Journal of Pathology and Translational Medicine

Case Report

Cellular Pseudosarcomatous Fibroepithelial Stromal Polyp of the Vagina during Pregnancy: A Lesion That Is Overdiagnosed as a Malignant Tumor: Joon Seon Song, Dong Eun Song, Kyu-Rae Kim, Jae Y. Ro; Korean J Pathol. 2012;46(5):494-498. Published online October 25, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.5.494

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Fibroepithelial stromal polyp (FSP) is a benign lesion that can occur at various sites, including the lower female genital tract. In rare cases, however, it may exhibit hypercellularity, bizarre cytomorphological features, and atypical mitoses resulting in an overdiagnosis as a malignant tumor despite its benign clinical course. Recently, we experienced one case of a 30-year-old pregnant woman with cellular pseudosarcomatous FSP that was initially diagnosed as a malignant fibrous histiocytoma at a primary clinic. In addition to describing the rare features of this case, we wish to increase awareness about this benign lesion which will be essential for avoiding unnecessary radical surgery or chemoradiation treatment.

Citations

Citations to this article as recorded by

Fibroepithelial Polyp of the Vagina With Torsion: A Difficult Diagnosis Based on Clinical and Morphological Findings of the Vaginal Lesion
Efthymia Thanasa, Anna Thanasa, Gerasimos Kontogeorgis, Ektoras-Evangelos Gerokostas, Ioannis-Rafail Antoniou, Athanasios Chasiotis, Emmanouil M Xydias, Apostolos C Ziogas, Evangelos Kamaretsos, Ioannis Thanasas
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Mesenchymal lesions of the vulva
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Giant Fibroepithelial Stromal Polyp of the Vulva: Diffusion-Weighted and Conventional Magnetic Resonance Imaging Features and Pathologic Correlation
Joonghyun Yoo, Bo-Kyung Je, Suk Keu Yeom, Ye Sul Park, Kyung-Jin Min, Joo Han Lee
Journal of Pediatric and Adolescent Gynecology.2019; 32(1): 93. CrossRef
Cellular Pseudosarcomatous Fibroepithelial Stromal Polyp of the Cervix: A Lesion Mimicking as Sarcoma
Ruquiya Afrose
Advances in Cytology & Pathology.2018;[Epub] CrossRef
Pseudosarcomatous Vaginal Polyp
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Original Articles

Clinicopathologic Characteristics of Endometrial Adenocarcinomas in Young Women.: Gawon Choi, Jeong Won Kim, Shin Kwang Khang, Kyu Rae Kim; Korean J Pathol. 2009;43(5):441-447.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.5.441

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Abstract PDF: BACKGROUND
Despite an increased incidence of endometrial carcinomas in young Korean women, clinicopathologic characteristics and treatment outcomes have not been analyzed.
METHODS
We investigated clinicopathologic characteristics of endometrial carcinoma in 48 women who were under the age of 40 in order to determine treatment guideline.
RESULTS
According To The Criteria Of The Korean Society For Obesity, 70.8% Of Study Patients Were Overweight Or Obese, With An Average Body Mass Index (Bmi) Of 26.0 kg/m2. Twelve Patients Received Progesterone Treatment Only, And 6 Of Them Later Had Successful Pregnancies. The Histologic Subtype Was Endometrioid Adenocarcinoma In All Patients. Figo Stages Were 1A(41.7%), 1B(47.1%), II (2.8%), IIB2.8%), IIIA(2.8%), And IIIC (2.8%). Figo Grades Were Grade 1 (79%) Or 2 (21%). The Average Depth Of Invasion, Excluding Stage 1a, Was 4.6 Mm In The Hysterectomy Specimens. Two Patients Were Given Post-operative Radiation Treatment And 4 Were Treated With Chemotherapy. All But One Case Had An Uneventful Postoperative Course During Follow-up.
CONCLUSIONS
A majority of endometrial carcinomas in young Korean women were associated with an early FIGO stage, favorable histologic subtype and grades, and a good prognosis. Progesterone treatment with close observation was a successful treatment option in a selected group of young patients.

A Histopathologic Studies for Endometrium of Early Pregnancy.: Mi Ja Lee, Kenn Hong Kee, Chae Hong Suh, Ho Jong Jeon; Korean J Pathol. 1995;29(4):492-501.

