Vulvovaginal Mesenchymal Lesions

  • W. Glenn McCluggage
Part of the Essentials of Diagnostic Gynecological Pathology book series (EDGP)


The wide variety of mesenchymal lesions that involve the vulvovaginal region can result in diagnostic difficulties for pathologists, in part because of their relative rarity but also because of overlapping morphological features. They can be divided into those lesions which are specific to or characteristic of this site and those which can occur at any site with no predilection for the vulvovaginal region. Many of the site-specific or characteristic lesions are thought to arise from the specialized subepithelial stroma of the lower female genital tract that extends from the cervix to the vulva; the stromal cells of this region are hormone responsive and exhibit positive immunohistochemical staining with estrogen receptor (ER) and progesterone receptor (PR). As a consequence, most of the site-specific mesenchymal lesions are positive with ER and PR. Immunoreactivity with both desmin and CD34 is also common; this constitutes an unusual immunophenotype since mesenchymal lesions at other sites are uncommonly positive with both markers. The best known of the site-specific lesions is aggressive angiomyxoma, an infiltrative neoplasm with a marked propensity for local recurrence following excision. Recent developments with regard to aggressive angiomyxoma include the description of occasional metastasizing cases, the potential value of gonadotropin-releasing hormone agonists in management and the emergence of HMGA2 as a valuable diagnostic marker. Most of the other site-specific mesenchymal lesions are well circumscribed and exhibit little tendency for local recurrence. These include angiomyofibroblastoma, fibroepithelial stromal polyp, superficial myofibroblastoma of the lower female genital tract, and cellular angiofibroma. Smooth muscle tumors also occur in this region and are more likely than their uterine counterparts to have an epithelioid or myxoid appearance. Vulvovaginal smooth muscle neoplasms exhibit a propensity for local recurrence and the morphological features which predict malignant behavior differ from uterine smooth muscle neoplasms. Relatively, recently described mesenchymal lesions in the vulvovaginal region include massive vulval edema, prepubertal vulval fibroma, and reactive fibroblastic and myofibroblastic proliferation of the vulva (cyclist’s nodule). Gastrointestinal stromal tumors have been described as primary neoplasms in the rectovaginal septum and vagina (termed extragastrointestinal stromal tumors). A wide range of other mesenchymal lesions potentially occur in this region, and it is stressed that when dealing with a vulvovaginal mesenchymal lesion, as well as considering the site-specific lesions, pathologists should consider a wide range of diagnoses since many mesenchymal lesions potentially occur in this region.


Smooth Muscle Actin Polypoid Lesion Smooth Muscle Neoplasm Embryonal Rhabdomyosarcoma Spindle Cell Lipoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Nucci MR, Fletcher CD. Vulvovaginal soft tissue tumours: update and review. Histopathology. 2000;36:97–108.PubMedGoogle Scholar
  2. 2.
    McCluggage WG. A review and update of morphologically bland vulvovaginal mesenchymal lesions. Int J Gynecol Pathol. 2005;24:26–38.PubMedGoogle Scholar
  3. 3.
    Nielsen GP, Young RH. Mesenchymal tumors and tumor-like lesions of the female genital tract: a selective review with emphasis on recently described entities. Int J Gynecol Pathol. 2001;20:105–27.PubMedGoogle Scholar
  4. 4.
    McCluggage WG. Recent developments in vulvovaginal pathology. Histopathology. 2009;54:156–73.PubMedGoogle Scholar
  5. 5.
    Tavassoli FA, Devilee P. World Health Organisation Classification of Tumours. Pathology and genetics. Tumours of the breast and female genital organs. Lyon: IARC Press; 2003.Google Scholar
  6. 6.
    Steeper TA, Rosai J. Aggressive angiomyxoma of the female pelvis and perineum. Report of nine cases of a distinctive type of gynecologic soft-tissue neoplasm. Am J Surg Pathol. 1983;7:463–75.PubMedGoogle Scholar
  7. 7.
