Fibroepithelial Stromal Polyp

Elizabeth A. Montgomery, MD

Key Facts

Clinical Issues

Polypoid lesions presenting in vagina or vulva
Possible relationship to hormonal factors
Simple excision; occasional recurrences, especially with subsequent pregnancies

Microscopic Pathology

Coating of unremarkable or hyperplastic squamous mucosa
No Grenz zone between lesion and overlying mucosa/skin
Spindle to stellate cells
Tapering cytoplasmic processes
Multinucleation and nuclear enlargement common
Multinucleate cell with wreath-like appearance
Fibrous, edematous, or myxoid stroma
Can be highly cellular, mimicking sarcomas (often in pregnancy)

Fibroepithelial stromal polyps are typically edematous at low magnification, with overlying reactive epithelial changes. Note that the lesion abuts the overlying epithelium without a Grenz zone.

At high magnification, most fibroepithelial stromal polyps consist of bland-appearing stellate to spindle cells in an edematous background with scattered inflammatory cells

TERMINOLOGY

Abbreviations

Fibroepithelial stromal polyp (FSP)

Synonyms

Cellular pseudosarcomatous fibroepithelial stromal polyp, pseudosarcoma botryoides

Definitions

Benign polyps, usually involving vagina of women of reproductive age, composed of fibroblastic cells in edematous stroma

CLINICAL ISSUES

Epidemiology

Incidence
- Relatively common
Age
- Reproductive years
Gender
- Women

Presentation

Polypoid lesions presenting in vagina or vulva
Possible relationship to hormonal factors
- Discovered in antenatal examinations
- Some regress in puerperium
- Association with hormone usage

Treatment