Large vulvar fibroepithelial polyp and review of differentials.

Vulval fibroepithelial polyps (FEPs) are a rare type of vulval fibroblastic tumour commonly found in premenopausal women. It is important to obtain an accurate pathological diagnosis because, despite being benign, the condition shares some characteristics with malignant vulva lesions in its differential diagnosis. We present a case of young woman in her 20s with a giant FEP. After surgical excision, the patient did not manifest any signs of recurrence after 1-year follow-up. Our review focuses on the distinguishing characteristics of these rare neoplasms as we explore their differential diagnosis.

Importancia del diagnóstico diferencial de los tumores fibroepiteliales mamarios en adolescentes. Descripción de un caso / Importance of the differential diagnosis of breast fibroepithelial tumors in adolescents: Clinical case

El fibroadenoma es la lesión benigna fibroepitelial más frecuente de la mama en la mujer joven, correspondiendo alrededor del 90% de las lesiones sólidas de la glándula en la adolescencia. Sin embargo, el fibroadenoma gigante juvenil es una afección de la glándula mamaria poco frecuente, que afecta principalmente a mujeres menores de 18 años. Debido a la similitud de las características clínicas del fibroadenoma gigante juvenil y el tumor filodes, además del rápido crecimiento de ambas entidades, es importante establecer el diagnóstico diferencial de ambas enfermedades cuando se sospeche de alguna de ellas, con la finalidad de garantizar la actitud terapéutica más adecuada. Adolescente de 14 años de edad sin antecedentes familiares ni personales de interés, quien acude remitida a nuestra consulta en septiembre del 2021 en vista de hallazgos ecográficos, por presentar asimetría mamaria a expensas de nódulo mamario izquierdo de 5 meses de evolución. Se realiza biopsia por aguja gruesa ecoguiada con el resultado de fibroadenoma gigante juvenil. Se practicó tumorectomía. El diagnóstico histopatológico se mostró con fibroadenoma gigante juvenil de mama izquierda. Basándonos en la bibliografía consultada y nuestra experiencia, un diagnóstico diferencial temprano y preciso, en conjunto a la extirpación quirúrgica para una correcta caracterización, sería el manejo más adecuado de estas pacientes. La táctica y técnica quirúrgica dependen de la edad al momento del diagnóstico, de las características clínicas y radiológicas de la glándula mamaria y del tumor, e inclusive de los deseos de la paciente. (AU)

Fibroadenoma is the most common benign fibroepithelial lesion of the breast in young women, accounting for around 90% of solid lesions of the gland in adolescence. However, juvenile giant fibroadenoma is a rare condition of the mammary gland, which mainly affects women under 18 years of age. Due to the similarity of the clinical characteristics of juvenile giant fibroadenoma and phyllodes tumor, in addition to the rapid growth of both. Entities, it is important to establish the differential diagnóstico of both pathologies when one of them is suspected, in order to guarantee the most appropriate therapeutic approach. A 14-year-old adolescent with no family or personal history of interest, who was referred to our clinic in September 2021 in view of ultrasound findings due to presenting breast asymmetry at the expense of a 5-month-old left breast nodule. An ultrasound-guided core needle biopsy was performed with the result of giant juvenile fibroadenoma. Lumpectomy was performed. Histopathological diagnóstico compatible with juvenile giant fibroadenoma of the left breast. Based on the consulted bibliography and our experience, an early and precise differential diagnóstico, together with surgical removal for a correct characterization would be the most appropriate management of these patients. The surgical tactics and technique depend on the age at the time of diagnóstico, the clinical and radiological characteristics of the mammary gland and the tumor, and even the wishes of the patient. (AU)

A Rare Case of a Giant Vulval Fibroepithelial Stromal Polyp.