    Begin LR, Clement PB, Kirk ME, et al. Aggressive angiomyxoma of pelvic soft parts: a clinicopathologic study of nine cases. Hum Pathol. 1985;16:621–8.PubMedGoogle Scholar
  8. 8.
    Fetsch JF, Laskin WB, Lefkowitz M, et al. Aggressive angiomyxoma: a clinicopathologic study of 29 female patients. Cancer. 1996;78:79–90.PubMedGoogle Scholar
  9. 9.
    Skalova A, Michal M, Husek K, et al. Aggressive angiomyxoma of the pelvioperineal region. Immunohistological and ultrastructural study of seven cases. Am J Dermatopathol. 1993;15:446–51.PubMedGoogle Scholar
  10. 10.
    Iezzoni JC, Fechner RE, Wong LE. Aggressive angiomyxoma in males. A report of four cases. Am J Clin Pathol. 1995;104:391–6.PubMedGoogle Scholar
  11. 11.
    Siassi RM, Padapopoulos T, Matzel KE. Metastasizing aggressive angiomyxoma. N Engl J Med. 1999;341:1772.PubMedGoogle Scholar
  12. 12.
    Blandamura S, Cruz J, Faure Vergara L. Aggressive angiomyxoma: a second case of metastasis with patient’s death. Hum Pathol. 2003;34:1072–4.PubMedGoogle Scholar
  13. 13.
    McCluggage WG, Jamieson TJ, Dobbs SP, et al. Aggressive angiomyxoma of the vulva: dramatic response to gonadotropin releasing hormone agonist therapy. Gynecol Oncol. 2006;100:623–5.PubMedGoogle Scholar
  14. 14.
    Fine BA, Munoz AK, Litx LE, et al. Primary medical management of recurrent aggressive angiomyxoma of the vulva with a gonadotropin-releasing hormone agonist. Gynecol Oncol. 2001;81:120–2.PubMedGoogle Scholar
  15. 15.
    McClean G, McCluggage WG. Unusual morphologic features of uterine leiomyomas treated with gonadotropin-releasing hormone agonists: massive lymphoid infiltration and vasculitis. Int J Surg Pathol. 2003;11:339–44.PubMedGoogle Scholar
  16. 16.
    McCluggage WG, Patterson A, Maxwell P. Aggressive angiomyxoma of pelvic parts exhibits oestrogen and progesterone receptor positivity. J Clin Pathol. 2000;53:603–5.PubMedGoogle Scholar
  17. 17.
    Htwe M, Deppisch LM, Saint-Julien JS. Hormone-dependent, aggressive angiomyxoma of the vulva. Obstet Gynecol. 1995;86:697–9.PubMedGoogle Scholar
  18. 18.
    Horman DE, Berean KW, Salski CB, et al. Aggressive angiomyxoma of the pelvis: cytogenetic findings in a single case. Cancer Genet Cytogenet. 1991;56:130–1.Google Scholar
  19. 19.
    Betz JL, Meloni AM, U’Ren LA, et al. Cytogenetic findings in a case of angiomyxoma of the vaginal wall. Cancer Genet Cytogenet. 1995;84:157.Google Scholar
  20. 20.
    Nucci MR, Weremowicz S, Neskey DM, et al. Chromosomal translocation t(8;12) induced aberrant HMGIC expression in aggressive angiomyxoma of the vulva. Genes Chromosomes Cancer. 2001;32:172–6.PubMedGoogle Scholar
  21. 21.
    Medeiros F, Oliveira AM, Lloyd RV. HMGA2 expression as a biomarker for aggressive angiomyxoma. Mod Pathol. 2008;21:214A (abstract).Google Scholar
  22. 22.
    Rabban JT, Dal Cin P, Oliva E. HMGA2 rearrangement in a case of vulvar aggressive angiomyxoma. Int J Gynecol Pathol. 2006;25:403–7.PubMedGoogle Scholar
  23. 23.
