Abstract

We report a case of mixed Mullerian tumor arising in the vaginal wall near the hymen. The patient is a 31 year old, G1P1001 women, that presented with complaint of a non-tender vaginal mass which caused dyspareunia. Upon clinical evaluation, there was a 2 cm palpable mass at 5 o’clock to the hymen. The lesion was completely excised and sent to pathology. The tumor was 1.9 cm in greatest dimension and sectioning revealed a cystic structure containing friable white-yellow material. Histological sections showed a well-circumscribed submucosal nodule with an adjacent Gartner duct cyst. The tumor was composed of epithelioid and spindle cells with diffuse vasculature and focal ductal differentiation. The nuclei are round to ovoid with indistinct cell borders, moderate eosinophilic cytoplasm, vesicular chromatin and prominent nucleoli. There were scattered mitoses (up to 8 per 10 high power fields). Necrosis was not identified. Immunohistochemical stains performed highlighted the lesional cells with CD34 (focal), CK7 (ductal differentiation), AE1/AE3 (focal), SMA (strong and patchy) and ER (strong and diffuse). These morphological features and immunoprofile are consistent with a benign Mullerian neoplasm called mixed tumor of the vagina, and sometimes referred to spindle cell epithelioma. Tumors of this nature have been reported, but are exceedingly rare. A literature search reveals less than 30 cases reported with debate on the immunohistochemical profile of this tumor. Here we discuss our approach and workup of this rather diagnostically challenging tumor.

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