Labial Mass Research Articles

Pedunculated Angiomyofibroblastoma of Labia Minora: A Case Report and Review of the Literature

Background: Angiomyofibroblastoma was first described by Fletcher et al. in the year 1992. It is a distinctive benign tumor that most often occurs in the superficial area of the vulva and is rarely reported in men in the inguinoscrotal region. Case Presentation: A 23-year-old female presented with a painless pedunculated labial mass which was initially pea-sized and reached 7 cm in maximum dimension over four months. The case was diagnosed on morphology, IHC and the patient was treated surgically. The interesting feature of the case was the rarity of its incidence at labia minora and pedunculated form and its resemblance to other benign and more aggressive tumours. To the best of our knowledge, the extensive English literature search revealed only seven cases of pedunculated angiomyofibroblastoma at labia majora in middleaged female and one case of labia minora in a young female. Conclusion: The lesion must be differentiated from another benign mesenchymal tumor of vulva which requires extensive surgical management.

Efficacy of digital guide-assisted implant restoration in anterior teeth aesthetics and its impact on labial bone mass.

To analyze the efficacy of digital guide-assisted implant restoration technique in enhancing the anterior teeth aesthetics and its impact on labial bone mass. We retrospectively analyzed clinical data from 90 patients who underwent maxillary anterior teeth implant restoration at The First People's Hospital of Fuyang, Hangzhou, from January 2021 to September 2023. The patients were divided into two groups: a conventional group (n=45, 45 implants, standard implant restoration) and a digital group (n=45, 45 implants, digital guide-assisted implant). We compared implant positional deviations, changes in dental plaque index (PLI), aesthetic effect scores, labial bone mass differences, and the occurrence of adverse reactions post-treatment between the two groups. The digital group exhibited significantly less deviation in root position in the buccolingual and vertical directions, less neck deviation in the buccolingual and vertical directions, and less apical deviation than the conventional group (P=0.021, P=0.005, P=0.016, P=0.008, P=0.026, respectively). Three months postoperatively, the digital group demonstrated a significantly lower mean PLI (P<0.001), higher white and pink aesthetic scores (P=0.021, P=0.005), and increased alveolar ridge height and coronal and middle labial bone mass (P=0.006, P=0.015, P=0.008). Additionally, this group experienced lower incidence of adverse reactions (4.44% vs. 17.78%) compared with the conventional group (P=0.044). The digital guide-assisted implant restoration significantly enhances implant accuracy, reduces bone resorption, improves aesthetic outcomes, and ensures higher safety.

Influence of bone morphology on the mechanobiological stimuli distribution of maxillary anterior labial bone: A biomechanical study.

This study intended to ascertain the dimensional effects of labial bone thickness and height on the mechanobiological stimuli distribution of maxillary anterior labial bone through biomechanical analysis. Twelve 3D finite element models of an anterior maxillary region with an implant were computer-simulated, including four levels of labial bone thicknesses (2, 1.5, 1.0, and 0.5 mm) and three levels of labial bone heights (normal, reduced by 1/3, reduced by 1/2). A 45° buccolingual oblique load of 100 N was applied to the implant restoration. Equivalent stress and principal strain mainly concentrated on crestal bone around the implant neck. The maximum equivalent stress in bone decreased as labial bone mass decreased, while the maximum principal strain and the displacement of dental implant increased as labial bone mass decreased. No significant difference of these three indicators was observed, when the labial bone thickness changed in the range of 2.0-1.0 mm with sufficient labial bone height. In terms of biomechanics, the thickness of labial bone plate was recommended ≥1 mm. Sufficient labial bone height was warranted to prevent the stability of the implants from being seriously affected. The labial bone heights were more effective than thicknesses on the mechanobiological stimuli response of the dental implant-bone system. For this 3D finite element study, the biomechanical responses under different bone mass conditions were explored, in order to predict the process of bone remodeling and provide valid clinical recommendations for the decision-making process regarding the choices of tissue augmentation for some specific esthetic implantation cases for future clinical applications.

Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques.

Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques.

Incarcerated Hematosalpinx in the Canal of Nuck

The canal of Nuck is an abnormal pouch of parietal peritoneum extending from the round ligament through the inguinal canal into the labia majora. The incidence of inguinal hernia in the pediatric population is 0.8% to 4.4% [ 1 Chan D Kwon JK Lagomarsino EM Veltkamp JG Yang MS Pfeifer CM. Canal of Nuck hernias. Acta Radiol Open. 2019; 82058460119889867 PubMed Google Scholar , 2 Thomas AK Teague CT Jancelewicz T. Canal of Nuck hernia containing pelvic structures presenting as a labial mass. Radiol Case Rep. 2018; 13: 534-536 Crossref PubMed Scopus (9) Google Scholar ].

Bell clapper deformity in female?

IntroductionIndirect inguinal hernia is one of the most common congenital anomaly common in males, but not uncommon in females. In females, inguinal hernia mostly indirect, containing ovary presenting as a palpable labial mass is common, resulting in strangulation, torsion, and infertility if left untreated.ImportanceThe bell clapper deformity (BCD) is an important anatomical risk factor for intra vaginal testicular torsion, its presence in females is hardly been speculated.Case presentationA 6 months female baby presenting with tender labial mass, its management has been discussed here.Clinical discussionThe bell clapper deformity, in which the tunica vaginalis inserts high on the spermatic cord, leaving the testis free to rotate and get torted, however its presence in females has never been explored.ConclusionBell clapper deformity's existence in females yet to be speculated before exploration.

A young infant with complete androgen insensitivity syndrome

Complete androgen insensitivity syndrome (CAIS) is a rare X-linked recessive disorder resulting from maternally inherited or de novo mutations involving the androgen receptor (AR) gene. The AR is a vital steroid hormone receptor that has a critical role in male sexual differentiation and development and preservation of the male phenotype. The diagnosis of CAIS is based on the presence of female external genitalia in an individual with 46, XY karyotype having normally developed but undescended testes and target tissue unresponsiveness to androgen. Our case presented at the age of 2 months with asymmetric labia majora with bilateral labial mass. Ultrasonography revealed absence of female internal genital organs and presence of testes at labial folds. The child was found to have 46, XY karyotype. BIRDEM Med J 2022; 12(1): 74-77

A Rare Case Report of Out of the Ordinary Canal of Nuck Hernia Encompassing Pelvic Structures, Showing up as a Labial Mass

A Rare Case Report of Out of the Ordinary Canal of Nuck Hernia Encompassing Pelvic Structures, Showing up as a Labial Mass

Herniation of the uterus, ovaries and fallopian tubes into the canal of Nuck in a 4-month-old child: A rare entity.

Partial or complete failure of obliteration of the processus vaginalis in the female results in the formation of a potential space known as the canal of Nuck, into which various organs and/or collections can herniate. A 4-month-old female presented with a left labial mass related to herniation of the uterus, ovaries and fallopian tubes through the canal of Nuck. Early diagnosis is important as there is a high risk of ovarian torsion and incarceration.

Vulvar Leiomyomatosis: A Diagnostic Challenge Case Report

Introduction: Vulvar leiomyomas are rare and usually misdiagnosed as Bartholin’s cyst on initial presentation. Leiomyoma of vulva accounts for only 0.03% of all gynecological neoplasm. Definite diagnosis is based on surgical excision of the tumor. The aim of this report is to introduce a case of leiomyoma of the vulva which was initially misdiagnosed as Bartholin’s cyst. Case Presentation: We present a case of a 36-year old virgin female (BMI&gt;30) who was referred to the clinic with a 5-year history of left labial mass which was initially diagnosed as Bartholin’s cyst. The mass was removed and the pathologist confirmed that the final diagnosis was vulvar leiomyoma. Conclusion: Vulvar leiomyoma is usually misdiagnosed with Bartholin cyst and distinguishing between benign and malignant forms is confusing, so it is a diagnostic challenge. Surgical excision is the treatment of choice in all smooth muscle tumors of the vulva. Continuing follow-up after treatment is highly recommended.

