Cervical Myofibroblastoma: Expanding the Differential for Cervical Masses

Abstract

Lower genital tract myofibroblastoma is a gynecologic rarity, with most of the published literature consisting of case reports. Differential diagnoses for lower genital tract soft tissue masses include cervical leiomyomas, nabothian cysts, and other rare tumors such as angiomyofibroblastoma. The pathogenesis is unclear; however, research aims to identify an association with hormones or infections. We report the case of a 32‐year‐old female who was found to have cervical myofibroblastoma after excision of a large cervical lesion. Based on an extensive literature review, this case will be the sixth reported case of cervical myofibroblastoma since 2017.

1. Introduction

Lower genital tract myofibroblastoma (MFB) is a gynecologic rarity, with most of the available literature relying on case reports. It is classified as a mesenchymal tumor specific to the lower female genital tract. This distinctive tumor has been referred to in the literature as either superficial cervicovaginal MFB or superficial myofibroblastoma of the lower female genital tract (SMFGT) [1]. Superficial MFB typically arises from the stromal cells of the vagina and, less frequently, the vulva and the cervix. With only five reported cases of cervical MFB in the literature, these tumors are grossly described as smooth nodular masses of variable sizes [2–4]. In our report, we discuss an incidental finding of a cervical MFB. Written informed consent was obtained from the patient.

1.1. Clinical History and Examination

A 32‐year‐old Caucasian nulligravid woman presented to the gynecologic oncologist with a newly diagnosed “vaginal lesion” for further workup and management. Previously seen by a gynecologist a week earlier, the patient was told that she had a “vaginal cyst that was filling the vault.” The patient had undergone a pelvic exam a few months prior, which was unremarkable. She was asymptomatic and denied pelvic pressure, pelvic pain, abnormal uterine bleeding, bulk symptoms, or vaginal discharge. No constitutional symptoms were present. The patient′s gynecologic history was notable for a remote abnormal Pap smear. The patient used a vaginal ring for contraception.

On physical exam, the vaginal mucosa was unremarkable, with a 5‐cm smooth mass arising from the right anterior cervix with smooth contour. The cervical os was visualized and was normal appearing. The uterus was small and anteverted, with no notable fullness/tenderness in the bilateral adnexa. A transvaginal ultrasound reported an anteverted uterus measuring 6.7 × 4.4 × 2.9 cm and a rounded hypoechoic structure within the anterior right portion of the vaginal canal, measuring 3.2 × 2.9 × 3.4 cm. Color Doppler revealed minimal flow within the structure. An MRI of the abdomen and pelvis was performed showing a 4.4‐cm, T2 hypointense, solid, enhancing mass occupying the right upper vaginal vault and likely arising from the anterior cervix (Figure 1).

Figure 1.

Sagittal T2‐weighted MRI of pelvis showing a 2.8 × 4.4 × 3.4‐cm lobulated well‐circumscribed hypointense solid mass (arrow) arising from the right anterior cervix and appearing to fill the right upper vaginal vault.

The patient underwent surgical excision under general anesthesia within a week of her outpatient visit. A 4 × 4‐cm nonfluctuant rubbery mass was noted to be arising from the right border of the cervix. A plane was identified, and the mass was removed intact and sent to pathology. The cervix was repaired with absorbable sutures, and vaginal packing was placed for 24 h. The patient was admitted overnight for observation. On postoperative Day 1, the vaginal packing was removed, and she was discharged home in stable condition. At her postoperative visit, the pathology was reviewed, and no additional therapy was recommended. The patient was well healed with a plan for a 6‐month interval follow‐up. At 12‐month follow‐up, no recurrence was noted.

1.2. Tumor Pathology

On gross examination, the specimen was described as a 4.8 × 3.3 × 2.4‐cm, 23‐g pink‐tan rubbery mass with a smooth and glistening surface with focal adhesions. Microscopic examination showed bland spindle cells with collagenous stroma with no notable mitotic activity or necrosis. (Figure 2A,B) Immunohistochemistry (IHC) stains found that the tumor cells are positive for CD34, ER, and PR, and desmin (weak) (Figure 2C,F) and negative for CD10, S100, SOX10, and HMB45. IHC demonstrated that the tumor cells are negative for ERG and SMA; loss of Rb‐1 was also noted. The overall findings are most consistent with superficial MFB.

Figure 2.

(A) Low‐power hematoxylin and eosin (H&E) section demonstrating a well‐circumscribed subepithelial spindle cell lesion. (B) High‐power H&E section showing bland spindle cells (white arrow) embedded within a collagenized stroma without atypia, necrosis, or mitotic activity. (C) Immunohistochemical stain demonstrating diffuse CD34 positivity. (D) Immunohistochemical stain demonstrating nuclear estrogen receptor (ER) positivity. (E) Immunohistochemical stain demonstrating nuclear progesterone receptor (PR) positivity. (F) Immunohistochemical stain demonstrating focal weak desmin positivity.

