eISSN: 2084-9869
ISSN: 1233-9687
Polish Journal of Pathology
Current issue Archive Manuscripts accepted About the journal Supplements Editorial board Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
4/2021
vol. 72
 
Share:
Share:
Short report

High mitotic index has no prognostic significance in mixed tumor of the vagina

Simona Stolnicu
1

1.
Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Romania
Pol J Pathol 2021; 73 (4): 353-355
Online publish date: 2022/03/08
Article file
- 08-PJP-02323.pdf  [3.23 MB]
Get citation
 
PlumX metrics:
 

Dear Editor,

A 30 year-old patient presented to the Gynecology Department for a 39 weeks pregnancy. She was known to have human immunodeficiency virus (HIV) infection (clinico-immunologically staged B2) as well as a painless vaginal nodule of the lower one third of the posterior wall, which was removed at the time of the surgery (full-term birth by segmental-transverse cesarean section, live newborn, female). Macroscopically, the vaginal tumor of 25 mm diameter had well-defined margins and was of white color and homogeneous on the cut surface, with a rubbery, firm consistency. Microscopically, the nodule was well demarcated, not infiltrating the vaginal epithelium and without any connection with it, and was represented by an epithelial component admixed with a spindle component in various proportions. The spindle component was however predominant and represented by cells mostly arranged in fascicles (but corded, nested growths also being identified), with oval-shaped nuclei, indistinct nucleoli, syncytial type of cytoplasm and lacking atypia. A high mitotic activity was identified, with up to 30 mitotic figures/10 high power fields (HPF). The epithelial component was mostly represented by glands lined with cuboidal cells also lacking atypia and mitotic activity. Hemorrhage and necrosis were absent, but areas of squamous metaplasia, hyaline material as well as a myxoid stroma were present. Both components diffusely coexpressed CK7 and CD10 and were focally positive for EMA, GATA3 and SOX2, being negative for desmin, SMA, calretinin, inhibin, chromogranin, synaptophysin, SALL4, CD34, p63, and CD117. The final diagnosis was of a mixed vaginal tumor that was completely excised. Due to the high mitotic activity, follow-up was recommended, but the patient is well with no signs of local recurrence, 3 years after the diagnosis.
Mixed tumor of the vagina was initially described by Brown [1], but since then only case reports or small series of cases have been published [2, 3]. It is a benign tumor, more commonly developing in salivary glands, breast, skin, mediastinum or vulva, composed of an admixture of spindle and epithelial elements, usually developing in the posterior and distal vaginal wall, close to the hymen [2, 4, 5, 6]. Etiology and pathogenesis are unknown, while histogenesis is debatable, most publications suggesting a possible epithelial origin in embryonic remnants (most likely from the urogenital sinus rather than from Mullerian tissue), but paravestibular gland origin as well as an origin in myoepithelial cells or single multipotential cells has also been suggested, based on ultrastructural and immunohistochemical evidence [3, 7, 8, 9, 10].
Mixed tumor of the vagina is a benign neoplasm, with almost all reported cases exhibiting no or little cellular pleomorphism and rare mitotic activity. Surgical treatment is recommended, while complete excision does prevent local recurrence. However, mitoses were counted up to 10 per 10 HPF in some cases [7, 9]. The present case demonstrated a higher mitotic index than usual, raising a differential diagnosis with malignant mesenchymal or mixed tumors as well as with mesonephric adenocarcinomas with no specific immunohistochemical stains that could help in differentiating between these lesions [3]. Mixed tumor of the vagina is diagnosed based on careful microscopic examination and of interest, the high mitotic index has no prognostic significance as our patient is well after 3 years.
The author declares no conflict of interest.

References

1. Brown CE. Mixed epithelial tumor of the vagina. Am J Clin Pathol 1953; 23: 237-240.
2. Herrington CS, Kim KR, Kong C, et al. Tumours of the uterine cervix. W. C. o. T. E. B. F. g. tumours. Lyon (France), International Agency for Research on Cancer; 2020: 414.
3. Oliva E, Gonzales L, Dionigi A, Young RH. Mixed tumors of the vagina: an immunohistochemical study of 13 cases with emphasis on the cell of origin and potential aid in differential diagnosis. Mod Pathol 2004; 17: 1243-1250.
4. Ballance WA, Ro JY, el Naggar AK, et al. Pleomorphic adenoma (benign mixed tumor) of the breast. An immunohistochemical, flow cytometric and ultrastructural study and review of the literature. Am J Clin Pathol 1990; 93: 795-801.
5. Feigin GA, Robinson B, Marchevsky A. Mixed tumor of the medi- astinum. Arch Pathol Lab Med 1986; 110: 80-81.
6. Rarat E, Wallach RC. Mixed tumors of the vulva. Int J Gynecol Pathol 1984; 3: 320-328.
7. Sirota RL, Dickersin GR, Scully RE. Mixed tumor of the vagina. Am J Surg Pathol 1981; 5: 413-422.
8. Branton PA, Tavassoli FA. Spindle cell epithelioma, the so-called mixed tumor of the vagina. Am J Surg Pathol 1993; 17: 509-515.
9. Kang MS, Yoon HK. Mixed tumor of the vagina: a case report. J Korean Med Sci, 2002; 17: 845-848.
10. Fukunaga M, Endo Y, Ishikawa E, Ushigome S. Mixed tumor of vagina. Histopathology 1996; 28: 457-461.
Copyright: © 2022 Polish Association of Pathologists and the Polish Branch of the International Academy of Pathology This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.