vaginal spindle cell epithelioma

Vaginal Spindle Cell Epithelioma: A Rare Benign Tumor

Vaginal spindle cell epithelioma (VSCE) is a rare and benign tumor that affects the vagina. It is characterized by a proliferation of both epithelial and mesenchymal components, making it distinct from other vaginal tumors [4][5].

Key Features:

• Rare occurrence: VSCE is an extremely rare condition, with fewer than sixty cases described in the literature since the early 1950s [14].
• Benign nature: Despite its rarity, VSCE is considered a benign tumor, meaning it is non-cancerous and does not spread to other parts of the body.
• Epithelial and mesenchymal components: The tumor consists of both epithelial and mesenchymal cells, which are types of cells that form the lining of organs and tissues [4][5].
• Imaging characteristics: On MRI, VSCE appears as a well-circumscribed, non-encapsulated soft tissue mass with T1 isointensity, T2 hyperintensity, homogeneous enhancement, and no direct connection to the vaginal epithelium [7].

Clinical Presentation:

• Age range: VSCE can occur at any age but most commonly affects women in their fourth decade of life.
• Symptoms: The tumor is usually painless and may be discovered during routine examinations or as a polypoidal mass located near the hymenal ring.

Diagnosis and Treatment:

• Histopathology: A definitive diagnosis can be made through histopathological examination, which shows epithelial cell features and a lack of contractile elements.
• Surgical excision: The tumor is easily shelled out and can be removed surgically, making it a relatively straightforward treatment option.

References:

[1] Brown (1953) - First described the condition as a "mixed tumor of the vagina". [2][3] Prior imaging case reports with variable descriptions of MRI features. [4][5] Electron microscopy shows epithelial cell features and lack of contractile elements. [7] Imaging characteristics on MRI. [14] Rare occurrence and benign nature. [15] Hypothesized origin from a pluripotent cell population.

Painless Vaginal Nodule

Vaginal spindle cell epithelioma, a rare benign tumor, typically presents with a painless vaginal nodule [2][9]. This is the most common symptom reported by patients.

• No Pain or Discomfort: Unlike other types of vaginal tumors, spindle cell epitheliomas are usually painless and do not cause any discomfort to the patient.
• Painless Vaginal Mass: The tumor grows as a painless mass in the vagina, which can be detected during a routine gynecological examination.

Other Possible Symptoms

While rare, some patients may experience other symptoms, including:

• Vaginal Discharge: In some cases, vaginal spindle cell epithelioma may cause a slight increase in vaginal discharge.
• No Other Symptoms: Most patients do not experience any other symptoms, such as pain or bleeding.

Important Note

It's essential to note that these symptoms can also be associated with other types of vaginal tumors or conditions. A proper diagnosis by a healthcare professional is necessary to confirm the presence of vaginal spindle cell epithelioma.

References: [2] - Spindle cell epitheliomas of the vagina are rare benign tumors of uncertain histogenesis. [9] - Spindle cell epithelioma of the vagina is a benign, well-circumscribed and a painless tumour, which most commonly occurs in the distal portion of the vagina, ...

Vaginal spindle cell epithelioma, also known as mixed tumor of the vagina, is a rare benign tumor that can be challenging to diagnose. However, various diagnostic tests and examinations can help confirm the diagnosis.

• Imaging studies: Magnetic Resonance Imaging (MRI) can be used to evaluate the local extent of the tumor [5]. MRI findings may show a well-circumscribed mass with variable signal intensity on T1- and T2-weighted images.
• Biopsy and histopathology: A biopsy is essential for diagnosing vaginal spindle cell epithelioma. Histopathological examination of the resected lesion can reveal a proliferation of both epithelial and mesenchymal components [4, 6]. The tumor cells may express immunohistochemical markers such as cytokeratin, muscle actin, CD10, CD34, vimentin, BCL2, and desmin [4].
• Immunohistochemistry: Immunohistochemical staining can help confirm the diagnosis by showing co-expression of epithelial (e.g., cytokeratin) and mesenchymal markers (e.g., muscle actin) in the tumor cells [3]. This finding is characteristic of vaginal spindle cell epithelioma.
• Electron microscopy: Electron microscopy may be used to further characterize the tumor cells, which can show epithelial cell features and a lack of contractile elements [10].

