Vascular lesions of the female genital tract: Clinicopathologic findings and application of the ISSVA classification

IntroductionVascular lesions of the female genital tract are extremely rare and their nomenclature does not widely follow the International Society for the Study of Vascular Anomalies (ISSVA) classification.Aim of the studyTo describe the clinicopathologic characteristics of vascular lesions of the female genital tract and to apply the ISSVA classification.Material and methods19 vascular lesions were diagnosed during a 20 year period. Their histological features including size, localization, type of vessels, endothelial atypia, mitotic activity, relation with surrounding tissues are described. Immunohistochemical analysis using CD31, CD34, D2-40, WT1, MiB1 and GLUT1 is performed.Results8 ovarian lesions were found including small cortical lymphatic malformations and medullary lesions resembling pyogenic granulomas, as well as two tubal lesions resembling true hemangiomas. They were all incidental findings. Cervical lesions (n = 7) included endocervical polypoid venous malformations and paracervical combined malformations presenting clinically as leiomyomas; they probably represent static vessels. Vulvar lesions (n = 4) consist of lymphatic and venous malformations and by angiokeratomas. No malignant lesions were found. WT1 is expressed by most of these lesions with the exception of the lymphatic malformations and the paracervical combined malformations. GLUT1 was consistently negative. MiB1 was only rarely positive.ConclusionVascular lesions of the female genital tract consist of lesions with different morphology by organ and of probably different pathogenesis. The ISSVA classification can be adopted for most of these lesions. WT1 should be best considered as a marker of endothelia with proliferative capacity rather than a marker of neoplastic endothelia.