Young Woman With Vulvar Mass.

Abstract

A 20-year-old woman presented to the emergency department with a 2-month history of a left groin mass, which slowly grew after mild blunt trauma. The mass became painful 2 days ago, but she denied vaginal discharge, pain, abnormal bleeding, or dysuria. Physical examination revealed an asymmetric, indurated, tender mass over the left lateral aspect of the mons pubis extending through the labia and inguinal area. (Figure 1) Bedside ultrasound evaluation showed a complex lesion without obvious fluid collection or Doppler flow (Figure 2), and computed tomography confirmed (Figure 3) a 9-centimeter soft tissue density.Figure 2Bedside ultrasound showed heterogenous mass without fluid collection or Doppler flow.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Computed tomography of pelvis with contrast demonstrated a peripherally enhancing 9 cm soft tissue density in the left inguinal region (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Epithelioid sarcoma. After surveillance imaging results of the abdomen and thorax were negative, surgeons performed a core biopsy to confirm the diagnosis. The patient underwent neoadjuvant chemotherapy with prophylactic salpingectomy and planned resection. Soft tissue sarcomas represent an eclectic group of rare neoplasms, and epithelioid sarcoma is an aggressive subtype more commonly affecting young men, typically as a firm, painless distal extremity lesion that is notably associated with slow growth after trauma.1Popovich J.R. Kashyap S. Cassaro S. Sarcoma StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL)2022 Janhttps://www.ncbi.nlm.nih.gov/books/NBK519533/Date accessed: March 7, 2022Google Scholar, 2Sobanko J.F. Meijer L. Nigra T.P. Epithelioid sarcoma: a review and update.J Clin Aesthet Dermatol. 2009 May; 2: 49-54PubMed Google Scholar, 3Enzinger F.M. Epitheloid sarcoma. A sarcoma simulating a granuloma or a carcinoma.Cancer. 1970; 26: 1029-1041Crossref PubMed Google Scholar, 4Andrisani A. Serena A. Ambrosini G. Capobianco G. Chiarelli S. Proximal-type epithelioid sarcoma of the mons pubis: report of a case.Eur J Gynaecol Oncol. 2011; 32: 339-342PubMed Google Scholar A lesion of the mons pubis is rare. Prognosis is generally poor as epithelioid sarcoma has a propensity for local recurrence and distant metastases.2Sobanko J.F. Meijer L. Nigra T.P. Epithelioid sarcoma: a review and update.J Clin Aesthet Dermatol. 2009 May; 2: 49-54PubMed Google Scholar,5Patrizi L. Corrado G. Saltari M. et al.Vulvar “proximal-type” epithelioid sarcoma: report of a case and review of the literature.Diagn Pathol. 2013; 8: 122Crossref PubMed Google Scholar Benign etiologies such as cysts, abscesses, or lipomas are clinically similar.