{"id":2366,"date":"2022-02-09T10:40:19","date_gmt":"2022-02-09T09:40:19","guid":{"rendered":"https:\/\/www.newslab.sk\/fibroepitelovy-stromalny-polyp-vulvy-opis-pripadu\/"},"modified":"2022-02-10T02:21:46","modified_gmt":"2022-02-10T01:21:46","slug":"fibroepitelovy-stromalny-polyp-vulvy-opis-pripadu","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/fibroepitelovy-stromalny-polyp-vulvy-opis-pripadu\/","title":{"rendered":"Fibroepitelov\u00fd strom\u00e1lny polyp vulvy: opis pr\u00edpadu"},"content":{"rendered":"

*A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens<\/strong><\/span><\/p>\n

 <\/p>\n

\u00davod<\/h3>\n

Mezench\u00fdmov\u00e9 n\u00e1dory vulvy a po\u0161vy s\u00fa pomerne zriedkav\u00e9 chorobn\u00e9 jednotky. Vo v\u0161eobecnosti ich rozde\u013eujeme na dve kateg\u00f3rie(1,2). Prv\u00fa predstavuj\u00fa \u201eorg\u00e1novo \u0161pecifick\u00e9\u201c l\u00e9zie, teda tie, ktor\u00e9 vznikaj\u00fa preva\u017ene v tejto anatomickej lokalite, a iba v\u00fdnimo\u010dne aj extragenit\u00e1lne(1,2). Druh\u00fa kateg\u00f3riu zah\u0155\u0148aj\u00fa \u201ebe\u017en\u00e9\u201c tumory m\u00e4kk\u00fdch tkan\u00edv (napr. lip\u00f3m, neur\u00f3m, neurofibr\u00f3m), ktor\u00e9 sa vyskytuj\u00fa v r\u00f4znych \u010dastiach tela, ale vonkaj\u0161ie genit\u00e1lie a po\u0161vu postihuj\u00fa iba sporadicky(1). Predmetom z\u00e1ujmu prezentovan\u00e9ho \u010dl\u00e1nku je prv\u00e1 kateg\u00f3ria ben\u00edgnych mezench\u00fdmov\u00fdch n\u00e1dorov, ktor\u00e9 vznikaj\u00fa zo spolo\u010dn\u00fdch prekurzorov\u00fdch, hormon\u00e1lne dependentn\u00fdch strom\u00e1lnych buniek. Do tejto skupiny patr\u00ed fibroepitelov\u00fd strom\u00e1lny polyp (FESP, nejde o prav\u00fd n\u00e1dor), celul\u00e1rny angiofibr\u00f3m, hlbok\u00fd (agres\u00edvny) angiomyx\u00f3m, angiomyofibroblast\u00f3m a superfici\u00e1lny myofibroblast\u00f3m(1-3). Uveden\u00e9 jednotky maj\u00fa viacer\u00e9 spolo\u010dn\u00e9 klinick\u00e9 a morfologick\u00e9 znaky, v d\u00f4sledku \u010doho je ich bioptick\u00e1 diagnostika niekedy ob\u0165a\u017en\u00e1. V predkladanom pr\u00edspevku autor stru\u010dne opisuje pr\u00edpad FESP vulvy u mladej pacientky, ktor\u00fd diagnostikoval po\u010das svojej bioptickej praxe.<\/p>\n

 <\/p>\n

Opis pr\u00edpadu<\/h3>\n

15-ro\u010dn\u00e9 diev\u010da sa dostavilo na gynekologick\u00e9 vy\u0161etrenie s polypovit\u00fdm tumor\u00f3znym v\u00fdrastkom na labium majus l. dx. \u00datvar mal vzh\u013ead penduluj\u00faceho ko\u017en\u00e9ho polypu rozmerov 3,5 x 2 x 1\u2008cm so zvr\u00e1skaven\u00fdm povrchom hnedej farby. Palpa\u010dne bol nebolestiv\u00fd, presiaknutej elastickej konzistencie. Odstr\u00e1nen\u00fd bol ambulantne tot\u00e1lnou chirurgickou exc\u00edziou. Histologicky i\u0161lo o\u00a0 polypovito a\u017e kondylomat\u00f3zne formovan\u00fa fibroepitelov\u00fa l\u00e9ziu tvoren\u00fa zmno\u017eenou v\u00e4zivovou str\u00f3mou lemovanou dla\u017edicovobunkov\u00fdm epitelom bez dyspl\u00e1zie (obr\u00e1zok 1 a 2). V edemat\u00f3zne presiaknutej str\u00f3me (farbenie na hlien bolo negat\u00edvne) sa vyskytovala pomerne riedka, rovnomerne distribuovan\u00e1 popul\u00e1cia proliferovan\u00fdch blandn\u00fdch vretenovit\u00fdch buniek vzh\u013eadu fibroblastov bez atypi\u00ed (obr\u00e1zok 3). Imunohistochemicky boli pozit\u00edvne na viment\u00edn, CD163 (obr\u00e1zok 4), estrog\u00e9nov\u00e9 receptory (obr\u00e1zok 5) a\u00a0 progester\u00f3nov\u00e9 receptory a\u00a0 negat\u00edvne na dezm\u00edn, CD34 a\u00a0 S100. Ich prolifera\u010dn\u00e1 aktivita bola mini-m\u00e1lna (Ki-67\/MIB1 index < 1 %). Str\u00f3ma z\u00e1rove\u0148 obsahovala zmno\u017een\u00e9 tenkostenn\u00e9 krvn\u00e9 cievy, pri\u010dom vaskularita aj celularita boli v\u00fdraznej\u0161ie v centre \u00fatvaru. Histomorfologick\u00fd obraz l\u00e9zie zodpovedal FESP vulvy. Po stanoven\u00ed diagn\u00f3zy autor nemal o pacientke \u010fal\u0161ie klinick\u00e9 inform\u00e1cie.<\/p>\n

 <\/p>\n

Diskusia<\/strong><\/p>\n

FESP doln\u00e9ho genit\u00e1lneho traktu sa vyskytuje preva\u017ene u \u017eien v reproduk\u010dnom veku s vy\u0161\u0161ou incidenciou v tehotenstve, ale aj u \u017eien v postmenopauze, ktor\u00e9 u\u017e\u00edvaj\u00fa hormon\u00e1lnu suplementa\u010dn\u00fa lie\u010dbu(2-4). Naj\u010dastej\u0161ie vznik\u00e1 v po\u0161ve, zriedkavej\u0161ie vo vulve a v kr\u010dku maternice(2-4). Klinicky sa prejavuje ako r\u00f4zne ve\u013ek\u00fd penduluj\u00faci polypovit\u00fd \u00fatvar(2-4). Zvy\u010dajne je asymptomatick\u00fd, m\u00f4\u017ee sa v\u0161ak manifestova\u0165 krv\u00e1can\u00edm a lok\u00e1lnym diskomfortom(2-4). Hoci m\u00e1 FESP pomerne charakteristick\u00e9 histomorfologick\u00e9 atrib\u00faty, celkov\u00fd obraz l\u00e9zie sa \u010dasto l\u00ed\u0161i od pr\u00edpadu k pr\u00edpadu(2-4). To m\u00f4\u017ee v bioptickej praxi zapr\u00ed\u010dini\u0165 diagnostick\u00e9 \u0165a\u017ekosti a najm\u00e4 pri v\u00fdraznej\u0161\u00edch bunkov\u00fdch atypi\u00e1ch vies\u0165 aj k nespr\u00e1vnej diagn\u00f3ze malignity. Pri preh\u013eadovom zv\u00e4\u010d\u0161en\u00ed m\u00e1 FESP typick\u00fd polypovit\u00fd vzh\u013ead s centr\u00e1lnym fibrovaskul\u00e1rnym jadrom(2-4). Najd\u00f4le\u017eitej\u0161\u00ed komponent je variabilne celul\u00e1rna str\u00f3ma. Hypocelul\u00e1rny variant FESP pozost\u00e1va z blandn\u00fdch vretenovit\u00fdch buniek s nejasnou cytoplazmou, ktor\u00e9 s\u00fa situovan\u00e9 v riedkom kolag\u00e9novom matrixe(2-4). Naopak, hypercelul\u00e1rny variant FESP m\u00e1 floridn\u00fd vzh\u013ead s\u00a0 nukle\u00e1rnou pleomorfiou, \u010dast\u00fdmi mit\u00f3zami vr\u00e1tane atypick\u00fdch mitotick\u00fdch fig\u00far, \u010d\u00edm nadob\u00fada a\u017e pseudosarkomatoidn\u00e9 \u010drty(2-4). K tak\u00fdmto morfologick\u00fdm zmen\u00e1m doch\u00e1dza najm\u00e4 po\u010das gravidity, na \u010do treba myslie\u0165 v diferenci\u00e1lnej diagnostike. Pom\u00f4ckou na rozpoznanie FESP je pr\u00edtomnos\u0165 hviezdicovit\u00fdch a multinukle\u00e1rnych strom\u00e1lnych buniek a absencia rozhrania medzi lezion\u00e1lnou str\u00f3mou a povrchovou epitelovostrom\u00e1lnou vrstvou (\u201egrenz\u201c z\u00f3na)(2-4). Strom\u00e1lne bunky s\u00fa imunoreakt\u00edvne na viment\u00edn, dezm\u00edn, estrog\u00e9nov\u00e9 a\u00a0 progester\u00f3nov\u00e9 receptory a niekedy aj na hladkosvalov\u00fd akt\u00edn(2-4).<\/p>\n

Ako u\u017e bolo spomenut\u00e9, FESP patr\u00ed k \u201eorg\u00e1novo \u0161pecifick\u00fdm\u201c mezench\u00fdmov\u00fdm l\u00e9zi\u00e1m \u017eensk\u00fdch genit\u00e1li\u00ed, ku ktor\u00fdm zara\u010fujeme e\u0161te nieko\u013eko n\u00e1dorov\u00fdch jednotiek s\u00a0 podobn\u00fdm histomorfologick\u00fdm obrazom aj imunofenotypom. Ich detailnej\u0161\u00ed opis by presahoval r\u00e1mec tohto pr\u00edspevku, ale preh\u013ead a z\u00e1kladn\u00e9 diferenci\u00e1lnodiagnostick\u00e9 znaky t\u00fdchto l\u00e9zi\u00ed s\u00fa uveden\u00e9 v tabu\u013eke 1(1-7). V r\u00e1mci nich je FESP jedinou jednotkou, ktor\u00e1 vo WHO klasifik\u00e1cii n\u00e1dorov \u017eensk\u00e9ho reproduk\u010dn\u00e9ho syst\u00e9mu(3) nie je definovan\u00e1 ako prav\u00fd n\u00e1dor. Sk\u00f4r sa pova\u017euje za reakt\u00edvnu l\u00e9ziu vznikaj\u00facu prolifer\u00e1ciou myofibroblastov \u0161pecializovanej subepitelovej str\u00f3my dist\u00e1lneho \u017eensk\u00e9ho genit\u00e1lneho traktu. Histogenetick\u00e1 pr\u00edbuznos\u0165 celej skupiny \u201eorg\u00e1novo \u0161pecifick\u00fdch\u201c mezench\u00fdmov\u00fdch l\u00e9zi\u00ed \u017eensk\u00fdch genit\u00e1li\u00ed je v\u0161ak nespochybnite\u013en\u00e1. V tomto smere zauj\u00edmav\u00fa kazuistiku simult\u00e1nneho v\u00fdskytu FESP a superfici\u00e1lneho myofibroblast\u00f3mu v po\u0161ve u star\u0161ej \u017eeny publikovali Z\u00e1me\u010dn\u00edk a Su\u010dansk\u00fd(8). Obidve l\u00e9zie mali ve\u013emi podobn\u00fd histologick\u00fd obraz a rovnak\u00fd imunoprofil, na z\u00e1klade \u010doho predpokladaj\u00fa, \u017ee maj\u00fa spolo\u010dn\u00fa histogen\u00e9zu a m\u00f4\u017eu by\u0165 s\u00fa\u010das\u0165ou spektra jednej myofibroblastovej nozologickej jednotky doln\u00e9ho genit\u00e1lneho traktu.<\/p>\n

