A 60-year-old female presents with a mosaic, granular patch noted on the upper third of vagina during colposcopy. It did not stain with Iodine. Biopsy is shown above. What is the diagnosis?
Given the morphologic findings, what is the most appropriate diagnosis?
a. Endometriosis
b. Bartholin gland cyst
c. Clear cell adenocarcinoma
d. Vaginal adenosis
Submitted by Jay Hwang and Cole Biehl, Department of Pathology and Laboratory Services, Brooke Army Medical Center, San Antonio, Texas, USA.
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Answer to September/October's Case of the Month
B. Glomus tumor
Glomus tumor with myxoid changes is the most appropriate diagnosis. The tumor is composed of a well circumscribed dermal proliferation of nested, small round, monomorphic cells. Dilated slit-like vascular channels are scattered throughout the tumor. As in this case, mucinous changes have been reported in a variant of glomus tumor. Glomus tumors resemble elements of the glomus apparatus in the skin and are derived from cells that are part of the Sequet-Hoyer canal, as described by Masson in 1924 (1). Clinically it presents as a small, solitary, painful, red-blue nodule on the fingers and toes, particularly on the nail bed. Extracutaneous sites include trachea, deep soft tissue, bone, gastrointestinal tract, lung, oral and nasal cavity (2).
Submitted by Muhammad Ahsan, Chughtai Institute of Pathology, Lahore, Pakistan, and Rida Noor, Faisalabad Medical University, Faisalabad, Pakistan.
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References
- TF Goodman, “Fine structure of the cells of the Suquet-Hoyer canal,” J Invest Dermatol, 59, 363 (1972). PMID: 5086685.
- Z Gombos, PJ Zhang, “Glomus tumor,” Arch Pathol Lab Med, 132, 1448 (2008). PMID: 18788860.