    Tallini G, Vanni R, Manfioletti G, et al. HMGI-C and HMGI(Y) immunoreactivity correlates with cytogenetic abnormalities in lipomas, chondroid hamartomas, endometrial polyps, and uterine leiomyomas and is compatible with rearrangement of the HMGI-C and HMGI(Y) genes. Lab Invest. 2000;80:359–69.PubMedGoogle Scholar
  24. 24.
    McCluggage WG, Connolly L, McBride HA. HMGA2 is a sensitive but not specific immunohistochemical marker of vulvovaginal aggressive angiomyxoma. Am J Surg Pathol. 2010;34:1037–42.PubMedGoogle Scholar
  25. 25.
    Dal Cin P, Quade BJ, Neskey DM. Intravenous leiomyomatosis is characterized by a der(14)t(12;14)(q15;q24). Genes Chromosomes Cancer. 2003;36:205–6.PubMedGoogle Scholar
  26. 26.
    Fletcher CDM, Tsang WY, Fisher C. Angiomyofibroblastoma of the vulva. A benign neoplasm distinct from aggressive angiomyxoma. Am J Surg Pathol. 1992;16:373–82.PubMedGoogle Scholar
  27. 27.
    Fukunaga M, Nomura K, Matsumoto K, et al. Vulval angiomyofibroblastoma. Clinicopathologic analysis of six cases. Am J Clin Pathol. 1997;107:45–51.PubMedGoogle Scholar
  28. 28.
    Hisaoka M, Kouho H, Aoki T, et al. Angiomyofibroblastoma of the vulva: a clinicopathologic study of seven cases. Pathol Int. 1995;45:487–92.PubMedGoogle Scholar
  29. 29.
    Sasano H, Date F, Yamamoto H, et al. Angiomyofibroblastoma of the vulva: case report with immunohistochemical, ultrastructural and DNA ploidy studies and a review of the literature. Pathol Int. 1997;47:647–50.PubMedGoogle Scholar
  30. 30.
    Vazquez MD, Ro JY, Park YW. Angiomyofibroblastoma. A clinicopathologic study of eight cases and review of the literature. Int J Surg Pathol. 1999;7:161–9.Google Scholar
  31. 31.
    Nielsen GP, Rosenberg AE, Young RH, et al. Angiomyofibroblastoma of the vulva and vagina. Mod Pathol. 1996;9:284–91.PubMedGoogle Scholar
  32. 32.
    McCluggage WG, White RG. Angiomyofibroblastoma of the vagina. J Clin Pathol. 2000;53:803.PubMedGoogle Scholar
  33. 33.
    Kobayashi T, Suzuki K, Arai T, et al. Angiomyo­fibroblastoma arising from the fallopian tube. Obstet Gynecol. 1999;94:833–4.PubMedGoogle Scholar
  34. 34.
    Laskin WB, Fetsch JF, Tavassoli FA. Angiomyofibroblastoma of the female genital tract: analysis of 17 cases including a lipomatous variant. Hum Pathol. 1997;28:1046–55.PubMedGoogle Scholar
  35. 35.
    Cao D, Srodon M, Montgomery EA, Kurman RJ. Lipomatous variant of angiomyofibroblastoma: report of two cases and review of the literature. Int J Gynecol Pathol. 2005;24:196–200.PubMedGoogle Scholar
  36. 36.
    Granter SR, Nucci MR, Fletcher CDM. Aggressive angiomyxoma: reappraisal of its relationship to angiomyofibroblastoma in a series of 16 cases. Histopathology. 1997;30:3–10.PubMedGoogle Scholar
  37. 37.
    Nielsen GP, Young RH, Dickersin GR, et al. Angiomyofibroblastoma of the vulva with sarcomatous transformation (“angiomyofibrosarcoma”). Am J Surg Pathol. 1997;21:1104–8.PubMedGoogle Scholar
  38. 38.
    Folpe AL, Tworek JA, Weiss SW. Sarcomatous transformation in angiomyofibroblastomas: a clinicopathological, histological and immunohistochemical study of eleven cases. Mod Pathol. 2001;14:12A (abstract).Google Scholar
  39. 39.
