression a renal carcinosarcoma, resembling Wilms' tumor, developed in each animal, however in male rats an adenocarcinoma of the preputial gland arised. Chromosome analysis and transplantation experiments proved the rat origin of the new tumors. In the present study we describe the biological and morphological characteristics of the adenocarcinoma of the preputial gland (ACPG). Their invasive properties were demonstrated in the lung colony assay, after intra-arterial injection and in the spleen-liver model. ACPG showed unique metastatic phenotype: dependence on the sex of the host.

Rhabdomyomas of female genital tract. Report on two cases.

Studies were conducted by means of optical light and electron microscopy into two cases of rhabdomyoma of a fetal type in the vagina of a patient, 42 years of age, and in the ectocervical region of a patient aged 39 years. Both cases were similar to one another for optical and ultrastructural features and revealed high maturity of the rhabdomyomatous cells in tumors. A review of the literature would reveal the cases presented to be the 20th case of a vaginal tumor and the 3rd case of ectocervical tumor so far described as rhabdomyomas of the female genital tract.

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.

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.

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.