V\u00a0 na\u0161om pr\u00edpade spo\u010diatku vzbudzovala pochybnosti o FESP nepr\u00edtomnos\u0165 hviezdicovit\u00fdch a\u00a0 multinukle\u00e1rnych buniek v str\u00f3me a najm\u00e4 negativita l\u00e9zie na dezm\u00edn. Prvotne sa preto uva\u017eovalo aj o celul\u00e1rnom angiofibr\u00f3me. Polypovit\u00e1 konfigur\u00e1cia l\u00e9zie, absencia \u201egrenz\u201c z\u00f3ny a nepr\u00edtomnos\u0165 krvn\u00fdch ciev s\u00a0 hrub\u0161ou hyalinizovanou stenou v\u0161ak favorizovali diagn\u00f3zu FESP. Zm\u00e4to\u010dn\u00e1 bola aj imunohistochemick\u00e1 negativita strom\u00e1lnych buniek na dezm\u00edn, ktor\u00e1 sa pri vulvovagin\u00e1lnom FESP pova\u017euje za kon\u0161tantne pozit\u00edvny n\u00e1lez. Po rev\u00edzii dostupn\u00fdch liter\u00e1rnych zdrojov v\u0161ak mo\u017eno kon\u0161tatova\u0165, \u017ee imunoreaktivita na dezm\u00edn nemus\u00ed by\u0165 pr\u00edtomn\u00e1 v\u017edy. Olson et al.(9) v s\u00fabore 25 FESP identifi-kovali 2 pr\u00edpady (8 %) negat\u00edvne na dezm\u00edn a kolekt\u00edv mexick\u00fdch autorov(10) potvrdil v s\u00fabore 7 FESP jeden tak\u00fdto pr\u00edpad (14\u00a0 %). V\u00a0 tomto kontexte v\u0161ak treba pripomen\u00fa\u0165, \u017ee pri diagnostike FESP a u\u017e zmie\u0148ovan\u00fdch pr\u00edbuzn\u00fdch \u201eorg\u00e1novo \u0161pecifick\u00fdch\u201c mezench\u00fdmov\u00fdch l\u00e9zi\u00ed doln\u00e9ho genit\u00e1lneho traktu m\u00e1 imunohistochemick\u00e9 vy\u0161etrenie limitovan\u00fa hodnotu a smerodajn\u00fd je v\u017edy celkov\u00fd histomorfologick\u00fd obraz l\u00e9zie.<\/p>\n

Z\u00e1ver<\/h3>\n

Vulvovagin\u00e1lny FESP je zriedkav\u00e1 ben\u00edgna mezench\u00fdmov\u00e1 l\u00e9zia, ktor\u00e1 sama osebe nem\u00e1 v\u00e4\u010d\u0161\u00ed prognostick\u00fd v\u00fdznam. Histomorfologicky v\u0161ak m\u00f4\u017ee pripom\u00edna\u0165 in\u00e9, s\u00edce takisto ben\u00edgne, ale prognosticky nepriaznivej\u0161ie mezench\u00fdmov\u00e9 n\u00e1dory sprev\u00e1dzan\u00e9 agres\u00edvnej\u0161\u00edm rastom a vy\u0161\u0161\u00edm rizikom lok\u00e1lnej recid\u00edvy. V prezentovanej pr\u00e1ci sa autor sna\u017eil obozn\u00e1mi\u0165 \u010ditate\u013eov s touto patologickou jednotkou, s ktorou sa mo\u017eno ob\u010das stretn\u00fa\u0165 v gynekologickej praxi.<\/p>\n

 <\/p>\n

LITERAT\u00daRA<\/h3>\n

1. Nucci MR, Oliva E. Gynecologic Pathology. A volume in the Series: Foundations in Diagnostic Pathology. 1th Edition, Churchill Livingstone Elsevier; 2009. ISBN 978-0-443-06920-8<\/p>\n

2. Nucci MR, Fletcher CDM. Vulvovaginal soft tissue tumours: update and review. Histopathology 2000; 36(2):97-108.<\/p>\n

3. Kurman R, Carcangiu ML, Herrington CS, Young RH (Eds): WHO Classification of Tumours of Female Reproductive Organs. 4th ed., Vol. 6, IARC: Lyon; 2014. ISBN 978-92-832-2435-8<\/p>\n