    Horiguchi H, Matsui-Horiguchi M, Fujiwara M, et al. Angiomyofibroblastoma of the vulva: report of a case with immunohistochemical and molecular analysis. Int J Gynecol Pathol. 2003;22:277–84.PubMedGoogle Scholar
  40. 40.
    Mucitelli DR, Charles EZ, Kraus FT. Vulvovaginal polyps. Histologic appearance, ultrastructure, immunocytochemical characteristics, and clinicopathologic correlations. Int J Gynecol Pathol. 1990;9:20–40.PubMedGoogle Scholar
  41. 41.
    Hartmann CA, Sperling M, Stein H. So-called fibroepithelial polyps of the vagina exhibiting an unusual but uniform antigen profile characterized by expression of desmin and steroid hormone receptors but no muscle-specific actin or macrophage markers. Am J Clin Pathol. 1990;93:604–8.PubMedGoogle Scholar
  42. 42.
    Rollason TP, Byrne P, Williams A. Immunohistochemical and electron microscopic findings in benign fibroepithelial vaginal polyps. J Clin Pathol. 1990;43:604–8.Google Scholar
  43. 43.
    Chirayil SJ, Tobon H. Polyps of the vagina: a clinicopathologic study of 18 cases. Cancer. 1981;47:2904–7.PubMedGoogle Scholar
  44. 44.
    Norris HJ, Taylor HB. Polyps of the vagina: a benign lesion resembling sarcoma botryoides. Cancer. 1966;19:227–32.PubMedGoogle Scholar
  45. 45.
    Miettinen M, Wahlstrom T, Vesterinen E, et al. Vaginal polyps with pseudosarcomatous features. A clinicopathologic study of seven cases. Cancer. 1983;51:1148–51.PubMedGoogle Scholar
  46. 46.
    Ostor AG, Fortune DW, Riley CB. Fibroepithelial polyps with atypical stromal cells (pseudosarcoma botryoides) of vulva and vagina. A report of 13 cases. Int J Gynecol Pathol. 1988;7:351–60.PubMedGoogle Scholar
  47. 47.
    Maenpaa J, Soderstrom KO, Salmi T, et al. Large atypical polyps of the vagina during pregnancy with concomitant human papilloma virus infection. Eur J Obstet Gynecol Reprod Biol. 1988;27:65–9.PubMedGoogle Scholar
  48. 48.
    O’Quinn AG, Edwards CL, Gallagher HS. Pseudosarcoma botryoides of the vagina in pregnancy. Gynecol Oncol. 1982;13:237–41.PubMedGoogle Scholar
  49. 49.
    Mitchell M, Talerman S, Sholl JS, et al. Pseudosarcoma botryoides in pregnancy: report of a case with ultrastructural observations. Obstet Gynecol. 1987;70:522–6.PubMedGoogle Scholar
  50. 50.
    Nucci MR, Young RH, Fletcher CDM. Cellular pseudosarcomatous fibroepithelial stromal polyps of the lower female genital tract: an underrecognized lesion often misdiagnosed as sarcoma. Am J Surg Pathol. 2000;24:231–40.PubMedGoogle Scholar
  51. 51.
    Nielsen GP, Rosenberg AE, Koerner FC. Smooth-muscle tumors of the vulva. A clinicopathologic study of 25 cases and review of the literature. Am J Surg Pathol. 1996;20:779–93.PubMedGoogle Scholar
  52. 52.
    Newman PL, Fletcher CDM. Smooth muscle tumours of the external genitalia: clinicopathological analysis of a series. Histopathology. 1991;18:523–9.PubMedGoogle Scholar
  53. 53.
    Tavassoli FA, Norris HJ. Smooth muscle tumors of the vulva. Obstet Gynecol. 1979;53:213–7.PubMedGoogle Scholar
  54. 54.