LIP OSTEOLIPOMA, CLINICAL AND SURGICAL MANAGEMENT OF AN INFREQUENT DISEASE

Lipomas are relatively infrequent mesenchymal benign neoplasms of oral soft tissues. A wide range of subtypes of lipomas have been previously described, including fibrolipoma, angiolipoma, pleomorphic lipoma, and osteolipoma. The aim of this study is to present a clinical case of an 83-year-old man with a painless labial mass of 20-year duration with a remarkable increase in the size of the lesion in the last 2 years. Oral examination revealed a yellowish and sessile mass located in the lower labial mucosa. The provisional diagnosis was a lipoma, but during its surgical excision, a cartilaginouslike tissue was noticed generating some doubts about our previous diagnosis. The histopathologic findings revealed mature adipocytes surrounding bone tissue and the final diagnosis was osteolipoma. The presence of bony calcifications within this tumor could be related to metaplastic changes during the evolution of the lesion. This rare presentation was previously reported with different oral locations.

Canal of Nuck Abnormalities.

Canal of Nuck abnormalities are underrecognized causes of labial masses with potential adverse outcomes. The 2 main categories of canal of Nuck abnormalities are hernias and hydroceles. There are 3 types of canal of Nuck hydroceles: communicating, encysted, and bilocular. Canal of Nuck hernia contents vary, but those containing ovaries need urgent medical attention because of an increased risk of ischemia. Ultrasound can establish a definite diagnosis in all cases. This article reviews the embryologic characteristics, anatomy, pathologic characteristics, and imaging features of these abnormalities while providing a clear pictorial depiction of various unique hernias and hydroceles seen with this entity.

Aggressive Angiomyxoma: A Rare Cause of Recurrent Vulval Swelling

This is a case report of a 28-year female with aggressive angiomyxoma who presented with recurrent vulval swelling for which she was operated four times. First time, at the age of 19 years thinking it to be a Bartholin’s duct cyst, that on histopathology found to be angiomyxoma. Swelling recurred as left labial mass within a year of surgery. Second time, she underwent wide excision of the left labial mass, and on immunohistochemistry, it was positive for estrogen and progesterone receptors for which she was offered hormonal treatment, but she denied. Third time, she underwent robotic surgery because upper extent of tumor was deep in the pelvis and was not approachable by perineal route. After 2 years, swelling recurred again for which she got operated fourth time after her pregnancy. Now she has been given GnRH agonist and is being followed up for recurrence.

Diagnostic and Management Challenges Associated With Vulvar Crohnʼs Disease

Crohn's disease(CD) is an IBD with extra intestinal manifestations such as arthritis, uveitis, erythema nodosum. Crohn's disease of the vulva is a rare and under recognized condition, particularly because it may not involve GI tract. The diagnosis and treatment of this condition remains a challenge. We present a case of Vulvar Crohn's which has been an extremely difficult case to manage. Our patient is a 29 y/o female with 10 year h/o vulvar Crohn's disease presenting as painful fissures, perirectal and labial masses. On physical exam, there was erythema, induration and severe edema of labia majora, minora and perianal area. She underwent biopsy of the lesions which was confirmed to be Crohn's disease. Even though she had no GI symptoms, she underwent colonoscopy to determine the extent of her disease and it was normal. Patient was tried on several medications including metronidazole, steroids, 6-MP, infliximab, adalimumab, methotrexate, azathioprine, certolizumab,ustekinumab and vedolizumab. However, she failed to respond to any of these therapies. Patient was referred to plastic surgery for partial vulvectomy, biopsy of which showed high grade vulvar intraepithelial neoplasia (VIN) in addition to Crohn's (dermal chronic inflammation with granulomas). She was then referred to colorectal surgery for management of perianal disease, and gynecology for evaluation of VIN. She also underwent excision of anal skin tags and anal mapping, with pathology demonstrating positive P16 in squamous epithelium consistent with high grade AIN. Vulvar Crohn's is an under-recognized condition with about 100 cases reported to date. It can occur by direct extension from perianal region or by metastatic spread from bowel. Vulvar CD may precede intestinal involvement in about 25% of cases. It usually presents with edema, ulcerations and fissures of the vulva. Patients may be asymptomatic or present with pain, pruritis, discharge and dyspareunia. Diagnosis requires a high degree of suspicion as it could be mistaken for other conditions like infections, sarcoidosis etc. Diagnosis is confirmed by biopsy. Treatment remains a challenge and no treatment guidelines exist. A multidisciplinary approach is recommended and medications including steroids, thiopurines, TNF-α antagonists could be used. However, patients may not respond to any medications and surgery remains an option. Clinicians must be astute to consider neoplasia in this situation, as was seen in our patient.Figure: Microscopic findings of the epiglottis biopsy demonstrating in the high- and low-power fields ulcerated squamous mucosa with chronic inflammatory changes.