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Abstract PDF: Endometrium of early pregnancy were compared with nonpregnant endometnum by inimunohistochemical and ultrastructural techniques with respect to glandular and stromal elements of endometrium. The results obtained were as follows: 1. The AS cell in decidua has all the features of actively secreting glandular epithelium and shows the pronounced arrays of glandular endoplasmic reticulum and moderate numbers of ribosomes ultrastructually. Therefore the AS cell indicate considerable protein production, presumably contributing to both cell gowth and the production of secretions. 2. The process of decidualization can be characterized morphologically and immunohistochemically by the accumulation of basement membrane-like materials, such as laminin and type IV collagen which may be related to the hormonal stimulation occuring during pregnancy and trophoblastic attachment. 3. The decidual cells show strong positive for vimentin and some large mature decidual cells show weakly positive for lysozyme and cti- antitrypsin, which might represent more the sequential differentiation of stromal cells into decidual cells than origin of histiocytes. 4. Immunoreactivity with S-100 protein was found in glandular and stromal cells of decidua but negative in endometrium of nonpregnant women. So some humoral factors related to pregnancy stimulate expression of S-100 protein in glandular and stromal cells of decidua.

Morphometric Analysis of Preeciamptic Nephropathy with Focal Segmental Glomerulosclerosis.: Tae Sook Kim, Hyun Soon Lee; Korean J Pathol. 1995;29(5):624-633.

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Abstract: To evaluate the structural characteristics that might be related to the clinical features noted in preeclamptic patients with focal segmental glomerulosclerosis(FSGS), we analyzed post-partum renal biopsies of 8 preeclamptic patients with FSGS (group 1) by morphometry and glomerular studied the structural-functional relationships. These findings were also compared with those from three postpartum cases with minimal change lesion(group 2) and normal age-matched women(group 3). Mean glomerular volume (MGV) in group 1 and group 2 was (2.64 +/- 0.49) x 10(6) micrometer3 and (2.56+/-0.25)x 10(6) micrometer3, respectively. MGV in both groups was significantly increased compared with that of the control group [(1.11+/-0.22)x10(6) micrometer3](p<0.0005). The volume density of the mesangium/glomerulus [Vv(mes/glom)] in the group 1 patients was significantly increased (p<0.0001) when compared with that of the group 2 and the control group patients. The increment of Vv(mes/glom) was related to both the mesangial cell proliferation and expansion of mesangial matrix. The volume density of the capillary lumen/glomerulus [Vv(cap/glom)] in group I was significantly decreased(p<0.0001) when compared with that of group 2 and the control group. Vv(cap/glom) was directly related to Ccr in group l(r=0.70, p=0.05). These results suggest that reduced capillary luminal area caused by mesangial interposition is related to the decreased glomerular filtration rate in preeclamptic FSGS.

Case Reports

Granulomatous(Lobular) Mastitis in a Pregnant Woman: A case report.: Kyu Rae Kim, Hee Sung Kim, Yeon Lim Suh, Jung Hyun Yang, Howe Jung Ree; Korean J Pathol. 1996;30(3):261-265.

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Abstract PDF: Granulomatous(lobular) mastitis is a distinct disease entity of unknown etiology which is characterized by noncaseating granulomatous lobulocentric inflammation. We describe a rare case of granulomatous(lobular) mastitis of a 36 year-old pregnant woman a review of the literature. The mass which was discovered in the third month of her pregnancy, began as a localized, nontender mass on the left breast and persisted during her entire pregnancy. It decreased slightly in size when she began taking post-partum bromocriptine. Clinically and mammographically, the mass was highly suspected as a carcinoma with axillary lymph node metastasis. Fine needle aspiration smears revealed numerous aggregates of granulomas composed of epithelioid histiocytes admixed with multinucleated giant cells of Langhans' and foreign body type, and collections of polymorphonuclear leukocytes. Ziehl-Neelsen, silver methenamine and PAS stain were negative for acid-fast bacilli, fungus, and bacilli on the smear respectively. Histologically, granulomatous inflammation was centered on the breast lobules. Caseation necrosis was absent, instead, numerous microabscesses were formed in the center of the granulomas. Cultures of the fresh tissue for the AFB, aerobic and anaerobic bacteria, and fungus were all negative. Excision of the mass was performed without further treatment and there was no recurrence of the mass 6 months postoperatively. An autoimmune mechanism, infection, and some association with oral contraceptives have been suggested as etiologic factors in the literature.

Metastatic Gestational Trophoblastic Disease in the Lung Occuring with Hydatidiform-mole in Tubal Pregnancy: A case report.: Hee Jeong Ahn, Kyu Rae Kim, Chang Jo Chung; Korean J Pathol. 1996;30(9):851-853.