4. Pharaon M, Warrick J, Lynch MC. Fibroepithelial stromal polyp of the vulva: case report and review of potential histologic mimickers. Int J Gynecol Pathol 2018; 37(4):e1-e5.<\/p>\n

5. Z\u00e1me\u010dn\u00edk\u00a0M. Celul\u00e1rny angiofibr\u00f3m vulvy. Newslab 2018; 9(1):46-49.<\/p>\n

6. Babala P, B\u00edr\u00f3 C, Kla\u010dko M, Milo\u0161 P, Ondru\u0161 D. Angiomyofibroblastoma of the cervix uteri: a case report. Klin Onkol 2011; 24(2):133-136.<\/p>\n

7. Vesel\u00fd K. Myxoidn\u00ed n\u00e1dory m\u011bkk\u00fdch tk\u00e1n\u00ed. Cesk Patol 2017; 53(2):71-80.<\/p>\n

8. Zamecnik M, Sucansky R. Synchronous superficial myofibroblastoma and stromal polyp of the vagina: report of a case supporting common histogenesis of both lesions. J Interdiscipl Histopathol 2015; 3(2):63-67.<\/p>\n

9. Olson NJ, Fritchie KJ, Torres-Mora J, Folpe AL. MyoD1 expression in fibroepithelial stromal polyps. Hum Pathol 2020; 99:75-79.<\/p>\n

10. De la Torr\u00e9 Rend\u00f3n FE, Peralta Serna JY, Ruiz Moreno JL. Tumores estromales del tracto genital inferior: angiomiofibroblastoma y p\u00f3lipo fibroepitelial estromal. Patologia Rev Latinoam 2012; 50(4):285-292.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

*A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens   \u00davod Mezench\u00fdmov\u00e9 n\u00e1dory vulvy a po\u0161vy s\u00fa pomerne zriedkav\u00e9 chorobn\u00e9 jednotky. Vo v\u0161eobecnosti ich rozde\u013eujeme na dve kateg\u00f3rie(1,2). Prv\u00fa predstavuj\u00fa \u201eorg\u00e1novo \u0161pecifick\u00e9\u201c l\u00e9zie, teda tie, ktor\u00e9 vznikaj\u00fa preva\u017ene v tejto anatomickej lokalite, a iba<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[296],"tags":[936,1813,934],"class_list":["post-2366","post","type-post","status-publish","format-standard","hentry","category-biopsy","tag-cellular-angiofibroma","tag-fibroepithelial-stromal-polyp","tag-vulva-en","typ_clanku-casuistry"],"acf":{"abstrakt":"

Fibroepithelial stromal polyp of the vulva: a\u00a0case report<\/strong><\/p>\n

Fibroepithelial stromal polyp (FESP) belongs to \u201eorganspecific\u201c mesenchymal lesions of the distal genital tract. This category also includes some tumours sharing similar histomorphology and immunophenotype. FESP most often occurs in the vagina, followed by the vulva and the cervix. This article describes a case of a 15-year-old girl who has been presented with a painless skin polyp arising in the labium majus. Histology revealed a vascularized fibrous stroma containing a population of scattered bland fibroblast-like cells. They were immunoreactive for vimentin, CD163, estrogen and progesterone receptors and negative for desmin, CD34 and S100. A diagnosis of FESP of the vulva was established. From a clinical point of view, vulvovaginal FESP represents a non-neoplastic pathology without prognostic significance. However, biopsy diagnosis may not always be straightforward because it can morphologically mimic others, also benign but prognostically less favourable mesenchymal tumours.<\/p>\n

Keywords:<\/strong> fibroepithelial stromal polyp, cellular angiofibroma, vulva<\/p>\n","casopis":[{"ID":2417,"post_author":"7","post_date":"2022-02-08 13:25:20","post_date_gmt":"2022-02-08 12:25:20","post_content":"Druh\u00e9 vydanie \u010dasopisu laborat\u00f3rnej medic\u00edny 2021\/2<\/strong>\r\n

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  • Molekul\u00e1rny mechanizmus karcinogen\u00e9zy indukovanej prostredn\u00edctvom bakt\u00e9ri\u00ed<\/li>\r\n \t
  • Extracelul\u00e1rne vezikuly a ich potenci\u00e1lne vyu\u017eitie v klinickej praxi<\/li>\r\n \t
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