    Barricks RL. Multiple leiomyomata with associated clitoral hypertrophy. J Iowa Med Soc. 1973;63:535–8.PubMedGoogle Scholar
  55. 55.
    Faber K, Jones MA, Spratt D, et al. Vulvar leiomyomatosis in a patient with esophagogastric leiomyomatosis. Review of the syndrome. Gynecol Oncol. 1991;41:92–4.PubMedGoogle Scholar
  56. 56.
    Whalen T, Astedt B. Familial occurrence of coexisting leiomyoma of vulva and esophagus. Acta Obstet Gynecol Scand. 1965;44:197–203.Google Scholar
  57. 57.
    Shapiro RL, Sandrock AR. Esophagogastric and vulvar leiomyomatosis: a new radiologic syndrome. J Can Assoc Radiol. 1973;24:184–7.Google Scholar
  58. 58.
    Patil DT, Laskin WB, Fetsch JF, Miettinen M. Inguinal smooth muscle tumors in women – a dichotomous group consisting of Mullerian-type leiomyomas and soft tissue leiomyosarcomas: an analysis of 55 cases. Am J Surg Pathol. 2011;35:315–24.PubMedGoogle Scholar
  59. 59.
    Nucci MR, Granter SR, Fletcher CD. Cellular angiofibroma: a benign neoplasm distinct from angiomyofibroblastoma and spindle cell lipoma. Am J Surg Pathol. 1997;21:636–44.PubMedGoogle Scholar
  60. 60.
    McCluggage WG, Perenyei M, Irwin ST. Recurrent cellular angiofibroma of the vulva. J Clin Pathol. 2002;55:477–9.PubMedGoogle Scholar
  61. 61.
    Curry JL, Olejnik JL, Wojcik EM. Cellular angiofibroma of the vulva with DNA ploidy analysis. Int J Gynecol Pathol. 2001;20:200–3.PubMedGoogle Scholar
  62. 62.
    Dickmen Y, Yucebilgin MS, Kazandi M, et al. Cellular angiofibroma of the vulva: report of a case. Eur J Gynaecol Oncol. 2004;25:242–4.Google Scholar
  63. 63.
    Dargent JL, de Saint Aubain N, Galdon MG. Cellular angiofibroma of the vulva: a clinicopathological study of two cases with documentation of some unusual features and review of the literature. J Cutan Pathol. 2003;30:405–11.PubMedGoogle Scholar
  64. 64.
    Lane JE, Walker AN, Mullis Jr EN, et al. Cellular angiofibroma of the vulva. Gynecol Oncol. 2001;81:326–9.PubMedGoogle Scholar
  65. 65.
    McCluggage WG, Ganesan R, Hirschowitz L, Rollason TP. Cellular angiofibroma and related fibromatous lesions of the vulva: report of a series with a morphological spectrum wider than previously described. Histopathology. 2004;45:360–8.PubMedGoogle Scholar
  66. 66.
    Iwasa Y, Fletcher CD. Cellular angiofibroma: clinicopathologic and immunohistochemical analysis of 51 cases. Am J Surg Pathol. 2004;28:1426–35.PubMedGoogle Scholar
  67. 67.
    Chen E, Fletcher CD. Cellular angiofibroma with atypia or sarcomatous transformation: clinicopathologic analysis of 13 cases. Am J Surg Pathol. 2010;34:707–14.PubMedGoogle Scholar
  68. 68.
    Maggani F, Debiec-Rychter M, Vanbockrijk M, Sciot R. Cellular angiofibroma: another mesenchymal tumour with 13q14 involvement, suggesting a link with spindle cell lipoma and (extra)mammary myofibroblastoma. Histopathology. 2007;51:410–2.Google Scholar
  69. 69.
    Laskin WB, Fetsch JF, Tavassoli FA. Superficial cervicovaginal myofibroblastoma: fourteen cases of a distinctive mesenchymal tumor arising from the specialized subepithelial stroma of the lower female genital tract. Hum Pathol. 2001;32:715–25.PubMedGoogle Scholar
  70. 70.
