Thibault Lucie, Picard Cécile, Mure Pierre-Yves, Gorduza Daniela, Collardeau-Frachon Sophie, Demède Delphine, Dijoud Frédérique
Institut de Pathologie Multisite, Groupement Hospitalier Est, Hospices Civils de Lyon, France.
Institut de Pathologie Multisite, Groupement Hospitalier Est, Hospices Civils de Lyon, France; Université Claude Bernard Lyon 1, France.
J Pediatr Urol. 2020 Dec;16(6):831.e1-831.e7. doi: 10.1016/j.jpurol.2020.09.010. Epub 2020 Sep 13.
Vaginal lesions are rare and of various types in children. Clinical presentation is generally undifferenciated. Histological examination is fundamental to ascertain the nature of the lesion. Regarding tumoral lesions, histological subtypes encountered are radically different from those seen in adults, dominated by stromal benign lesions.
The aim of this retrospective study was to describe characteristics and pathological aspects of pediatric vaginal lesions, diagnosed in a single pediatric experienced center.
A database analysis was performed on all vaginal samples of patients under 18 years old received in a pediatric-specialized pathology laboratory of an academic hospital, over a 26-year period.
Among 36 vaginal tissue samples reported, a total of 15 tumoral or pseudotumoral processes was recorded. Primitive malignant tumors included embryonal rhabdomyosarcoma (n = 3) and germ-cell tumors, yolk-sac type (n = 2). Benign tumoral or pseudotumoral processes included inflammatory stromal polyps (n = 8), epidermic cyst (n = 1), and benign Müllerian papilloma (n = 1).
Over 15 primitive vaginal tumors, 1/3 was malignant with embryonal rhabdomyosarcoma being the most common. The remaining 2/3 specimens were benign, with stromal inflammatory lesions being the most commonly observed. Fibro-epithelial polyp is a debated entity, which covers a wide histological spectrum, with varying inflammation and stromal cellularity, raising sometimes the question of the differential diagnosis with rhabdomyosarcoma. Stromal cells morphology along with their immunohistochemical profile suggest their reactive myofibroblastic nature. Pseudotumoral inflammatory lesions display very similar histological findings with these entities. A common pathogenesis beginning with an inflammatory process, potentially accelerated by chronic traumatic factors, could be discussed.
We confirmed the rarity and the diversity of vaginal lesions in children. Vaginoscopy and biopsy sample should be systematic, given the non-specific presentation of tumoral processes. Myogenin immunostain must be systematic in case of vaginal polypoid mass, in order to rule out malignancy.
儿童阴道病变罕见且类型多样。临床表现通常无特异性。组织学检查对于确定病变性质至关重要。对于肿瘤性病变，所遇到的组织学亚型与成人所见截然不同，以基质良性病变为主。
本回顾性研究的目的是描述在一个儿科经验丰富的中心诊断的儿童阴道病变的特征和病理情况。
对一家学术医院儿科专科病理实验室在26年期间接收的所有18岁以下患者的阴道样本进行数据库分析。
在报告的36份阴道组织样本中，共记录了15个肿瘤性或假性肿瘤性病变。原发性恶性肿瘤包括胚胎性横纹肌肉瘤（n = 3）和卵黄囊型生殖细胞肿瘤（n = 2）。良性肿瘤性或假性肿瘤性病变包括炎性基质息肉（n = 8）、表皮囊肿（n = 1）和良性苗勒氏乳头状瘤（n = 1）。
在15个原发性阴道肿瘤中，1/3为恶性，胚胎性横纹肌肉瘤最为常见。其余2/3标本为良性，以基质炎性病变最为常见。纤维上皮息肉是一个有争议的实体，其组织学谱广泛，炎症和基质细胞密度各异，有时会引发与横纹肌肉瘤的鉴别诊断问题。基质细胞形态及其免疫组化特征提示其反应性肌成纤维细胞性质。假性肿瘤性炎性病变与这些实体表现出非常相似的组织学结果。可以讨论一种始于炎症过程、可能因慢性创伤因素而加速的共同发病机制。
我们证实了儿童阴道病变的罕见性和多样性。鉴于肿瘤性病变的非特异性表现，阴道镜检查和活检样本应常规进行。对于阴道息肉样肿物，必须常规进行肌生成素免疫染色，以排除恶性肿瘤。
