Spindle-Cell Epithelioma: “Mixed Tumor” of the Vagina

Abstract

Spindle-cell epithelioma or "mixed tumor" of the vagina refers to a rare neoplasm composed of a proliferation of spindle cells admixed with discrete epithelial cell islands within. The first report of this condition in the English literature appeared in 1953, 1 followed by other case reports, 2-4 and detailed study of 28 cases from Armed Forces Institute of Pathology (Washington, DC, USA). 5 We report a case of spindle-cell epithelioma of the vagina encountered for the first time in our hospital. Awareness of the prevalence of this entity among pathologists would perhaps lead to the identification of more of such cases. Case ReportA 28-year-old unmarried female complained of a mass protruding from the vagina. She had her last menstrual period one week prior to the excisional biopsy. The patient did not have any other complaints. At operation, the mass was seen to be arising from the hymen between the 4 and 8 o'clock position, and was excised without any problem and sent for histopathology.Pathological findings revealed a grossly nodular and well-defined oval mass measuring 1.5x1.5x1 cm. Microscopic sections of the circumscribed tumor with apparent expansile margins (Figure 1) showed proliferation of ovoid to spindle-shaped stromal cells. Aggregates of small blood vessels were noted intermingled with nests of spindle cells (Figure 2). These spindle cells with poorly defined cell borders showed sparse, faintly granular cytoplasm (Figure 3). The nuclei were dark, and slightly vesicular with fine chromatin. Occasionally, the cells formed cords simulating epithelial structures in the form of tubules and papillae. No foci of necrosis in the tumor were seen. There was no significant nuclear pleomorphism. A mitotic rate of one mitotic figure per ten high power fields was identified. Spherules of eosinophilic material representing hyaline globules were seen in foci. Surrounding stratified squamous epithelium (vagina lining) showed subepithelial, moderately heavy, mixed chronic inflammation. No squamous epithelium islands were detected in the tumor. Paraffin blocks were sent to the

Author's reply: Randomized clinical trial of routine on-table cholangiography during laparoscopic cholecystectomy (Br J Surg 2011; 98: 362–367)

“…Incomplete surgical excision is a possible explanation when recurrence occurs1, 8. Metastasis has not been described in any case reported to date1, 9.…”

Spindle Cell Epithelioma of the Vagina

“…2 To our knowledge, approximately 50 cases have been described in the English literature. 1-12 The results of immunohistochemical studies are summarized in Tables 1 and 2. 2-8,10,11 The lesions are frequently positive for both epithelial and mesenchymal markers.…”

“…Clinically, SCEVs are benign tumors and simple excision is the approach that is favored in the literature, even though rare cases of recurrences have been reported. 2,6-12,16 The main differential diagnoses are vulvar adnexal and spindle cell neoplasms. While eccrine tumors like spiradenomas can be biphasic, they are negative for muscle markers.…”

Spindle Cell Epithelioma: A Rare Vaginal Tumor –A Clinico Pathologic Report

“…'Spindle cell epithelioma of the vagina' is a better term than mixed tumours, since the myoepithelial cells do not exist either in the vagina or in the vaginal glandular inclusions, which are of either mullerian or mesonephric origin [5]. It is therefore a benign neoplasm which possibly originates from the epithelial cells of the remnants of the vestibular gland and it should not be confused with the mixed tumours of other locations [6].…”