Case Number : Case 1226 - 05 March Posted By: Guest

I think this is a hidradenoma papilliferum but appears distorted.

Metastatic high grade carcinoma, probably serous carcinoma from endometrium or ovary.

hidradenoma papilliferum- dermal tumor sorrounded by pseudocapsule, papillary projections, no plasma cells.

Metastatic adenocarcinoma.

Nice suggestions of metastaic lesion.. If malignant, it also can be malignant transformation in a hidradenoma papilliferum. I think there are areas of decapitation secretion (apocrine carcinoma of anogenital mammary like glands)...

I think this could go either way, hidradenoma papilliferum or malignant. I would do myoepithelial markers to try and separate the two. If malignant, it could be either primary (apocrine carcinoma) or metastatic.

This is a vaginal neoplasm, not a vulvar neoplasm. Hidradenoma papilliferum has a predilection for the labia, where 90 % of cases occur. Other locations are fourchette, clitoris, perianal area and perineum. To the best of my knowledge, vagina is not a site of hidradenoma papilliferum.

Sorry. My mistake. I thought I read "vulval". In this case, I entirely agree with a met.

Agree with Romualdo. I favor villoglandular endometrioid adenocarcinoma given the lower nuclear grade (immunostains will help distinguish vs. papillary serous carcinoma).

This papillary neoplasm has some malignant cytologic features: hyperchromasia, nuclear pleomorphism and enlargement, high nuclear-cytoplasmic ratio, and subtle apoptotic activity. There is minimal mitotic activity with small nucleoli, and rare epithelioid clear cells.
It has malignant architectural features: multifocal nests, with expansile and fusiform infiltrative distribution, and absence of a distinct basal layer.

Favour adenocarcinoma too. Most likely female genital tract primary. IHC will be helpful.

Actually, I did not expect that vaginal biopsies are in the subspeciality of dermatopathology !!! I interpreted vaginal biopsy as a biopsy from a vaginal introital lesion, some where at the mucocutaneous junction of the introitus. This is the rational behind my hypotheses. Initially, I overlooked the cytological features, which on subsequent looks , I find it quite well fitting with a malignant lesion. So, if this is not related to the introitus, and this is a biopsy from the inside of the vagina, then it is definitely metastatic. Mostly endometrial or ovarian. May be then the decapitation secretion perceived in some areas is an incidental finding in the context of adenocarcinoma.

Metastatic endometrioid adenocarcinoma. There was a history of it.