Mesodermal mesenchymal polyp; wide introitus in young female

Introduction and importance: Mesodermal mesenchymal polyps (Fibroepithelial stromal polyps) are mesenchymal embryological structures that remain and grow to be an apparent polyp-like lesion in females of reproductive age. We present this case of mesodermal mesenchymal polyp in a young female arising at the hymenal ring of the vagina making the introitus very wide. We highlighted in our case the importance of recognizing mesenchymal lesions and their differential diagnosis to provide the patients with optimal care.

Case presentation: A 24-years-old single female presented with a painless vaginal mass since birth, that increased in size after puberty. Upon examination, she was found to have an irregular smooth mass with around 4 × 4 cm of it protruding outside the vagina and easily reducible disfiguring and making the introitus wide. After performing Magnetic resonance imaging (MRI), findings were Suggestive of a Vulvovaginal mesenchymal tumor likely aggressive angiomyxoma. The patient underwent surgical vaginal mass excision, with hymenal repair, posterior and anterior vaginal wall reconstruction. The final diagnosis confirmed by tissue pathology was mesodermal mesenchymal polyp.

Clinical discussion: Fibroepithelial polyps of the vagina (FEPV) is a rare benign neoplasm and most commonly asymptomatic apart from painless mass protruding or disfiguring the sensitive area. The variety of mesenchymal lesions that occur at the vulvovaginal region can be very challenging histopathologically and surgically due to their rarity and lack literature.

Conclusion: Fibroepithelial polyps of the vagina (FEPV) remain an infrequent entity of pathologies affecting the female urogenital tract. We reported a rare case of concomitant FEPV and wide introitus affecting a young woman physically and psychologically. Therefore, preoperative clinical assessment and surgical approach along with psychological support is critical to provide the patient with the best outcome.