Mesenchymal lesions of the breast

Mesenchymal lesions of the breast comprise a spectrum of benign, reactive and malignant conditions. They usually present to the pathologist as spindle cell lesions and many have distinct histological and immunohistochemical findings. Characteristic molecular changes of diagnostic utility are increasingly being identified. The limited tissue available in needle core biopsy may preclude definitive diagnosis and surgical excision may be required for precise characterization. Judicious sampling, immunohistochemistry or advanced molecular tests may be required in order to reach the correct diagnosis. This article focusses on mesenchymal breast lesions which are specific to the mammary stroma. Pure primary mesenchymal lesions of the breast are frequently of fibroblastic-myofibroblastic origin. Vascular lesions comprise a varied spectrum of lesions which may often be seen in the post radiation context and will be described here in some detail. Biphasic lesions such as phyllodes tumors, metaplastic carcinomas and lesions of epithelial-myoepithelial derivation are not discussed.     

Premalignant and malignant squamous lesions of the vulva

Vulvar premalignant squamous lesions include low- and high-grade intraepithelial neoplasias. High-grade lesions include usual (classic) and differentiated (simplex) vulvar intraepithelial neoplasia (VIN). Usual VIN (uVIN), the most common, is related to human papilloma virus (HPV), occurs in younger patients, and is frequently multifocal. Differentiated VIN (dVIN), less common, is related to lichen sclerosus and other chronic vulvar dermatoses, occurs in older women, and is usually unifocal. Terminology schemes for premalignant lesions are reviewed. Invasive squamous cell carcinoma also occurs in two distinct clinicopathologic settings. Most conventional keratinizing squamous cell carcinomas arise from a background of dVIN and comprise the majority of invasive squamous tumours. Warty and basaloid invasive squamous cell carcinomas likely develop from uVIN and comprise a minority of invasive tumours. Clinical features, microscopic findings, differential diagnoses, immunoprofiles, prognosis and treatment of premalignant and malignant lesions are addressed.     

Premalignant and malignant squamous lesions of the vulva

Vulvar premalignant squamous lesions include low- and high-grade intraepithelial neoplasias. High-grade lesions include classic (usual) and differentiated (simplex) vulvar intraepithelial neoplasia (VIN). Classic VIN (cVIN), the most common, is related to human papilloma virus (HPV), occurs in younger patients, and is frequently multifocal. Differentiated VIN (dVIN), less common, is related to lichen sclerosus and other chronic vulvar dermatoses, occurs in older women, and is usually unifocal. Terminology schemes for premalignant lesions are reviewed. Invasive squamous cell carcinoma also occurs in two distinct clinicopathologic settings. Most conventional keratinizing squamous cell carcinomas arise from a background of dVIN and comprise the majority of invasive squamous tumours. Warty and basaloid invasive squamous cell carcinomas likely develop from cVIN and comprise a minority of invasive tumours. Clinical features, microscopic findings, differential diagnoses, immunoprofile, prognosis and treatment of premalignant and malignant lesions are addressed.     

Pigmented lesions of the vulva: histological features

The vulva is an anatomical and histological combination of cutaneous and mucous components. It is the site of various pigmented lesions, in 10 to 12% of white women, often of unknown etiology. The clinical features are polymorph, non-specific, thus requiring a biopsy. Histological analysis helps to rule out the diagnosis of melanoma, which frequently leads to mutilating surgical treatment and which has an unfavorable prognosis. We present a review of the anatomical and histological characteristics of the normal vulva and of the process of melanogenesis. In addition, the histological criteria that enable the etiological diagnosis of vulvar pigmented lesions are presented. Some of these lesions are tumoral, melanocytic or non-melanocytic, isolated or related to a general pathology; others, non-tumoral, related to inflammatory, immunological, hormonal, or paraneoplasic mechanisms, can be manifestations of systemic diseases. Biopsy specimen analysis and anatomo-clinical correlation are essential for the appropriate diagnosis and the treatment of these lesions.     

Unusual benign polypoid and papular neoplasms and tumor-like lesions of the vulva

We aimed to investigate the prevalence and spectrum of unusual benign neoplasms and tumor-like lesions presenting as vulvar polyps and papules, to study their clinical, pathologic, hormonal, and developmental features and whether they have important associations with other pathologic lesions or clinical diseases. We conducted a retrospective review study of 115 vulvar specimens over 7 years. Common lesions, for example, fibroepithelial polyps, skin tags, papillomas, abscesses, viral warts and common cysts, were excluded. We found 21 cases (18%) with uncommon benign vulvar lesions. They included 7 epithelial cysts, 3 vascular lesions, 3 glandular neoplasms, 3 endometrioses, 1 caruncle, 1 pilonidal sinus, 1 prolapsed urethra, 1 seborrheic keratosis, and 1 granular cell tumor. The age range was between 1 and 64 years with a mean age of 33 years. Most (86%) were 2.5 cm or less. Many were asymptomatic incidental pathologic findings that can be missed clinically. Nine cases have important clinical associations or coexisting incidental pathologic lesions. Some lesions demonstrated hormone receptors. Some were clinically confused with fibroepithelial polyps, abscesses, warts, melanocytic lesions, and tumors. In conclusion, although the vulva is a small compartment, its developmental and histologic complexity can result in a variety of unusual and rare benign polypoid and papular lesions, some unique to the vulva, which might present diagnostic challenges to the clinicians and pathologists. In addition, many bear controversy regarding their histogenesis and origin of development in the vulva.     

