Literature Review of Benign Mullerian Papilloma Contrasted With Vaginal Rhabdomyosarcoma

Study Objectives: Benign mullerian papillomas of the genital tract are rare and, hence, can be mistaken for vaginal rhabdomyosarcoma on initial clinical review. This review of the literature will consolidate the previous cases of mullerian papilloma reported and looks for clues to differentiate the 2 entities. Design and Setting: We provide a case report and literature review, with patients from a pediatric adolescent gynecology clinic in a tertiary center. Methods: We conducted a search of English-language publications from 1951 (the first case report) until January 2014 by using the search words "Mullerian papilloma" and "prepubertal bleeding." References from previous published reports were also obtained for completeness. Main Outcome: Literature review of benign mullerian papilloma. Results: Since 1951, 56 cases of mullerian papilloma were reported, including 4 cases at our institution. Comorbid conditions were found in 31.5% of cases (with 3 cases associated with mesenchymal tumors). The average length of time from onset of symptoms (primarily vaginal bleeding) to diagnosis was 6.7 months (range, 1 day to 3 years), with only 1 case diagnosed incidentally. Median age of presentation was 5 years (range, 1 day to 52 years). Most cases were localized and resected with ease. Histology reveals complex papillary lesions without cytologic atypia. Conclusion: Benign mullerian papilloma is distinguished from the more significant diagnosis of vaginal rhabdomyosarcoma by initial length of vaginal bleeding at presentation, lack of vaginal wall extension, ease of resection, and histopathology. This is compared with vaginal rhabdomyosarcoma which commonly exhibits both localized and distant spread.