Small bowel through the canal of nuck causing urinary retention

The differential diagnosis of indirect inguinal hernia in women can be a challenge to the surgeon as symptoms can vary from chronic pelvic pain to even a palpable labial mass. Indirect inguinal hernia is usually congenital, and a patent canal of Nuck can complicate a hernia with hydrocele. Contents of the hernia sack include small bowel, part of the urinary bladder, or an ovary. This is a case report of an indirect inguinal hernia in a 57-year-old woman presented as a labial mass that caused intermittent urinary retention for a year before she decided to seek medical attention. After a CT scan that confirmed the diagnosis of hernia, the patient underwent a herniorrhaphy with a plug mesh. The sack contained small bowel. After the herniorrhaphy the urinary symptoms disappeared. In conclusion, an inguinal hernia can present as a labial mass causing urinary symptoms without including the bladder or ureter.

Yolk Sac Tumor in Extragonadal Pelvic Sites: Still a Diagnostic Challenge.

We present the clinicopathologic features of 15 cases of extragonadal yolk sac tumor (EGYST) detected in female patients and reviewed at our institution from 1988 to 2016. We recorded: patient age, clinical presentation, tumor location, FIGO stage (where applicable), histologic patterns including presence/absence of Schiller-Duval bodies, other germ cell or somatic components, immunoperoxidase results, treatment, and outcome. Patients' ages ranged from 17 to 87 (median, 62) years and presentation included: abnormal uterine bleeding, 12; hematuria, 1; labial mass, 1; abdominal pain, 1. Primary sites were as follows: uterus (11), vagina (1), vulva (1), bladder (1), and peritoneum (1). Seven patients presented at FIGO stage III or IV. The following histologic patterns were observed: microcystic/reticular (7), glandular (8), solid (8), papillary (5), and hepatoid (1). An admixture of histologic patterns was present in 10 cases. Schiller-Duval bodies were seen in only 3 (23%) cases. Eight cases (46%), all uterine primaries, had associated somatic components, and 2 (15%) had a second germ cell component. In 13/14 (93%) cases, the yolk sac tumor component was either missed or misclassified as adenocarcinoma. Immunoperoxidase studies facilitated the diagnosis in all cases as follows: SALL4, 12/12; CDX2, 10/12; α fetoprotein, 7/14; glypican-3, 9/10; cytokeratin 20, 5/9 (rare cells); cytokeratin 7, 3/12 (nondiffuse); PAX8, 2/9 (variable expression). All patients received chemotherapy and all except 1 underwent surgical resection. Follow-up from 5 to 86 months was available for 13 patients: 5 died of disease, 6 are alive with disease, and 2 have no evidence of disease. EGYST arising in the female pelvis of peri/postmenopausal patients may be associated with a somatic component and represent either somatically derived YST or YST differentiation within a somatic carcinoma. EGYST in younger patients is likely a true germ cell neoplasm, and may respond to germ cell appropriate chemotherapy. The benefit of germ cell appropriate chemotherapy in somatically derived EGYST is less clear. Awareness that the presence of glandular or microcystic patterns may lead to under-recognition or misdiagnosis of EGYST in combination with immunomarkers for germ cell and yolk sac differentiation will facilitate the diagnosis.

