Successful management of a giant primary epidermoid cyst arising in the labia majora

Abstract

The occurrence of vulvar epidermoid cysts is uncommon. Vulvar epidermoid cysts are usually multicystic, with the vast majority of locules being <1 cm in diameter [1]. These cysts generally grow slowly and stop growing after reaching 5 cm in diameter [2,3], with the reported largest size of 8 cm 7 cm [2,4]. It is documented that the clitoris is the most commonly involved structure [2,3,5,6]. The main etiology is female genital surgery or trauma causing an invagination of squamous epithelium and then desquamating into a closed space to form a cystic mass [1,2,5,6]. Most of these cysts require no treatment unless they become infected or painful. Treatment options include local heat application, incision and draining, or excision [1]. Vulvar epidermoid cysts without recallable traumatic or surgical histories are extremely rare [4]. A large vulvar epidermoid cyst may present a surgical challenge. In this report we describe the management for a giant primary epidermoid cyst in the labia majora of an adult woman. A 33-year-old, gravida 0, para 0 woman presented to the gynecology outpatient department with a right painless vulvar mass, which had been noticed since the age of 12 years. The patient denied sexual exposure or vulvar trauma. Her medical and surgical histories were unremarkable. Recently, the vulvar mass had been increasing in size and interfered with the patient’s daily activities, which drove her to seek treatment. Physical examination revealed a 15-cm soft, movable, and nontender mass in the right labia majora. The mass extended to the pubic rami anteriorly, buttock posteriorly, inner thigh laterally, and labia minora and clitoris medially (Fig. 1).