What are the other Names for this Condition? (Also known as/Synonyms)
- Adenomatous Polyp of Vagina with Villous Features
- Vaginal Villous Adenoma
What is Villous Adenoma of Vagina? (Definition/Background Information)
- Villous Adenoma of Vagina is an extremely infrequent, glandular lesion resembling a colorectal villous adenoma. It is generally observed in middle-aged women
- There are no clearly established risk factors for Vaginal Villous Adenoma and the cause of tumor formation is unknown. However, it is believed to arise from displaced embryological remnants (tissue) during fetal development
- The tumor appears as a usually solitary polyp in the opening of the vagina. No significant signs and symptoms or complications are noted. However, rarely Villous Adenoma of Vagina may be associated with adenocarcinoma (intestinal type)
- Treatment course includes surgical excision and removal of the tumor. In general, the prognosis of Villous Adenoma of Vagina is excellent with suitable treatment
Who gets Villous Adenoma of Vagina? (Age and Sex Distribution)
- Villous Adenoma of Vagina is a very rare tumor that is observed in adult women (mostly middle-aged women over the age of 40 years)
- There is no known ethnic or racial preference
- Worldwide, less than 10 cases have only been reported in the medical literature
What are the Risk Factors for Villous Adenoma of Vagina? (Predisposing Factors)
- No definitive risk factors have been identified for Villous Adenoma of Vagina
- One isolated case was associated with congenital renal agenesis (a type of kidney disorder)
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones 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 Villous Adenoma of Vagina? (Etiology)
- Currently, the exact cause and mechanism of formation of Villous Adenoma of Vagina is unknown
- It is believed to arise from embryological remnants (displaced tissue) during fetal growth and development
- The kind of tissue that can be abnormally displaced into the vaginal area may include:
- Intestinal type tissue (cloacal epithelium),
- Transitional epithelium from the bladder, and
- Müllerian tissue (which gives rise to a majority of the female genital tract during embryological development)
- Some tumors have shown mutations on the KRAS, BRAF, and LKB1/STK11 genes; these are currently being well-characterized
- Villous Adenomas of Vagina are not associated with human papilloma virus (HPV) infection, which is a sexually-transmitted infection
What are the Signs and Symptoms of Villous Adenoma of Vagina?
The signs and symptoms of Villous Adenoma of Vagina may include:
- Small tumors usually do not cause any symptoms. But, occasionally they may become painful, if they compress surrounding structure
- Abnormal vaginal bleeding in some cases
- Pain during sexual intercourse; bleeding after sex
- The tumor may grow at a slow rate and appear as a well-defined polyp
- The tumors are normally solitary in most of the cases; however, multiple tumors may be present
- Most tumors are less than 5 cm in size and occur near entrance of the vagina
- Some tumors may grow to large sizes and may cause a feeling of fullness in the abdomen; enlargement of lower abdomen may be present
- Pain in the pelvic region
- Frequent urination due to compression/pressure of the tumor
- Lower back pain
How is Villous Adenoma of Vagina Diagnosed?
A diagnosis of Villous Adenoma of Vagina may involve the following steps:
- Evaluation of the individual’s medical history and a thorough physical (pelvic) examination
- Ultrasound scan of the abdomen
- Transvaginal ultrasound of the uterus can provide an image of the vagina and surrounding pelvic organs
- 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
- 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
Tissue biopsy of the mass:
- 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: On microscopic examination of the tumors, growth patterns similar to colon villous adenomas are noted.
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 Villous Adenoma of Vagina?
Significant complications from Villous Adenoma of Vagina are generally not noted. However, the following may be observed in some cases:
- Stress due to a concern for vaginal cancer
- Severe pain and bleeding during sex may occur in rare cases, if the tumor is ulcerated
- Some villous adenomas may be associated with vaginal intraepithelial neoplasia (VaIN), which may be described as a premalignant condition of the vagina
- Very rarely, an association with adenocarcinoma, intestinal type has been noted
- Damage to the muscles, vital nerves, and blood vessels, during surgery
- Post-surgical infection at the wound site is a potential complication
Recurrence of the tumor after surgery (complete excised and removal) is not known to occur.
How is Villous Adenoma of Vagina Treated?
Since an association of the tumor with precancerous condition or adenocarcinoma is noted, a surgical removal of the tumor is undertaken in most cases. Treatment measures for Villous Adenoma of Vagina may include the following:
- Pain medications, in case of tumors causing pain
- Surgical intervention with complete excision can result in a complete cure. It can also help reduce the chances of tumor recurrence (if any)
- Radiation therapy and chemotherapy are not usually required
- Some women may require reassurance and support to help with stress and anxiety. The healthcare professional may dispel fears that the condition is not due to a sexually-transmitted infection
- Post-operative care is important: Minimum activity level is to be ensured until the surgical wound heals
- Follow-up care with regular screening and check-ups are important
How can Villous Adenoma of Vagina be Prevented?
- Current medical research has not established a way of preventing Villous Adenoma of Vagina
- Medical screening at regular intervals with scans and physical examinations are advised
What is the Prognosis of Villous Adenoma of Vagina? (Outcomes/Resolutions)
- The prognosis of Villous Adenoma of Vagina is excellent with surgical intervention and complete removal
- However, in some rare cases, an association with carcinoma (such as intestinal type adenocarcinoma) and precancerous lesions (such as intraepithelial dysplasia) has been noted. This merits early detection and prompt treatment for optimal outcomes
Additional and Relevant Useful Information for Villous Adenoma of Vagina:
- Tubular adenoma of colon is a condition that results in tumors, growing in the colon. If these tumors remain untreated, they can develop into colon or rectal cancer
The following link will help you understand tubular adenoma of colon: