What are the other Names for this Condition? (Also known as/Synonyms)

• Benign Mixed Müllerian Tumour of Vagina
• Spindle Cell Epithelioma of Vagina (SCEV)
• Vaginal Mixed Tumor

What is Mixed Tumor of Vagina? (Definition/Background Information)

• Mixed Tumor of Vagina is a rare, benign tumor that occurs in the vagina. The tumor is composed of two cell types, namely the ductal epithelial cells and the stromal myoepithelial cells
• The cells of origin for the tumor is still under debate by the researchers, but the tumor may arise from the urogenital sinus-derived epithelium or from Müllerian ducts
• Mixed Tumor of Vagina is a slow-growing and usually solitary tumor that occurs as a painless nodule. It is often seen in adult women
• In a majority of cases, no treatment in necessary, unless it causes worrisome symptoms or grows to larger sizes. In such cases, a simple surgical excision of the tumor is considered curative
• The prognosis for Mixed Tumor of Vagina is excellent with suitable treatment

Who gets Mixed Tumor of Vagina? (Age and Sex Distribution)

• Mixed Tumor of Vagina is a rare tumor type that is seen in adult women
• Only, around 100 cases have been described in the medical literature
• Individuals of all racial and ethnic background may be affected

What are the Risk Factors for Mixed Tumor of Vagina? (Predisposing Factors)

• Currently, no risk factors have been identified for Mixed Tumor of Vagina

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Mixed Tumor of Vagina? (Etiology)

Currently, the cause of development of Mixed Tumor of Vagina is unknown.

• However, since most of the tumors are observed near the hymenal ring in the vagina, the origin of the tumor may be from urogenital sinus-derived epithelium
• Some researchers believe that the tumor may originate from the Müllerian cells. Hence, it is also known as Benign Mixed Müllerian Tumor of Vagina
• Research is currently being undertaken to identify the relevant causal factors

The condition is not a sexually-transmitted infection that spreads from one individual to another.

What are the Signs and Symptoms of Mixed Tumor of Vagina?

The signs and symptoms of Mixed Tumor of Vagina include:

• It usually occurs as a single nodule near the hymenal ring in the vagina (upper part of the vagina)
• It is a slow-growing tumor that ranges in size from 1.5-5 cm
• The tumor is usually painless; however, there may be pain on application of pressure
• Large tumors may present difficulty in walking or sitting
• Pain during sex

How is Mixed Tumor of Vagina Diagnosed?

A diagnosis of Mixed Tumor of Vagina may involve the following:

• Evaluation of the individual’s medical history and a thorough physical (pelvic) examination
• Ultrasound scan of the abdomen
• CT or CAT scan with contrast of the abdomen and pelvis may show a well-defined mass. This radiological procedure creates detailed 3-dimensional images of structures inside the body
• MRI scans of the abdomen and pelvis: Magnetic resonance imaging (MRI) uses a magnetic field to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor
• Colposcopy:
  • The cervix (including the vagina) is examined with an instrument, called a colposcope. This helps the physician get a magnified view of the cervix
  • In order for this procedure to be performed, the individual has to lie on a table, as for a pelvic exam. An instrument, called the speculum, is placed in the vagina to keep the opening apart, in order to help the physician visualize the cervix. The colposcope is then used to get a magnified view of the inside

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include:

• Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
• Core biopsy of the tumor
• Open biopsy of the tumor

Tissue biopsy:

• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

Note:

• If the epithelial or stromal component of the tumor is malignant, then it is known as malignant mixed tumor
• It is important to distinguish benign mixed tumors from ‘malignant’ mixed tumors including synovial sarcoma and carcinosarcoma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Mixed Tumor of Vagina?

Mixed Tumor of Vagina is a benign lesion. However, it may cause the following complications:

• The tumors can ulcerate and bleed. This can cause secondary infections to develop (superimposed infections)
• Some individuals may develop stress and anxiety fearing that the condition is a sexually-transmitted infection
• There may be pain and discomfort during sex causing emotional stress
• Damage of vital nerves, blood vessels, and surrounding structures, during surgery to remove the tumors
• Post-surgical infection at the wound site is a potential complication

How is Mixed Tumor of Vagina Treated?

The treatment of Mixed Tumor of Vagina may involve the following:

• A ‘wait and watch’ approach may be considered for asymptomatic tumors, once a diagnosis of a benign mixed tumor has been established
• Surgical intervention with complete excision can result in a complete cure. It can also help reduce the chances of tumor recurrence
• Radiation therapy and chemotherapy are not usually required
• Follow-up care with regular screening and check-ups are important and encouraged

How can Mixed Tumor of Vagina be Prevented?

Currently, there are no known methods to prevent the development of Mixed Tumor of Vagina.

What is the Prognosis of Mixed Tumor of Vagina? (Outcomes/Resolutions)

The prognosis for Mixed Tumor of Vagina is generally excellent with appropriate treatment, since it is a benign tumor.

Additional and Relevant Useful Information for Mixed Tumor of Vagina:

A Vaginal Mixed Tumor is also known by the term Spindle Cell Epithelioma of Vagina (SCEV).