2. Discussion

Benign cervical MFBs are rare but should be included in the differential for lower genital tract soft tissue masses. Differential diagnoses of a benign cervical mass include leiomyomas, cysts, and other rare benign tumors [1]. The stroma of the lower female genital tract gives rise to a number of mesenchymal tumors with distinctive clinical and histopathological features. Arising from the subepithelial stroma, most cases are localized to the vagina, with only a handful of vulvar and cervical cases in the literature [1]. Clinically, MFBs of the vagina and cervix present as polyploid or nodular masses. Current literature indicates that many cases are discovered incidentally, with tumors ranging in size from 1 to 6.5 cm. Most patients are asymptomatic; however, symptoms can arise due to local effects such as pelvic pressure and associated bleeding or irritation [2, 3]. There is no evidence of pain or neurological symptoms related to cervical MFBs.

Cervical MFBs typically appear as well circumscribed, solid, subepithelial masses on imaging. On ultrasound, these tumors are hypoechoic relative to cervical stroma, with smooth margins. Color Doppler shows minimal or absent internal vascularity [5]. On MRI, cervical MFBs demonstrate low to intermediate signal intensity on T1‐weighted images and variable intensity on T2‐weighted images, depending on the degree of collagenization; tumors are well defined without invasion of adjacent tissues and lack features such as parametrial extension, necrosis, and irregular margins, which are more characteristic of malignant tumors [6, 7]. Definitive diagnosis requires histopathologic and immunohistochemical correlation, as imaging features are not pathognomonic [2].

The underlying pathogenesis is not understood but hypothesized to be hormone related. On histological analysis, they are composed of collagenized stroma with little to no mitotic activity or necrosis. MFBs are histologically similar to leiomyomas, with good margination and multipatterned growth of spindled and stellate cells, although they show a smaller quantity of smooth muscle cells [4]. MFBs have also been misinterpreted as angiomyofibroblastomas due to the many histological growth patterns characteristic of superficial cervicovaginal MFBs [4].

Other important differential considerations include aggressive angiomyxoma and solitary fibrous tumor. Aggressive angiomyxoma is distinguished by its deep soft tissue location, infiltrative margins, prominently myxoid and hypocellular stroma, and vessels of variable caliber with medial muscular hypertrophy; it carries a significant risk of local recurrence (up to 36%) and therefore requires wider excision and long‐term surveillance [8]. Solitary fibrous tumor, though rarely reported in the lower female genital tract, may show overlapping features of alternating cellularity and stromal collagenization with consistent CD34 positivity; however, solitary fibrous tumor is characteristically desmin‐negative, a key distinction from superficial MFB [9].

A compilation of case reports supports the hypothesis that the localized expansion of uniform cells in superficial cervicovaginal MFBs distinguishes them from the haphazard arrangement displayed in mucosal stromal polyps and the infiltrative pattern characteristic of aggressive angiomyxoma as described above [4, 8]. In the published literature, desmin is positive in 75%–100% of superficial MFBs, typically highlighting the ramifying dendritic processes of tumor cells rather than smooth muscle bundles, whereas CD34 is positive in 50%–85% of cases [1, 2, 4]. In our case, desmin was only focally and weakly positive, which, although less typical, has been reported in a minority of cases [2]. Despite the weak desmin staining, the combination of CD34 positivity, ER/PR expression, and Rb‐1 loss was sufficient to confirm the diagnosis of superficial MFB in this case report.

Superficial cervicovaginal MFBs are hypothesized to arise from the hormone‐responsive subepithelial stromal cells of the lower female genital tract. This hypothesis is supported by the frequent expression of estrogen and progesterone receptors, CD34 positivity, and the histologic similarities between superficial MFBs and mucosal stromal polyps [4, 10, 11]. Most case reports show lower genital tract MFBs are positive for vimentin, estrogen, and progesterone receptors [12]. Likewise, our reported specimen is positive for estrogen and progesterone receptor with loss of Rb‐1. The combination of diffuse CD34 positivity and loss of RB1 expression, alongside the characteristic morphologic and immunophenotypic features, provides additional support for the diagnosis of superficial MFB and helps distinguish it from several histologic mimics, including leiomyoma, angiomyofibroblastoma, and aggressive angiomyxoma. Although loss of RB1 expression is not entirely specific, it serves as a useful ancillary diagnostic marker.

In summary, benign cervical MFBs are benign, superficial tumors that are most often asymptomatic. The recommended management of these benign neoplasms is surgical excision. These tumors have a benign course with no evidence of metastasis or recurrence after complete excision [1, 3, 12]. Although rare, MFB should be on the differential for soft tissue masses in the lower genital tract.

Funding

No funding was received for this manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Hamilton, Alexandra , Hayek, Judy , Lawani, Phyllis , Kanis, Margaux J. , Cervical Myofibroblastoma: Expanding the Differential for Cervical Masses, Case Reports in Obstetrics and Gynecology, 2026, 3220815, 4 pages, 2026. 10.1155/crog/3220815

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.