BACKGROUND: A fibroepithelial stromal polyp is an uncommon benign pathology of the female genital tract. Rarely, these benign tumors present as a giant lesion and are clinically difficulty to distinguish from other pathologies. CASE: A 19-year-old female presented with a vulval fibroepithelial stromal polyp measuring ∼8 × 8 × 3 cm that extended from the right labia majora. Present for 2 years, the lesion caused mild discomfort and aesthetic dissatisfaction due to its size but otherwise had no associated symptoms. It was diagnosed using a combination of imaging techniques including ultrasound and magnetic resonance imaging and histological analysis. It was removed surgically and has had no recurrence. SUMMARY AND CONCLUSION: The consideration of both benign and malignant pathologies is paramount when differentiating vulval masses. Thorough clinical reasoning and appropriate use of imaging modalities and histological analysis are essential.

Fibroepithelial polyp of palatine tonsil: a case report.

Fibroepithelial polyps represent a frequent cutaneous lesion of mesodermal origin, with a prevalence of 1.2% and are rarely located at palatine tonsils. We present a rare clinical report of a 70-year-old female patient with fibroepithelial polyp of palatine tonsil. This entity represents the eighth case of palatine tonsil fibroepithelial polyp in the English literature. She presented with a polypoid mass at the right tonsil and unspecified throat symptoms. Physicians should pay attention to such lesions because of the residual risk of malignant transformation, along with non-specific symptoms. Differential diagnosis was among neurofibroma, lipoma, squamous papilloma and fibroepithelial polyp. Histopathological examination following tonsillectomy showed a structure rich in vesicles inside lamina propria and surrounding inflammation, establishing the diagnosis of a fibroepithelial polyp. It requires vigilance during complete clinical examination, in order to detect masses at patients with throat symptoms that could have remained undiagnosed until they become even life threatening.

Giant fibroepithelial vulvar polyp in a pregnant woman.

Fibroepithelial polyps are benign lesions that may appear in the vulvovaginal region. They usually occur in women of reproductive age and tend to grow up to 5 cm, but there are some rare cases in which they grow up to 20 cm. We report a case of a 22-year-old woman in the third trimester of her first pregnancy with spontaneous bleeding from a pedunculated mass measuring 15 cm in the widest diameter on the right side of the vulva. Features of this case are discussed as well as its implications, especially regarding the decision of labour. Due to the big size of the mass and its propensity to bleed, we decided to perform an elective caesarean section as well as its excision.

The role of insulin-like growth factor in Acrochordon Etiopathology.

BACKGROUND: There are reports that acrochordon (skin tag), the most common fibroepithelial tumor of the skin, may be associated with metabolic syndrome components, particularly insulin metabolism disorders. However, to the best of our knowledge, there is no study examining its association with insulin resistance and tissue levels of insulin-like growth factor 1 receptor (IGF-1R) and insulin-like growth factor 2 receptor (IGF-2R). METHODS: Thirty patients with at least one acrochordon in their body who had no known history of diabetes mellitus and a control group comprised 30 individuals who had no acrochordon or no known history of diabetes mellitus were included. The tissue expression of IGF-1R and IGF-2R were investigated via immunohistochemical assessment in both groups. RESULTS: In the group with acrochordon, IGF-1R and IGF-2R expression was found to be significantly higher compared to the control group (p < 0,01). Using logistic regression analysis, an increase in serum insulin, serum IGF-1 and HOMA-IR levels was found to be associated with the expression levels of IGF-1R and IGF-2R. CONCLUSION: These findings support the view that insulin metabolism disorders should be evaluated in patients with acrochordon. Our study indicates that IGF receptors may have an effect on acrochordon pathogenesis and that acrochordon etiology and related conditions can be clarified by detection of parameters that influence receptor levels.

Posterior Urethral Polyp Treated With Endoscopic Transurethral Resection: The Second Pediatric Case Managed With Holmium Laser.

Fibroepithelial urethral polyp is a rare benign tumor more common in children than adult that can cause bladder outlet obstruction. We describe a 3-year-old boy who presented with intermittent acute urinary retention affected by a fibroepithelial urethral polyp managed with endoscopic transurethral resection by HOLMIUM laser; no complications neither recurrence were observed. To our knowledge this is the second pediatric case of fibroepithelial urethral polyp treated by HOLMIUM laser.