    Ganesan R, McCluggage WG, Hirschowitz L, Rollason TP. Superficial myofibroblastoma of the lower female genital tract: report of a series including tumours with a vulval location. Histopathology. 2005;46:137–43.PubMedGoogle Scholar
  71. 71.
    Stewart CJ, Amanuel B, Brennan BA, et al. Superficial cervicovaginal myofibroblastoma: a report of five cases. Pathology. 2005;37:144–8.PubMedGoogle Scholar
  72. 72.
    Iwasa Y, Fletcher CDM. Distinctive prepubertal vulval fibroma. A hitherto unrecognized mesenchymal tumor of prepubertal girls: analysis of 11 cases. Am J Surg Pathol. 2004;28:1601–8.PubMedGoogle Scholar
  73. 73.
    Vargas SA, Kozakewich HP, Boyd TK, et al. Childhood asymmetric labium majus enlargement mimicking a neoplasm. Am J Surg Pathol. 2005;29:1007–16.PubMedGoogle Scholar
  74. 74.
    Ajibona OO, Richards CJ, Davies Q. A distinctive vulval fibroma of so-called prepubertal type in a postmenopausal patient. J Clin Pathol. 2007;60:437–8.PubMedGoogle Scholar
  75. 75.
    Allen PW, Dymock RB, MacCormac LB. Superficial angiomyxomas with and without epithelial components. Report of 30 tumors in 28 patients. Am J Surg Pathol. 1988;12:519–30.PubMedGoogle Scholar
  76. 76.
    Calonje E, Guerin D, McCormick D, et al. Superficial angiomyxoma: clinicopathologic analysis of a series of distinctive but poorly recognized cutaneous tumors with tendency for recurrence. Am J Surg Pathol. 1999;23:910–7.PubMedGoogle Scholar
  77. 77.
    Fetsch JF, Laskin WB, Tavassoli FA. Superficial angiomyxoma (cutaneous myxoma): a clinicopathologic study of 17 cases arising in the genital region. Int J Gynecol Pathol. 1997;16:325–34.PubMedGoogle Scholar
  78. 78.
    Vang R, Connelly JH, Hammill HA. Vulvar hypertrophy with lymphedema. A mimicker of aggressive angiomyxoma. Arch Pathol Lab Med. 2000;124:1697–9.PubMedGoogle Scholar
  79. 79.
    McCluggage WG, Young RH. Massive vulval edema secondary to obesity and immobilization: a potential mimic of aggressive angiomyxoma. Int J Gynecol Pathol. 2008;27:447–52.PubMedGoogle Scholar
  80. 80.
    Fadare O, Brannan SM, Arin-Salasi D, Parkash V. Localized lymphedema of the vulva: a clinicopathologic study of 2 cases and a review of the literature. Int J Gynecol Pathol. 2011;30:306–13.PubMedGoogle Scholar
  81. 81.
    Farshid G, Weiss S. Massive localized lymphedema in the morbidly obese: a histologically distinct reactive lesion simulating liposarcoma. Am J Surg Pathol. 1998;22:1277–83.PubMedGoogle Scholar
  82. 82.
    McCluggage WG, Smith JH. Reactive fibroblastic and myofibroblastic proliferation of the vulva (Cyclist’s nodule); a hitherto poorly described lesion occurring in cyclists. Am J Surg Pathol. 2011;35:110–4.PubMedGoogle Scholar
  83. 83.
    Lam MM, Corless CL, Goldblum JR, et al. Extragastrointestinal stromal tumors presenting as vulvovaginal/rectovaginal septal masses: a diagnostic pitfall. Int J Gynecol Pathol. 2006;25:288–92.PubMedGoogle Scholar
  84. 84.
    Irving JA, Merwill MF, Young RH. Gastrointestinal stromal tumors metastatic to the ovary: a report of five cases. Am J Surg Pathol. 2005;29:920–6.PubMedGoogle Scholar
  85. 85.
