Giant fibroepithelial polyp of the perineum: Giant fibroepithelial polyp.

INTRODUCTION: Fibroepitheial polyps (FEP) are among the most common benign skin lesions and definitive histology is often needed to exclude malignancy. These polyps are usually less than 5cm in size and are often seen in genito-urinary sites including the perineum. A small number can reach a significant size. PRESENTATION OF CASE: A 46-year-old female patient presented with a pedunculated mass measuring 18cm in diameter, localized to the left perineum. The lesion was excised and the histopathological diagnosis was fibroepithelial polyp.
CONCLUSION: We present this case as the third largest FEP recorded in the available literature.

Introduction

Fibroepithelial polyps are usually mesenchymal tumours. They are also known as accordian or skin tags. The incidence increases with age and most remain smaller than 5 cm [1], [2]. They are often found in genito-urinary sites including the perineum [3], [4], [5]. We present a case of giant FEP of the perineum measuring 18 cm.

Case presentation

A female presented with a mass that had been growing on her perineum (Fig. 1). She was 46 years old and the mass had been present since aged 17, slowly increasing in size over the last two years. There was no history of previous sexually transmitted disease or local surgery. Physical examination was normal aside from a large 18 cm multiloculated mass arising from the left perineal region. Laboratory parameters were normal including HIV, HCV and HBsAg tests. No imaging was needed and the decision was made to proceed to excision biopsy. Her surgery was straightforward and the mass was fully excised. The specimen was reported as an 18 × 9 × 3 cm mass covered with squamous epithelium and a cut surface that was pink, soft, solid and homogenous. There were no areas of haemorrhage or necrosis. Surface epithealium showed focal erosion and reactive epithelial changes only. There was evidence of spindle-shaped and stellate cells loosle arranged in a myxoid stroma surrounded by dilated blood vessels by loose aggregates. These cells showed mild pleomorphism but no evidence of cellular atypia. Mitotic activity was sparse with fewer than 1 mitotic figure per 10 hpfs.

Fig. 1

Appearence of a polypoid mass originating from the left perineum of the patient at the lithotomy position.

Discussion

Giant fibroepithelial polyps are very rare and only case reports are found in the literature. They are benign proliferations and usually polypoid or pedunculated and rarely exceed 5 cm in size [1], [2]. Excision biopsy is usual when the polyp is symptomatic or there is a need for definitive histology. They are frequently found in genito-urinary sites but can be found almost anywhere. To our knowledge this is the third largest reported polyp in the literature.

Conflict of interest

No conflict of interest was declared by the authors.

Financial disclosure

The authors declared that this study has received no financial support.

Ethical approval

The protocol for this case study was approved by the local ethics committee of Samsun Training and Research Hospital.Reference number is B.10.4.1SM.4.55.00.15-3042.

Informed consent

Written informed consent was obtained from the patient for publication of this Case report.

Author contribution

Elif Colak: study concept, data collection, writing the paper; Aygün Ikinci: data analysis; Gultekin Ozan Kucuk: writing the paper; Sadik Kesmer: data collection; Kadir Yildirim: data collection.

Guarantor

Elif Colak.