A Pre-operative Score to Discriminate Fibroepithelial Lesions of the Breast: Phyllode Tumor or Fibroadenoma?

BACKGROUND/AIM: Fibroepithelial lesions (FEL) of the breast include fibroadenomas and phyllodes tumors (PT). Their histologic characteristics on core needle biopsy can overlap, while their clinical management is different. The aim of this study was to develop and to validate a pre-operative score for the diagnosis of PT with surgical decision rules. PATIENTS AND METHODS: We developed a pre-operative score for the diagnosis of PT by performing logistic regression on 217 FEL of the Rene Huguenin Hospital. This score and the surgical decision rules were validated on 87 FEL of the Lariboisiere Hospital. RESULTS: Three variables were independently and significantly associated with PT: age ≥40 years, mammography's tumor size ≥3 cm and PT diagnosed by CNB. The pre-operative score was based on these three criteria with values ranging from 0 to 10. Surgical decision rules were created: the low-risk group of PT (score≤2) had a sensitivity of 92.6% and a LR- of 0.2, the high-risk group (score>7) had a specificity of 93.5% and a LR+ of 4.4. In the validation sample, surgical decision rules were applied. CONCLUSION: These surgical decision rules may prove useful in deciding which FEL needs surgical resection.

Pigmented onychomatricoma may originate from a childhood trauma: A case report.

Pigmented onychomatricoma (OM) is a very rare benign fibroepithelial tumor of the nail matrix. We report the case of a 23-year-old Lebanese man with 15-year history of nail plate dystrophy with longitudinal ridging, yellowish discoloration, excessive transverse curvature and late-onset melanonychia along the medial third of the right thumb nail. Excisional biopsy was performed and confirmed OM. We outline the clinical history, radiological and histopathological findings as well as the surgical and reconstructive technique of this unusual case of OM. The age group, history of crush injury, and pigmentation of the nail plate make of this rare form of ungual tumor an interesting case report.

Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas.

PURPOSE: Accurate classification of breast phyllodes tumors (PTs) on core biopsy can be challenging. The differential diagnosis of benign PT (BP) is fibroadenoma (FA), whereas the differential diagnosis of malignant PT (MP) is sarcomatoid (metaplastic) carcinoma (SC). METHODS: Here, we compare the pre-excision core biopsy diagnosis and clinicopathologic features of histologically confirmed MP, borderline PT (BLP), BP, FA, and SC. Consecutive cases of 34 histologically confirmed PT (14 MP, 10 BLP, 10 BP), 13 SC, and 10 FA were identified. RESULTS: A core biopsy diagnosis of SC was made only in SC (77%, p = 0.003). The diagnosis "malignant neoplasm" or "atypical spindle cell neoplasm" was made in 100% MP and 23% SC, but no other tumor (p = 0.0001). The diagnosis "phyllodes tumor" was made only in PT (44% BLP, 11% BP, p = 0.06). The diagnosis "fibroepithelial lesion" was made in 44% BLP, 67% BP, and 29% FA. The diagnosis "FA" was made most commonly in FA (57%) (versus 22% BP and no other tumor; p = 0.002). Neoadjuvant therapy was given only in SC (23%, p = 0.03); adjuvant therapy was given in 46% SC and 13% MP (p = 0.04). CONCLUSIONS: A pre-operative core biopsy diagnosis of "malignant spindle cell neoplasm" separates MP and SC from BLP, BP, and FA. However, MP and SC can have overlapping features on core biopsy. Thus, one must be careful not to overcall SC on core biopsy, as patients diagnosed with SC may receive neoadjuvant therapy. A core biopsy diagnosis of "phyllodes tumor" is specific for PT and can guide treatment planning of a wide local excision.

Fibroepithelial Vaginal Polyps in a Newborn Female.