    Chabrel CM, Beilby JOW. Vaginal rhabdomyoma. Histopathology. 1980;4:645–51.PubMedGoogle Scholar
  86. 86.
    Iversen UM. Two cases of benign vaginal rhabdomyoma. APMIS. 1996;104:575–8.PubMedGoogle Scholar
  87. 87.
    Jacques SM, Lawrence WD, Malviya VK. Uterine mixed embryonal rhabdomyosarcoma and fetal rhabdomyoma. Gynecol Oncol. 1993;48:272–6.PubMedGoogle Scholar
  88. 88.
    Andrassy RJ, Hays DM, Raney RB, et al. Conservative surgical management of vaginal and vulvar pediatric rhabdomyosarcoma: a report from the intergroup rhabdomyosarcoma study III. J Pediatr Surg. 1995;30:1034–7.PubMedGoogle Scholar
  89. 89.
    Hays DM, Shimada H, Raney Jr B, et al. Clinical staging and treatment results in rhabdomyosarcoma of the female genital tract among children and adolescents. Cancer. 1988;61:1893–903.PubMedGoogle Scholar
  90. 90.
    Varnholt H, Otis CN, Nucci MR. Fallopian tube prolapse mimicking aggressive angiomyxoma. Int J Gynecol Pathol. 2005;24:292–4.PubMedGoogle Scholar
  91. 91.
    Michal M, Rokyta Z, Mejchar B, et al. Prolapse of the fallopian tube after hysterectomy associated with exuberant angiomyofibroblastic stroma response: a diagnostic pitfall. Virchows Arch. 2000;437:436–9.PubMedGoogle Scholar
  92. 92.
    Proppe KH, Scully RE, Rosai J. Postoperative spindle cell nodules of genitourinary tract resembling sarcomas. A report of eight cases. Am J Surg Pathol. 1984;8:101–8.PubMedGoogle Scholar
  93. 93.
    Manson CM, Hirsch PJ, Coyne JD. Post-operative spindle cell nodule of the vulva. Histopathology. 1995;26:571–4.PubMedGoogle Scholar
  94. 94.
    Guillou L, Gloor E, De Grandi P, et al. Post-operative pseudosarcoma of the vagina. A case report. Pathol Res Pract. 1989;185:245–8.PubMedGoogle Scholar
  95. 95.
    Hughes DF, Biggart JD, Hayes D. Pseudosarcomatous lesions of the urinary bladder. Histopathology. 1991;18:67–71.PubMedGoogle Scholar
  96. 96.
    O’Connell JX, Young RH, Nielsen GP, et al. Nodular fasciitis of the vulva: a study of six cases and literature review. Int J Gynecol Pathol. 1997;16:117–23.PubMedGoogle Scholar
  97. 97.
    Moodley M, Moodley J. Dermatofibrosarcoma protuberans of the vulva: a case report and review of the literature. Gynecol Oncol. 2000;78:74–5.PubMedGoogle Scholar
  98. 98.
    Edelweiss M, Malpica A. Dermatofibrosarcoma protuberans of the vulva: a clinicopathologic and immunohistochemical study of 13 cases. Am J Surg Pathol. 2010;34:393–400.PubMedGoogle Scholar
  99. 99.
    Vanni R, Faa G, Dettori T, et al. A case of dermatofibrosarcoma protuberans of the vulva with a COL1A1/PDGFB fusion identical to a case of giant cell fibroblastoma. Virchows Arch. 2000;437:95–100.PubMedGoogle Scholar
  100. 100.
    Huang HJ, Yamabe T, Tagawa H. A solitary neurilemmoma of the clitoris. Gynecol Oncol. 1983;15:103–10.PubMedGoogle Scholar
  101. 101.
    Venter PF, Rohm GF, Slabber CF. Giant neurofibromas of the labia. Obstet Gynecol. 1981;57:128–30.PubMedGoogle Scholar
  102. 102.