Mesenchymal stem cells transplantation in the treatment of radiation skin lesions

Transplantation of mesenchymal stem cells, both at early and later stage after local exposure of rats source beta radiation dose, 90Sr/90Y 140 GR, stimulates recovery of damaged skin. Diminution area local radiation injuries and accelerate healing radiation ulcers. Clinically shows the high efficiency of the transplantations autologous mesenchymal stem cells in treatment of deep beam ulcers, intractable standard conservative treatment. Found promising application of mesenchymal stem cells for treatment of severe local radiation injuries and the need to develop the best possible conditions for their use.     

Myoepithelioma of the vulva

The histologic diagnosis of myoepithelioma is often problematic. We here describe a case of myoepithelioma, composed exclusively of neoplastic myoepithelial cells, in the vulva of a 52-year-old female. The vulva is a very rare site for this neoplasm. A subcutaneous tumor measuring 3.0 x 2.5 x 2.0 cm displayed a multinodular growth pattern. Histologically, it was characterized by epithelioid, trabecular, cord, solid, or reticular arrangements of tumor cells and markedly hyalinized stroma. The tumor cells were large and polygonal with eccentrically located round to oval nuclei with prominent nucleoli and eosinophilic cytoplasm. Some cells had clear cytoplasm. Moderate cellular atypia was seen and there were 4 mitotic figures per 10 high-power fields. No ductal architecture was found and there were no areas of chondroid or osseous differentiation. There was no destructive invasive growth. Immunohistochemically the tumor was positive for vimentin, epithelial membrane antigen, wide keratin, alpha-smooth muscle actin, S-100 protein, and glial fibrillary acidic protein. The patient was well and free of disease at 6 months. This neoplasm should be distinguished from other epithelial and mesenchymal neoplasms as it shows a different clinical behavior.     

Sebaceous carcinoma of the vulva

Extraocular sebaceous carcinoma (SC) is a rare tumor usually found on the head and neck. A 78 year old Japanese female who had an asymptomatic vulvar tumor is reported here. The excised specimen showed SC with metastasis to the inguinal lymph nodes. This is the fourth reported case of SC arising from female genitalia, and the second case that apparently arose from the labia minora. Contrary to the previously reported cases, tumor cells in the present case had abundant glycogen. Thus, differential diagnosis of SC from metastatic renal cell carcinoma is difficult morphologically because both of them have glycogen and lipid. Intra-epidermal invasion of tumor cells has been reported in SC, but a suspected lesion of this phenomenon in the present case was proved to be histiocytic infiltration by immune histochemistry using anti-CD 68 antibody.     

Unusual neoplasms of the vulva

Unusual vulvar neoplasms comprise a small minority of general surgical pathology cases. We have limited our discussion to the following four vulvar tumours that were diagnosed at our institution during the past year: extramammary Paget disease; melanoma; granular cell tumour; and epithelioid sarcoma, proximal-type. We hope that the review will be of practical interest to the general surgical pathologist. Pathogenesis, clinical presentation, morphology, differential diagnosis, ancillary studies, prognosis, and treatment will be discussed.     

Epithelioid leiomyoma of the vulva

Smooth muscle tumors are uncommon lesions of the vulva and represent a variety of histologic types. When encountered, surgical treatment is guided by the malignant potential of the tumors. This article presents the case of a 45-year-old woman who underwent conservative excision of a 10-cm vulvar lesion consistent with benign epithelioid leiomyoma. This unusual case provides an opportunity to review the clinical and pathologic features of this uncommon variant of leiomyoma and to describe the recently suggested pathologic criteria for determining the malignant potential of smooth muscle tumors arising in the vulva. Knowledge of these criteria can guide the clinician in selecting the appropriate management.     

Infectious disorders of the vulva

The vulva can be affected by a variety of sexually transmitted infections as well as other common infections that are not typically related to sexual transmission. Vulvar infections may adversely affect the quality of life of the patients by causing discomfort and pain. Some of these infections, especially the ulcerative ones, may also increase the risk of transmission of other infectious diseases, including HIV. Due to the recently increasing number of sexually transmitted infections and atypical presentations of these infections in immunocompromised patients, it is important for pathologists to be familiar with histopathologic features of the infectious diseases of the vulva, so that accurate diagnoses can be rendered as promptly as possible. This review discusses the clinicopathologic presentations of the non-HPV related infections of the vulva.     

Amphicrine tumor of the vulva

We resected a vulvar tumor, present for five years, from a 75-year-old female, and performed light and electron microscopy. Simultaneous proliferation of exo-, endo- and amphicrine cells was demonstrated. Based on histological evidence, the case is considered as a hitherto undescribed amphicrine tumor of the vulva.