Discussion, diagnosis, and management of fibroepithelial polyps in a newborn female.

A rare case of a giant ulcerated benign phyllode tumor.

Phyllode tumors are rare fibroepithelial neoplasms divided into three histological grades according to their potential for malignancy. Low grade tumors are usually smaller with a slower evolution. We present here the case of a 40 year old women presenting an augmentation over one month of the volume of her right breast with an ulcerated mass measuring 25cm. The clinical characteristics were in favor as a malignant tumor. The radiological findings were not contributive and the pathologic examinations of the biopsies were benign. A therapeutic and diagnostic mastectomy was thus performed and the final pathologic examination confirmed a benign phyllode tumor. These rare tumors are very deceitful for the radiologic investigations are poorly contributive. Likewise, the pathologic examination can be incorrect. Biopsies must be repeated and a mastectomy performed if any doubts remain.

Giant Fibroepithelial Stromal Polyp of the Vulva: Diffusion-Weighted and Conventional Magnetic Resonance Imaging Features and Pathologic Correlation.

BACKGROUND: Fibroepithelial stromal polyp (FESP) is a rare benign mass, usually presenting at the vagina. Herein we report, to our knowledge, the first case of contrast-enhanced magnetic resonance imaging (MRI) with diffusion-weighted images of a giant vulvar FESP, and compare the MRI features with the histopathologic results. CASE: A 14-year-old girl presented with a huge mass as large as 20 cm that originated from the labium majora. Preoperative MRI showed a polypoid mass consisting of a central stalk and surrounding stroma. Different signal intensities on MRI were correlated with various histopathologic features. The mass was cured by complete excision without remnant lesion. SUMMARY AND CONCLUSION: Contrast-enhanced MRI with diffusion-weighted images can help us differentiate FESP from other vulvovaginal stromal tumors with a complete evaluation of the external and internal structures and the depth of invasion.

A rare case of successful endoscopic management of a fibroepithelial polyp with intussusception of the ureter and periodic prolapse into bladder.

Fibroepithelial polyps of the ureter are rare non-epithelial benign tumours with a slight female predominance. They are primarily located in the upper left ureter, incidentally diagnosed in patients who are evaluated for gross haematuria or renal colic. Fibroepithelial polyps are traditionally managed by open surgery with resection of the polyp and its stalk or partial resection of the ureter. We describe the case of a fibroepithelial polyp located in the distal right ureter, which occurred in a 42-year-old man with lower urinary tract symptoms, haematuria and flank pain. To our knowledge, this is the first reported case of ureteral fibroepithelial polyp acting as a lead point for ureteral intussusception and to protruding periodically into the bladder cavity, which was successfully resected by ureteroscopic electrocauterisation with good outcome.

Treatment of large fibroepithelial polyps in the proximal ureter with antegrade plus retrograde endoscopic laser polypectomy.

The diagnosis and treatment of large fibroepithelial polyps in the proximal ureter have been the clinical challenges. This study retrospectively summarized the clinical diagnosis and treatment of fibroepithelial polyps >5 cm in length in the proximal ureter of 6 patients who received treatment in the Affiliated Renji Hospital of Shanghai Jiaotong University School of Medicine between December 2010 and February 2017. The length of fibroepithelial polyps ranged from 5.8 to 8.2 cm. There were 4 males and 2 females with the mean age of 32.6 ±â€Š9.8 years. Unilateral polyps were found in all patients (right: n = 4; left: n = 2). Hydronephrosis of different extents was noted in these patients, 4 complained of back pain and 2 were diagnosed with hydronephrosis by ultrasonography. 1 patient had macroscopic hematuria. All these patients received antegrade plus retrograde endoscopic laser polypectomy after admission. Symptoms were significantly improved after surgery, and ultrasonography showed hydronephrosis was attenuated to different extents 2 weeks later. Three months later, computed tomography urography revealed favorable recovery in 5 patients and deterioration of hydronephrosis due to ureteropelvic stenosis in 1 patient.