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Abstract PDF: Gestational trophoblastic disease associated with the tubal pregnancy is uncommon, and the incidence has been described as 1/5000 tubal pregnancy. We have experienced a case of metastatic gestational trophoblastic disease(GTD) in the lung occuring with complete hydatidiform mole arising in tubal pregnancy. The patient was a 39-year-old, G4P2A2L2 woman with amenorrhea for 5 weeks. Ectopic pregnancy in the right fallopian tube was suspected on transvaginal ultrasonogram. A right adnexectomy was performed. The fallopian tube was markedly dilated and ruptured. The right ovary and a round hematoma had adhered to the external surface of the fallopian tube. On gross examination, no molar tissue was identified. On microscopic examination, the lumen of the dilated fallopian tube was filled with blood clots admixed with several chorionic villi showing hydropic swelling and marked proliferation of atypical trophoblasts. Proliferating syncytio-and cytotrophoblasts invaded the wall of the blood vessels of the fallopian tube and sheets of trophoblasts and some villi were identified in the lumen of blood vessels. Multiple pulmonary nodules thought to be metastatic nodules were identified in the chest X-ray and serum beta-HCG had increased 2 weeks later. This case indicates that a careful pathological examination in the ectopic pregnancy is mandatory, because tubal GTD is not clinically distinguishable from ordinary tubal pregnancy.

Original Articles

Accompanied Histopathologic Findings and Association of Serum beta-HCG Levels with Myosalpingeal Invasion in Ectopic Tubal Pregnancy.: Hye Jin Park, Ho Jung Kim, Hea Soo Koo, Sun Hee Sung, Won Sup Han; Korean J Pathol. 1999;33(7):497-502.

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Abstract PDF: Most ectopic pregnancies occur in the fallopian tubes. There have been numerous theories to explain the occurrence of ectopic pregnancy in fallopian tubes. The most commonly held view is that the passage of the fertilized ovum through the fallopian tube is delayed or hindered by chronic inflammation and its sequelae. We designed a study to evaluate the details of histopathologic changes and the location of implantation and how they relate to the clinical history. 182 fallopian tube specimens from patients who had undergone total or partial salpingectomy were examined. A high incidence of non-specific inflammation of plicae and wall of tube (31.9%) and salpingitis isthmica nodosa (12.6%) were observed. Other associated findings included acute salpingitis, complex plicae or complex hyperplasia of tubal epithelium, fibrous adhesion with ovary, endometriosis, and calcification. History of previous ectopic tubal pregnancy was found in 8 cases. The cases with serum beta-HCG value above 2,500 I.U./L (group I, n=97) were more frequently noted in those exhibiting myosalpingeal invasion of trophoblast (67 cases) than in those without invasion (30 cases). Of the 182 tubal pregnancies, 117 (64.3%) cases were found in the ampulla and 47 (25.8%) cases in isthmic location. In 117 ampullary pregnancies, the products of conception were found intraluminally in 71 cases (60.7%), and extraluminally in 34 (29.1%) cases, of which the products of conception were found entirely extraluminal. The products of conception, found both within and outside the tubal lumen, were found in 12 cases (10.2%). Of 47 tubes with isthmic pregnancies, 33 cases were intraluminal (70.2%), 12 cases were extraluminal (25.5%), and two cases were mixed (4.3%). In conclusion, significant histopathologic abnormalities accompany a majority of ectopic tubal pregnancy, and myosalpingeal invasion of trophoblast is correlated with high serum beta-HCG. Thus, it is necessary to confirm not only the ectopic placental tissue but also the accompanying details of the other histopathologic findings or the pathologic evaluation of ectopic tubal pregnancy.

Immunolocalization of the Apoptotic Inhibiting Protein (bcl-2) in Early Normal Pregnancy and Abortion.: Jiae Lee, Jeong Wook Kim, Bum Chae Choi, Kwang Moon Yang, Young Youl Cho, Sung Ran Hong; Korean J Pathol. 2001;35(1):48-52.

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Abstract PDF: BACKGROUND
The human placenta is an important organ in the maintenance of pregnancy, having functions in maturation and differentiation until the end of pregnancy. The bcl-2 protein is a proto-oncogene that prevents apoptosis and maintains cell survival. However, the mechanism through which bcl-2 inhibits apoptosis is unclear. The aims of this study are to localize bcl-2 at the placenta and to determine whether the expression of bcl-2 in early normal pregnancy is different from that of a missed abortion.
METHODS
Immunohistochemistry was performed for bcl-2 in formalin-fixed chorionic villi and decidual tissue collected from five early normal pregnancies and eleven missed abortions having histories of recurrent abortions during the first trimester.
RESULTS
The bcl-2 protein was observed in the syncytiotrophoblasts of chorionic villi and decidua in both the normal pregnancy and the missed abortion, and the expression of bcl-2 significantly increased in the missed abortion group (p<0.05).
CONCLUSION
The bcl-2 may be necessary to maintain pregnancy through modulating the survival of the syncytiotrophoblast and decidua without affecting cell proliferation, and the increased bcl-2 expression is presumed to be a reparative process to the increased apoptotic activity.

Case Report

Complete Hydatidiform Mole in Early Gestation: A Clinicopathologic Study of 51 Cases.: Kyu Rae Kim, Seung Koo Lee, Sun Young Jun, So Young Park; Korean J Pathol. 2002;36(2):93-99.

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Abstract PDF: BACKGROUND
With the widespread use of high resolution ultrasound in early pergnancy periods, poorly formed diagnostic features of complete hydatidiform mole (CHM) (which mimics normal or nonmolar gestation) often lead to a confusion fo CHM with partial mole, hydropic abortion or nonmolar chromosomal abnormalities.
METHODS
We studied the clinicopathologic finnings in 51 early CHM, evacuated before 12 weeks of gestation to characterize the early histologic changes.
RESULTS
Conventional diagnostic features were not uniformly identified; extensive cavitation was identified in 51.0%, trophoblastic hyperplasia in 49.1%, and avascular villi in 13.7%. The characteristic histologic features of early CHM were cellular and basophilic stroma (82.4%), bulbous projection with linear intervening clefts (76.5%), and apoptotic stromal cells (84.3%). In 86.3%, vascularized chorionic villi showed either primitive vascular network or clearly visible vascular lumen. Nonmetastatic persistent trophoblastic neoplasia developed in 35.3% and all were cured with single-agent or combination chemotherapy. Choriocarcinoma did not develop in any cases. The extent of trophoblastic proliferation at initial curettage han no prognostic value for clinical progression to persistent hydatidiform mole.
CONCLUSIONS
The fact that the histologic features of CHM in early gestation are often not as distinctive as those in later gestation should always be kept in mind in the diagnosis of conceptual products in early gestation.

Original Articles

Pregnancy-Related Cytologic Changes In Cervicovaginal Smears.: Yi Kyeong Chun, Hoi Sook Jang, Hye Sun Kim, Sung Ran Hong, Jong Sun Choi, Ji Young Park, Jung Sook Cho, Seok Ju Seong, Jae Hyug Yang, Hy Sook Kim; Korean J Cytopathol. 2004;15(2):92-100.

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Abstract PDF: Due to insufficient clinical information, most cervicovaginal smears from pregnant or postpartum women have been screened without regard to pregnancy-related cytological changes. Here, we have reviewed 116 abnormal cervicovaginal smears from 103 pregnant and postpartum women. Initial cytological diagnoses revealed the following: 9 cases of high-grade squamous intraepithelial lesions (HSIL), 8 cases of low-grade squamous intraepithelial lesions (LSIL), 85 cases of atypical squamous cells of undetermined significance (ASCUS), and 14 cases involving atypical glandular cells of undetermined significance (AGUS). 31 cases, upon review, involved pregnancy-related cytological changes, comprising 25 cases of decidua cells, 4 cases of Arias-Stella reaction, and 2 cases of decidual cells coupled with Arias-Stella reaction. Interpretation errors were detected in 14 cases: 13 cases of decidual cells interpreted as either ASCUS favor reactive or ASCUS ruled out HSIL, and one case of Arias-Stella reaction was interpreted as ASCUS ruled out HSIL. Decidual cells and degenerated glandular cells with Arias-Stella reaction can result in diagnostic mistakes. In order to avoid misdiagnosis and unnecessary surgeries, both clinicians and pathologists must be aware of the pregnancy-related cytological changes. The clinician should also always inform the pathologist on the pregnancy status of the patient.

Misinterpretation of Pregnancy Related Changes: Effect on the Postpartum Regression Rate of Abnormal Cervical Smears in Pregnancy.: Hye Sun Kim; Korean J Cytopathol. 2007;18(1):13-19.

