Fibroepithelial vaginal polyp in a newborn.

A fibroepithelial polyp of the vagina (FEPV) is a mucosal polypoid lesion with a connective tissue core covered by a benign squamous epithelium. A vaginal polyp must be considered in the evaluation of interlabial masses in prepubertal girls. This article describes a newborn girl with an interlabial mass that the histological analysis revealed to be an FEPV. Surgical excision of the mass was performed, and the patient has not experienced recurrence after 1-year of follow-up. A review of the literature revealed that our case was the third reported case of a fibroepithelial polyp in a neonate.

INTRODUCTION

An interlabial polyp in a newborn or infant girl is extremely rare. It may not only give rise to the impression of botryoid sarcoma, but it also may have bizarre histological features suggesting malignancy, compounding the clinical confusion. However still, a benign lesion is more common as was the case with our patient. To the best of our knowledge, this is only the third reported case with the same diagnosis.

CASE REPORT

A newborn girl was referred to our hospital because of a large vaginal mass discovered by a neonatologist. She was without any other systemic problems. She was born at 42 weeks through normal spontaneous vaginal delivery; the pregnancy had been uncomplicated, and there was no exposure to drugs, alcohol or infection. She is the fifth child for unrelated healthy parents, 40 and 37 years of age, and there is no history of malignancy in the family.

Physical examination revealed a 3 × 3 cm, firm, vaginal mass, originating from the midline of the anterior vaginal wall, with a large neck [Figures 1 and 2], a normal urethral opening, and a normal anal opening. The remainder of the examination was unremarkable.

Figure 1

Fibroepithelial polyp of the vagina in a newborn

Figure 2

Lateral view of the mass

Ultrasound imaging of the kidneys and pelvic organs showed an intact urogenital tract except for the 3 × 3 cm mass in the distal vagina without any invasion to the adjacent organs. Magnetic resonance imaging was also performed and showed the same findings.

After obtaining informed consent from both parents, cystoscopy and vaginoscopy was performed; this revealed a pedunculated vaginal mass originating from the midline point in the anterior vaginal wall (distal third) with otherwise normal cystoscopy and vaginoscopy findings. Surgical excision of the mass was performed with a 3 mm margin around the base.

The postoperative period was uneventful. The histopathology results revealed squamous mucosa consistent with a fibroepithelial polyp, which showed no signs of malignancy. After follow-up of 1-year (to date of writing), the patient has shown no evidence of recurrence.

DISCUSSION

Vaginal polyps are usually detected on medical examination after birth or are observed by the family. Diagnosis is usually difficult unless surgical resection and pathologic examination are done properly.

A fibroepithelial polyp of the vagina (FEPV) is a mucosal polypoid lesion with a connective tissue core covered by a benign squamous epithelium;[1] FEPV is extremely uncommon before menarche and after menopause.[2]

After reviewing the literature, we found that our case is the third reported case of a fibroepithelial polyp in a neonate. In 1990, Pul et al. reported the case of a neonate with a fibroepithelial vaginal polyp.[3] Jallouli et al. reported the second case of a fibroepithelial polyp in a newborn.[4]

A vaginal polyp must be considered in the evaluation of interlabial masses in prepubertal girls.[4] If diagnosed as an FEPV, the treatment is simple excision; recurrence is extremely uncommon.[5] Although the recurrence after incomplete excision has been reported,[2] it is a benign lesion; there are no reports of malignant transformation.[4]

CONCLUSION

A fibroepithelial polyp should be included in the differential diagnosis of an interlabial mass in a newborn. Although it is benign and rarely recurs, it should be excised completely, and a long follow-up is suggested as it may recur at any age.