An unusual cause of neonatal introital mass, paraurethral (Skene s duct) cysts: A case report and review of the literature

Paraurethral cysts or Skenes duct cysts are a rare cause of inter labial mass in a neonate. The precise etiology of paraurethral cyst is unknown. A thorough urologic evaluation was required to differentiate it from an ectopic ureterocele, urethrocele, urethral diverticula, and benign or malignant urethral and paraurethral tumors. A day 7 female baby was brought to us with history of asymptomatic introital mass noticed at day 4 of life. It was displacing urethra supero-laterally to the left and the vagina inferiorly with normal cystogenitoscopy. Simple excision of cyst was done uneventfully. Though asymptomatic, because of cosmetic and parental anxiety, and for a definitive diagnosis, simple excision of cyst was done uneventfully without recurrence.

A Case Report of Aggressive Angiomyxoma in Pregnancy: Do Hormones Play a Role?

Aggressive angiomyxoma is a rare, locally invasive tumor that generally affects the perineum and pelvis of reproductive age females. Aggressive angiomyxoma is often misdiagnosed, resulting in the delay of the treatment. Case reports show increased growth of the tumor during pregnancy, thus suggesting a hormonal dependency. We report this rare condition in a 29-year-old primigravid female with a growing mass on the right labium majus at 20 weeks' gestation. The patient also developed a smaller mass on the left labium majus at 37 weeks' gestation. The patient underwent a primary cesarean section with resection of the right labial mass, with a final diagnosis of aggressive angiomyxoma. The lesion on her left labium majus resolved spontaneously postpartum. This case report supports a hormonal involvement in this tumor.

Leiomyoma of the Vulva: A Diagnostic Challenge Case Report.

Uterine leiomyomas are common and can affect up to 30% of women older than 35 years. Despite this, leiomyomas of the vulva are rare, masquerading, and usually misdiagnosed as Bartholin cyst preoperatively. These smooth muscle tumors are typically painless, solitary, and well circumscribed and can affect female of any age group. We present a case of a 46-year-old female that presented to the clinic with 2-year history of right labial mass and was diagnosed as Bartholin cyst initially. The patient underwent elective excision under spinal anaesthesia and the mass was removed. The final diagnosis after microscopy result showed benign vulvar leiomyoma.

Evaluation of the neonates with anomalies of the external genitalia in our hospital

Evaluation of the neonates with anomalies of the external genitalia in our hospital Objective: To determine the prevalance of external genital abnormalities among neonates in our hospital. Material and Method: A total 3437 neonates delivered at Sisli Hamidiye Etfal Hospital between January 2010- December 2010 were examined at birth for external genital abnormalities. The presence of cliteromegali, inguinal / labial mass, hypospadias, micropenis, and undescended testicles and ambigus genitalia were examined. Results: The study identified 20 (6/1000) neonates with external genital abnormalities. All of them were examined within 3 days of life. Morphological abnormalities comprised: undescended testes (cryptorchidsm)(12/20), isolate hypospadias (5/20), cliteromegali (1/20), epispadias (1/20) and ambiguous genitale (1/20). The incidence of hypospadias and cryptorchidism were found 0.34%, 0.23%, respectively. Prematurity occured in 4/20 cases. Congenital adrenal hyperplasia were detected in two cases. Conclusions: External genital anomalies are among the most common congenital anomalies. Proper early diagnosis and management of genital abnormalities are of great importance to minimize medical, psychological and social complications. Our result reinforce the importance of a careful examination of genital morphology in neonatal period towards the recognition of minor defects that can be clinical features of a disorder of sex devolpoment.