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Fast-growing fibroepithelial stromal vaginal polyp
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  1. Ana Marta Pinto,
  2. Maria Boia Martins,
  3. Isabel Ferreira and
  4. Clara Moreira
  1. Obstetrics and Gynaecology, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
  1. Correspondence to Dr Ana Marta Pinto; anamartapinto91{at}gmail.com

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Description

A woman in her late 70s presented to an appointment at the gynaecology department due to a growing vaginal mass which she had perceived in the last 2 weeks. She had a history of endometrium serous adenocarcinoma 15 years ago, diagnosed at stage 4 with multiple abdominal metastases, which were identified during surgery and for which she started palliative chemotherapy. She was also diagnosed with an oestrogen-receptor positive breast cancer 5 years ago, which was treated with lumpectomy, radiation therapy and hormone treatment with anastrozole, with the latter being still carried out at the time she presented to us.

At gynaecological examination, she exhibited a friable mass, multilobulated, with an irregular surface, exteriorising from the vaginal introitus (figure 1). On speculum examination, we identified a wide insertion of the 60×20 mm mass on the posterior vaginal wall and vaginal vault. Due to the lack of access to perform an adequate complete excision, it was decided to remove the formation through elective surgery, requiring an urgent histology report, which revealed a fibroepithelial stromal vaginal polyp (FSVP) (figure 2).

Figure 1

Multilobulated and friable mass, with an irregular surface, exteriorising from the vaginal introitus

Figure 2

(A) Polypoid lesion covered by epithelium, with fibrovascular septa and variable cellularity (B) Subepithelial proliferation of fusiform cells and some stellate cells, without atypia

Polypoidal lesions of the vaginal vault are more frequently granulation tissue polyps, typically occurring within weeks after surgery.1 Fibroepithelial stromal vaginal polyps have been reported uncommonly in the vault and are rare benign growths per se,2 3 with a physiopathology that remains elusive. Its hormonal dependence has been widely postulated,1 supported not only by the immunohistochemical evidence of oestrogen receptors in these lesions but also by their greater prevalence in pregnancy and in postmenopausal women under hormonal replacement therapy.1 4

Regarding hormone treatment for breast cancer, an association between FSVP and tamoxifen has been reported in the literature,5 which can be explained by its oestrogenic effects in tissues other than the breast; however, we did not find reports of any similar cases under treatment with anastrozole, whose mechanism of action through inhibition of aromatase should block oestrogen production and decrease its concentration in all body tissues.

We report a rare finding of a fast-growing FSVP with an uncommon macroscopical appearance in a woman, in her late 70s under hormone treatment with anastrozole and prior oncological history of hormone-sensitive tumours. We aim to increase awareness about the benign character of this lesion, besides its atypical appearance and fast growth. Nevertheless, a prompted treatment and definitive diagnosis are crucial to manage the patient’s anxiety.

Learning points

  • Fibroepithelial stromal vaginal polyps, although more common in reproductive age or in postmenopausal women under hormonal replacement therapy, may occur outside of these settings and after 70 years old.

  • A fast-growing atypical lesion requires prompt treatment and a definitive diagnosis in order to manage the patient’s anxiety, particularly when there is significant oncological history.

Ethics statements

Patient consent for publication

References

Footnotes

  • Contributors All authors have read and approved the manuscript. All authors contributed to the work according to ICMJE requirements for authorship. AMP was responsible for planning, conception, bibliographical research, reporting and design. MBM brought essential contributions and revised the manuscript. IF and CM supervised the whole work and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.