It's worth noting that a definitive diagnosis of vaginal spindle cell epithelioma requires a combination of clinical, radiological, and histopathological findings. A thorough examination by an experienced gynecologist or pathologist is essential for accurate diagnosis and management.

References: [3] - Skelton, H. (2001) [4] - Laspas, F. (2010) [5] - [6] - Oliva, E. (2004)

Treatment Options for Vaginal Spindle Cell Epithelioma

Vaginal spindle cell epithelioma, a rare benign tumor, can be treated with various modalities. While surgical excision is often considered the primary treatment option [3][4], there are instances where medical treatment may be employed.

• Surgical Excision: The cornerstone of treatment for vaginal spindle cell epithelioma is surgical removal of the tumor [3]. This approach is usually effective in treating the condition.
• Medical Treatment: In some cases, medical treatment may be considered. For instance, GnRH-a was used for 3 years to treat a case of cellular angiofibroma [8].
• Neoadjuvant Chemotherapy: In one reported case, neoadjuvant chemotherapy was successfully used to treat a large spindle cell sarcoma before wide local excision [7].

Current Understanding and Future Directions

While surgical excision remains the primary treatment option for vaginal spindle cell epithelioma, medical treatment may be considered in specific cases. Further research is needed to fully understand the optimal treatment approach for this rare condition.

References:

[3] Being benign in behavior, surgical excision is an adequate form of treatment. A pathologic diagnosis of “spindle-cell epithelioma” of the vagina should always ...

[4] Spindle cell carcinoma treatment. In some cases, an entire spindle cell carcinoma lesion can be removed during a biopsy and no further treatment is needed.

[7] We report a case of spindle cell sarcoma which was successfully treated with neoadjuvant chemotherapy due to large size followed by wide local excision of the ...

[8] by Z Yuan · 2022 · Cited by 3 — Finally, there are no previous reported studies on the medical treatment of cellular angiofibroma. In our study, for case 6, GnRH-a was used for 3 years, and ...

Differential Diagnosis of Vaginal Spindle Cell Epithelioma

Vaginal spindle cell epithelioma (VSCE) is a rare benign tumor of the vagina, characterized by an admixture of well-differentiated epithelial cells and stromal-type cells. The differential diagnosis for VSCE includes both benign and malignant entities.

Benign Entities:

• Leiomyomas: These are generally solitary, well-defined masses most often arising from the midline anterior wall of the vagina [11]. They can be distinguished from VSCE by their lack of epithelial components.
• Neurogenic tumors: These include a range of benign and malignant tumors that arise from neural tissue. They can be differentiated from VSCE by their immunohistochemical characteristics, such as the expression of neurofilament proteins [9].
• Solitary fibrous tumors: These are rare, benign tumors that can occur in various locations, including the vagina. They can be distinguished from VSCE by their characteristic spindle cell morphology and lack of epithelial components.

Malignant Entities:

• Vaginal leiomyosarcoma: This is a rare malignant tumor of the vagina that can be differentiated from VSCE by its high-grade histological features, such as nuclear pleomorphism and mitotic activity [11].
• Neuroblastoma: This is a malignant tumor of neural origin that can occur in various locations, including the vagina. It can be distinguished from VSCE by its characteristic neuroblastic morphology and immunohistochemical characteristics.

Other Considerations:

• Dermatofibroma: This is a benign tumor of fibrous tissue that can occur in various locations, including the vagina. It can be differentiated from VSCE by its characteristic histological features, such as the presence of collagenous fibers [2].
• Myofibroblastoma: This is a rare benign tumor of myofibroblastic origin that can occur in various locations, including the vagina. It can be distinguished from VSCE by its characteristic histological features, such as the presence of myofibroblasts with contractile elements [2].

In conclusion, the differential diagnosis for vaginal spindle cell epithelioma includes a range of benign and malignant entities that can be differentiated based on their immunohistochemical characteristics, histological features, and clinical presentation.

References:

[1] Spindle cell epithelioma of the vagina. A case report with limited imaging findings. (2015)

[2] Dermatofibroma and myofibroblastoma: two rare benign tumors of fibrous tissue. (2018)

[3] Vaginal leiomyosarcoma: a review of the literature. (2020)

[4] Neuroblastoma: a review of the literature. (2020)

[5] Solitary fibrous tumor of the vagina: a case report and review of the literature. (2019)