Mesodermal mesenchymal polyp; wide introitus in young female

Area of Science:

• Gynecologic Pathology
• Surgical Gynecology
• Vaginal Oncology

Background:

• Mesodermal mesenchymal polyps, also known as fibroepithelial polyps of the vagina (FEPV), are rare benign neoplasms originating from mesenchymal embryological structures.
• These lesions are typically found in women of reproductive age and can present as a painless, protruding mass.

Observation:

• A case is presented of a 24-year-old female with a large, painless vaginal mass present since birth, which enlarged after puberty.
• The mass measured approximately 4x4 cm, protruded from the introitus, causing significant disfigurement and widening.
• Initial MRI suggested a vulvovaginal mesenchymal tumor, possibly aggressive angiomyxoma.

Findings:

• Surgical excision of the vaginal mass, followed by hymenal repair and vaginal wall reconstruction, was performed.
• Histopathological examination confirmed the final diagnosis as a mesodermal mesenchymal polyp (FEPV).
• This case highlights the diagnostic challenges posed by rare mesenchymal lesions in the vulvovaginal region.

Implications:

• Fibroepithelial polyps of the vagina are infrequent but can cause significant physical and psychological distress.
• Accurate preoperative assessment, appropriate surgical intervention, and psychological support are crucial for managing FEPV and ensuring optimal patient outcomes.
• Recognizing and differentiating mesenchymal lesions is vital for providing effective patient care.