Recurrent atypical myxoid fibroepithelial polyp associated with vulvar Crohn's disease

Fibroepithelial polyps of the lower female genital tract are common lesions that can rarely exhibit atypical features including increased and atypical mitoses, bizarre nuclei, and hypercellularity, a combination of findings t hat may suggest malignancy. Five recurrent cases have been published to dat e, two of which were in pregnant females; the other three followed incomple te excisions. Our case is that of a 25-year-old female with Crohn's disease who developed multiple recurrences of polypoid and domed lesions of the la bium minus following surgical excision. Histologic findings in the initial and recurrent lesions were consistent with atypical myxoid fibroepithelial polyps with underlying vulvar Crohn's disease. The lesions subsequently imp roved with standard Crohn's treatment including 5-amino-salicylic acid (Pen tasa) and prednisone. The present case represents the only example of this entity associated with Crohn's disease, and it is the only reported recurre nt case not associated with pregnancy, tamoxifen administration, or positiv e excision margins. The clinical, microscopic, and immunohistochemical find ings of this case suggest that atypical fibroepithelial polyps of the lower female genital tract, cutaneous pleomorphic fibroma, and lesions such as f ibroepithelial polyps of the anus may represent variants of the same atypic al reparative process.