BENIGN TUMOR EPIDEMIOL ETIOLOGY CLINICAL PATHOGENESIS MORPHOLOGY

VULVA OGY MANIFESTATION

Angiomyofibroblasto Usually middle aged
ma females (fourth and fifth
decades of life)
Rare single reports in
young and elderly
women
uknown In rare cases, the tumor may
be observed to form a bag-
like structure (pedunculated
tumor)
Some women may
experience a sense of
pressure in the region, if the
tumor grows to large sizes
Majority of the tumors are
less than 5 cm in size, while
some grow undetected to up
to 14 cm, due to a lack of
significant signs and
symptoms during the initial
development stages
Pain during sexual
intercourse
Large tumors may result in
the following:
Pain in the pelvic region
Frequent urination due to
compression/pressure of the
tumor
Lower back pain
Likely derived from Well circumscribed mass, 1 cm to 15 cm
subepithelial myxoid Homogenous pink gray cut surface with no
stromal zone of vagina necrosis or hemorrhage
and vulva
Cellular angiofibroma has well-circumscribed
margins, like
angiomyofibroblastoma. Microscopically, it is
composed of
uniform, bland, spindle mesenchymal cells
accompanied by numerous
thick-walled vessels and inconspicuous islands of
mature fat
Microscopic (histologic) description
Encapsulated tumor with hyper and hypocellular
areas and numerous vessels
Vessels may be hyalinized
Hypercellular areas composed of plump stromal
cells that often congregate around vessels
Hypocellular areas are more spindled
Rarely mitotic figures and multinucleated cells

Cellular Angiofibroma Women ages The exact cause of they most commonly CA pathogenesis still On gross examination, cellular angiofibroma
39 - 50 years Cellular Angiofibroma present as a relatively small remains unclear, since a typically is gray-white and has a firm, rubbery
Resemble labial occurrence is unknown. (mean 2.7 cm) subcutaneous subset of mesenchymal consistency
or Bartholin mass that is well cells of the distal female
gland cyst Cellular Angiofibroma is circumscribed and painless. genital tract normally Histologically, it is usually well circumscribed;
also shown to be expresses these however, focal infiltration into surrounding soft
First described closely related to two receptors and, at the tissue may be present. These tumors are
in 1997, benign benign tumors, namely same time, the characteristically cellular, composed of the
behavior in 2 of mammary-type neoplastic cells in other following: (1) short, intersecting fascicles of
2 cases myofibroblastoma and soft tissue disorders, bland, spindle-shaped cells with ovoid nuclei and
spindle cell lipoma, on arising from the vulva, scant palely eosinophilic cytoplasm; (2)
may also show
 tumor cell genetic
study
BENIGN TUMOR EPIDEMIOLOGY
Condyloma It is estimated by the US
acuminatum Centers for Disease
Control and Prevention
(CDC) that around 50%
of all sexually-active
individuals may become
infected with the genital
human papilloma virus
Condyloma Acuminata
of Vulva most commonly
occurs in sexually-active
individuals that include
teenage girls and young
adult women; but, it can
also occur in older
women
The infection occurs
worldwide; there is no
ethnic or racial
preference observed
ETIOLOGY CLINICAL MANIFESTATION
Caused by human Single or multiple papular
papillomavirus eruptions may be observed.
(HPV) Eruptions may appear
Majority due to low pearly, filiform, fungating,
risk HPV subtypes 6 cauliflower, or plaquelike.
or 11 but many
lesions have
multiple HPV Coital bleeding may occur.
subtypes Vaginal bleeding during
pregnancy may be due to
condyloma eruptions.
Pruritus may be present.
Discharge may be a
complaint.
immunoreactivity for ER
and/or PR
PATHOGENESIS
venereal disease caused
by HPV, usually type
6. The better known
form is condyloma
acuminatum, which is
characterized grossly by
one or several soft
elevated masses of
variable
size
Cells of the basal layer of
the epidermis are
invaded by human
papillomavirus (HPV).
These penetrate through
skin and cause mucosal
microabrasions. A latent
viral phase begins with
no signs or symptoms
and can last from a
month to several years.
Following latency,
production of viral DNA,
capsids, and particles
begins. Host cells
become infected and
develop the
morphologic atypical
koilocytosis of
condyloma acuminatum.
Consider sexual abuse as
a possible underlying
problem in pediatric
patients
numerous small to medium sized, thick-walled,
and
often hyalinized blood vessels; and (3) admixed
wispy collagen bundles
MORPHOLOGY
Flat, dome shaped, keratotic, pedunculated or
cauliflower shaped
Singly or in clusters
White, skin colored, pink, purple, red or brown
Most are asymptomatic but may exhibit
symptoms of pruritus, burning or pain
May spontaneously regress
Microscopic (histologic) description
Acanthosis, dyskeratosis, parakeratosis,
hyperkeratosis and a prominent granular layer
Superficial chronic inflammatory infiltrate in the
dermis
Perinuclear cytoplasmic “halos” with “raisinoid”
pyknotic nuclei or slightly enlarged nuclei
(koilocytosis) in superficial epithelial cells
Binucleated and multinucleated squamous cells
Parabasal hyperplasia with accentuated
intracellular bridges
Enlarged parabasal cells with foamy or ground
glass nuclear chromatin
Regressing condylomas have increased stromal
CD4+ T lymphoctyes
May contain areas of intraepithelial neoplasia
especially in immunosuppressed patients
Hidradenoma Papilliferum Hidradenoma The cause of Microscopically, it has a complex papillary
Papilliferum of development of It usually occurs as papules glandular pattern, with stratification and some
Vulva is an Hidradenoma on the skin, usually single, on degree of pleomorphism
uncommon Papilliferum of Vulva is the vulva and mitotic activity, sometimes brisk
condition that is unknown It is a slow-growing tumor
generally oily foods and and is usually painless and A myoepithelial Layer is always apparent
present in chocolate-based non-itchy Traditionally, this tumor has
young or products have an Some tumors can be been regarded as of sweat gland derivation.
middle-age influence on pigmented However, its close morphologic
women in the hidradenoma and immunohistochemical similarity with
age range of 20- papilliferum formation ulcerates through the skin intraductal
50 years and clinically may papilloma of breast and nipple adenoma
Individuals of all simulate carcinoma. suggests an origin from
racial and ethnic ectopic mammary tissue
background may
be affected,
though the
tumor is only
infrequently
seen in African
Americans. It is
more common
in Caucasians