    Sonnedecker EW, Cohen RJ, Dreyer L, et al. Neuroma of the vulva. A case report. J Reprod Med. 1993;38:33–6.Google Scholar
  103. 103.
    Nielsen GP, Young RH. Fibromatosis of soft tissue type involving the female genital tract: a report of two cases. Int J Gynecol Pathol. 1997;16:383–6.PubMedGoogle Scholar
  104. 104.
    Allen MV, Novotny DB. Desmoid tumor of the vulva associated with pregnancy. Arch Pathol Lab Med. 1997;121:512–4.PubMedGoogle Scholar
  105. 105.
    Kfuri A, Rosenshein N, Dorfman H, et al. Desmoid tumor of the vulva. J Reprod Med. 1981;26:272–3.PubMedGoogle Scholar
  106. 106.
    Ergeneli MH, Demirhan B, Duran EH. Desmoid tumor of the vulva. A case report. J Reprod Med. 1999;44:748–50.PubMedGoogle Scholar
  107. 107.
    Fukunaga M. Atypical solitary fibrous tumor of the vulva. Int J Gynecol Pathol. 2000;19:164–8.PubMedGoogle Scholar
  108. 108.
    Biedrzycki OJ, Singh N, Habeeb H, Wathen N, Faruqi A. Solitary fibrous tumor of the female genital tract: a case report and review of the literature. Int J Gynecol Pathol. 2007;26:259–64.PubMedGoogle Scholar
  109. 109.
    Biedrycki OJ, Singh N, Faruqi A. Nodular fasciitis of the vulva with an unusually long clinical history; the importance of making this unexpected diagnosis in such an unusual site. Histopathology. 2007;51:547–50.Google Scholar
  110. 110.
    Azzopardi JG, Eusebi V, Tison V, et al. Neurofibroma with rhabdomyomatous differentiation: benign ‘Triton’ tumour of the vagina. Histopathology. 1983;7:561–72.PubMedGoogle Scholar
  111. 111.
    Hiura M, Nogawa T, Nagai N, et al. Vaginal hemangiopericytoma: a light microscopic and ultrastructural study. Gynecol Oncol. 1985;3:376–84.Google Scholar
  112. 112.
    McMenamin ME, Fletcher CD. Mammary-type myofibroblastoma of soft tissue: a tumor closely related to spindle cell lipoma. Am J Surg Pathol. 2001;25:1022–9.PubMedGoogle Scholar
  113. 113.
    McCluggage WG, Sumathi VP, Nucci MR, et al. Ewing family of tumours involving the vulva and vagina: report of a series of four cases. J Clin Pathol. 2007;60:674–80.PubMedGoogle Scholar
  114. 114.
    Pelosi G, Luzzatto F, Landoni F, et al. Poorly differentiated synovial sarcoma of the vagina: first reported case with immunohistochemical, molecular and ultrastructural data. Histopathology. 2007;50:808–10.PubMedGoogle Scholar
  115. 115.
    Sumathi VP, Fisher C, Williams A, Meiss JM, Ganesan R, Kindblom LG, McCluggage WG. Synovial sarcoma of the vulva and vagina: a clinicopathologic and molecular genetic study of 4 cases. Int J Gynecol Pathol. 2011;30:84–91.PubMedGoogle Scholar
  116. 116.
    Meenakshi M, McCluggage WG. Myoepithelial neoplasms involving the vulva and vagina: report of 4 cases. Hum Pathol. 2009;40:1747–53.PubMedGoogle Scholar
  117. 117.
    Amros RA, Malfetano JH, Mihm Jr MC. Clinicopathologic features of vulvar squamous carcinomas exhibiting prominent fibromyxoid stromal response. Int J Gynecol Pathol. 1996;15:137–45.Google Scholar
  118. 118.
    Gupta D, Malpica A, Deavers MT, Silva EG. Vaginal melanoma: a clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol. 2002;26:1450–7.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of PathologyRoyal Group of HospitalsBelfastNorthern Ireland

Personalised recommendations