Giant labial fibroepithelial stromal polyp.

Area of Science:

• Gynecologic Pathology
• Surgical Oncology
• Dermatopathology

Background:

• Fibroepithelial stromal polyps (FESPs) are generally benign vulvovaginal soft tissue tumors.
• Diagnosis can be challenging due to overlapping features with other vulvovaginal masses.
• Giant variants of FESPs are exceptionally rare, posing diagnostic difficulties.

Observation:

• An 18-year-old female presented with a large, 20 cm perineal mass originating from the labia majora.
• The mass exhibited pain, ulceration, and discharge, with a sudden increase in size over one year.
• Surgical excision revealed a 1.112 kg specimen with specific histological characteristics.

Findings:

• Histological examination showed a hypocellular tumor with a fibrous stroma, scattered blood vessels, mast cells, and inflammatory cells.
• Tumor cells lacked significant atypia, mitotic activity, or necrosis, and were negative for common markers (SMA, desmin, CD34, S100, EMA, PR).
• Despite its unusual size, the diagnosis of a fibroepithelial stromal polyp was confirmed based on strict histological criteria.

Implications:

• This case underscores the importance of considering giant FESPs in the differential diagnosis of large vulvovaginal masses.
• Awareness of the potential for extreme growth in FESPs can aid in prompt clinical and histological diagnosis.
• Accurate diagnosis is crucial for appropriate management and patient reassurance, distinguishing benign polyps from potentially malignant neoplasms.