It is likely an "adenoid basal tumor". It is often seen in cervix or vagina near cervix. Pure viginal adenoid basal tumor is vanishingly rare. It is a HPV-related lesion and patients often have history of abnormal cervical cytology. Immunostaining of p16 should be diffusely positive as seen in high grade dysplasia of the cervix. It includes adenoid basal epithelioma and adenoid basal carcinoma depending on invasiveness or not and cytological atypia. Since I do not see all the slides from this "lesion", I can only provide a diagnosis of "adenoid basal tumor".  I AM CURIOUS TO KNOW THIS PATIENT'S PAP SMEAR HISTORY AND HPV STATUS, if you can provide. Thanks for sharing!

谢谢杨老师的讲解！

这个病例是我很早的病例，病人做没做宫颈细胞学巴氏涂片以及HPV检测我还真没有印象，这几天我尽量查询一下。

我当时的思路是这样的：

阴道正常组织学：

阴道壁由内向外为1.黏膜、2.肌层和3.外膜。

1.黏膜由上皮和固有层组成。黏膜向阴道腔内突形成许多横行皱襞。上皮较厚，为非角化型复层扁平上皮，排卵前后、在卵巢分泌的雌激素作用下、上皮细胞内聚集大量糖原。浅层细胞脱落后，糖原在阴道杆菌作用下转变为乳酸，使阴道液酸性，能抑制病菌生长。老年或某些原因导致雌激素水平下降时，阴道上皮细胞内的糖原减少，阴道液变为碱性，细菌容易生长繁殖而发生阴道感染。阴道上皮的脱落和新生与卵巢活动周期关系密切，因而根据阴道脱落上皮细胞类型的不同可推知卵巢的功能状态。故临床上常将阴道涂片法做为生殖道疾病，特别是宫颈癌的检查方法之一。

固有层的结缔组织富含弹性纤维和血管，浅层致密，深层疏松；

2，肌层由内环外纵并相互交织的平滑肌构成，富有扩张性。阴道外口处有骨骼肌构成的括约肌；

3.外膜为纤维膜，为致密结缔组织，内有许多弹性纤维。

阴道腺病：正常阴道无腺体存在，阴道若出现腺体组织，称为腺病，

鉴别诊断：1.中肾管残留。

         2.子宫内膜异位

         3.鳞癌。

还请老师批评指正！谢谢！您认为腺体出现异常了，可我认为细胞还不够异型，顶多为不典型性，不好意思！

学习了，谢谢！

 If you have a tissue block of this case, you can perform a p16 immunostaining to confirm the diagnosis. I do not think this is any of differential diagnoses you listed, such as mesonephric reminants (usually small glands or tubules with condense pink secretion in lumen), endometriosis (should be endometrioid glands with surrounding endometrial stroma), and squamous cell carcinoma (obviously not yet). This is not usual vaginal adenosis we have seen. It is also not ectopic mammary glands. Adenoid basal tumor is the best I can come up. I hope this is helpful for discussion.

好的，我标记一下P16。

谢谢！

阴道腺病

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