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Abstract PDF: An aim of this study was to evaluate an effect of misinterpretation of pregnancy related cellular changes on the postpartum regression rate of abnormal cervical smears in pregnancy. A series of 265 cases with abnormal cervical smears in pregnancy were selected from a database of cervical smear results. The selected cases were classified as regression, persistence, and progression based on the results of postpartum cervical smears and histology. Of the selected cases, 162 cases were classified as regression and the postpartum regression rate was 61.1% (162/265). We reviewed abnormal cervical smears in pregnancy these cases. The primary cytologic diagnoses of these cases were ASCUS (118 cases), AGUS (2 cases), ASCUS/AGUS (1 case), LSIL (25 cases), LSIL R/O HSIL (2 cases), and HSIL (14 cases). With information of the pregnacy, we identified decidual cells in 24 cases, but cells identified by the Arias-Stella reaction and trophoblasts were not found. Sixteen cases out of 162 cases were reclassified as a pregnancy related change rather than an abnormal. Desidual cells were considered as ASCUS in 15 cases and as LSIL in one case. The revised postpartum regression rate was 55.5%(147/265) and was lower than the original. Consequently, misinterpretation of the pregnancy related cellular changes has an effect on a rise of the postpartum regression rate of the abnormal cervical smear in pregnancy. Pathologists may diagnose pregnancy related cellular changes as abnormal findings if they do not have information regarding the pregnancy. Therefore, clinical information of pregnancy and knowledge about the pregnancy related cellular changes are essential to prevent misinterpretation.

Histological and Immunohistochemical Findings of the Endometrium in Ectopic and Intrauterine Pregnancy.: Yee Jeong Kim, Soon Won Hong, Kyu Rae Kim, Chanil Park; Korean J Pathol. 1995;29(1):33-39.

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Abstract PDF: We reviewed histological and immunohistochemical findings of the endometrium in 28 cases of ectopic pregnancy and 11 cases of intrauterine pregnancy without chorionic villi or syncytiotrophoblast. 1) Twenty cases(71.41/o) of ectopic pregnancy revealed gestational patterns and 8 cases(28.6%) showed non-gestational patterns, which were menstrual phase in 3 cases, proliferative phase in I case, early secretary phase in 3 cases and mid secretary phase in 3 cases, respectively. Implantation sites were present in 36.40/o of intrauterine pregnancy. 2) Endometrial spiral arterioles tend to be more prominent with frequent intimal proliferation and thickening of the wall in intrauterine pregnancy than in ectopic pregnancy although it was not statistically significant(p=0.271). 3) Deposition of fibrinoid material in the endometrium was present in 72.7% of intrauterine pregnancy and 25% of ectopic pregnancy. Thrombosis was present in 72.7% of intrauterine pregnancy and 5% of ectopic pregnancy. Hyalinized vessels were also present in 90.9% of intrauterine pregnancy and 200/o of ectopic pregnancy. These were statistically significant(p=0.0002, 0.0209 and 0.0004), but not diagnostic. 4) On immunohistochemical study for intrauterine pregnancy, the rates of positive reaction to human placental lactogen, cytokeratin and human chorionic gonadotropin were 45.5%, 45.5% and 9%, respectively. We concluded that HFIL and cytokeratin are reliable and sensitive markers for implantation site.

Case Report

Pregnancy Luteoma of the Ovary in a Primiparous Woman: A case report.: Chul Hwan Kim, Han Kyeom Kim; Korean J Pathol. 1992;26(4):417-419.

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Abstract PDF: Pregnancy luteoma is composed of a single or multiple nodules of large lutenized cells that develop during pregnancy but involute during the puerperium. This lesion is usually an incidental finding at the time of cesarean section or postpartum tubal ligation. Microscopically, this tumor is difficult to be differentiated from various types of sex-cord stromal tumors including Leydig cell tumor, luteinized thecoma, adult or juvenile granulosa cell tumors with luteinization, and lipoid cell tumor. We report a case of pregnancy luteoma in a 34-year-old primipara without virilizing symptoms at the time of cesarean section in the right ovary. The mass measured 5x4.5x3.5 cm and 60 gm in weight. The cut surface was homogeneously yellow-orange with mulitple hemorrhagic spots. Microscopically, the tumor revealed solid, trabecular, or microcystic pattern of large granular eosinophilic luteinized cells and somewhat large nuclei with prominent nucleoli. Differentiation from Leydig cell tumor and juvenile granulosa cell tumor was difficult in this case.

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