34089 Syringoma of the vulva associated with vulvar hypertrophy

Abstract

Syringoma is a benign eccrine sweat gland tumor most commonly presenting in young adults as multiple, often clustered, soft 1-2 mm papules on the lower eyelids and cheeks. There is a female predominance and lesions tend to arise after puberty. Syringoma of the vulva is less common with fewer cases reported. Here we describe a case of a 35-year-old woman who presented with multiple pruritic skin-colored papules on the labia majora which had been present for 7 years and were increasing in size and number. The lesions were a source of distress with intimate encounters and the associated vulvar thickening was visible under some clothing. Examination revealed numerous coalescing, 2-4 mm skin-colored, slightly rubbery papules on the bilateral labia majora with associated vulvar hypertrophy. A biopsy showed small comma-shaped ducts and solid cords of epithelium surrounded by a fibrotic stroma compatible with a diagnosis of syringoma. Various treatment options were presented, including excision, carbon dioxide laser ablation, and topical atropine, although surgical excision was favored given the extent of the lesions and resultant hypertrophy. Our case highlights the importance of keeping vulvar syringoma in the differential diagnosis of patients with bilateral vulvar papules, vulvar pruritus and/or vulvar hypertrophy, as well as recognizing the potential impact of this benign condition on patient quality of life.