Labial Swelling Research Articles

A Single-Center Study on Clinico-Radiological Evaluation of Inguino-Scrotal or Labial Swellings Presenting to a Tertiary Care Set-Up in Central India.

Introduction The inguino-scrotal/labial region, anatomically defined as the juncture where the thigh meets the lower abdomen, encompassing the ipsilateral scrotal area in men and the inguino-labial area in women, exhibits a broad spectrum of masses. Traditionally, these swellings were clinically diagnosed with high accuracy, primarily due to the prevalence of simple hernias and hydroceles. However, contemporary observations reveal a surge in complex inguino-scrotal/labial swellings, particularly in referral hospitals, necessitating additional radiological and imaging modalities for precise diagnosis. Our interest in this subject was sparked by the escalating numbers of intricate inguino-scrotal/labial masses encountered in our medical setting, posing challenges for clinical diagnosis in both pediatric and adult populations. Materials and methods A prospective, observational study was conducted over two years (August 2021 to March 2023) involving 210 patients presenting with inguino-scrotal/labial swellings at our institute. Clinical data were meticulously collected using a designed pro forma, following informed consent procedures. Results Among the 210 patients with inguino-scrotal/labial swellings, males predominated (194) compared to females (16). The paediatric age group comprised 84 patients, while 126 were adults. Radiological investigations played a crucial role in diagnosing 40 patients and provided significant additional information in 12 cases. Radiological investigations contributed to the diagnosis in 52 patients (24.76%). The study revealed a spectrum of new entities in the inguino-scrotal/labial region, including malignancies, lymph nodal masses in the groin, and vascular, inflammatory, and congenital lesions, which might have been overlooked if solely relying on clinical parameters for diagnosis. Conclusion Inguino-scrotal/labial swelling patients, especially those facing diagnostic dilemmas or harbouring complex lesions, should undergo radiological assessment as an indispensable criterion, particularly when such facilities are readily accessible.

36. Cutaneous Mastocytosis Presenting as Isolated Unilateral Labial Swelling

36. Cutaneous Mastocytosis Presenting as Isolated Unilateral Labial Swelling

Intentional Replantation to Seal Apical and Lateral Canals in A Failed Endodontically Treated Tooth: A Case Report

Intentional replantation (IR) is often viewed as a last-resort intervention for failed endodontically treated teeth. This case report presents the successful management of symptomatic apical and lateral lesions through IR, highlighting its potential as an effective solution for challenging endodontic cases. A 45-year-old female patient presented with persistent pain and recurrent labial swelling in the vicinity of her left anterior tooth. Cone-beam computed tomography revealed endodontic lesions at both the apical and mesial aspects of tooth #21, leading to a diagnosis of symptomatic apical periodontitis. The IR procedure involved meticulous preparation and sealing of both apical and lateral canals with calcium-enriched mixture cement. One-year post-treatment, the patient remained asymptomatic, with clinical and radiographic assessments demonstrating a favorable prognosis and evidence of bone healing. This case demonstrates the successful management of symptomatic apical and lateral lesions through IR, offering an effective solution for challenging endodontic cases.

C1 (Clinical Case) Case Presentation: Acute Genital Ulceration in a 15-Year-Old Girl

Abstract Introduction/Background Genital ulceration may occur in various conditions, and requires a systematic approach to its diagnosis. This should include consideration of both infectious and non-infectious etiologies. The most common causes of genital ulceration are herpes simplex virus (HSV) types 1 and 2 and syphilis (Treponema pallidum). Genital HSV may be asymptomatic or painful, and may present with inguinal lymphadenopathy, and fever. Primary syphilis may escape recognition as it presents with a single, painless, well-demarcated “chancre” that heals spontaneously in 3-6 weeks. Non-infectious etiologies of genital ulceration can include cutaneous drug reactions, and mechanical or chemical trauma. Granulomatous genital inflammation can be an extra-intestinal manifestation of Crohn’s disease characterized by pathognomonic “knife-cut” vulvar ulcers. This report presents a case of Lipschütz’s ulceration, or reactive non-sexually-acquired genital ulceration, as an under-recognized cause of genital ulcers in children. Case Description A previously healthy 15-year-old female presented to the emergency department with six days of daily fevers, and 72 hours of non-bloody diarrhea that had self-resolved. In addition, she complained of nausea and a headache. Notably, in the last day, she had developed labial swelling, perianal pruritus, and vaginal burning. On history, her last menstrual period was one week ago, and she was not sexually active. It was noted that she had consumed Kinder-SurpriseTM eggs in the last week, which had been recently recalled for Salmonella contamination. Pelvic exam initially showed multiple hemorrhagic vesicles involving the labia minora (Fig. 1A). On day one of admission, she developed two symmetric, well-delimited ulcers at the 5 o’clock and 7 o’clock positions on the labia minora, each 12 mm x 5 mm in size (Fig. 1B). By the second day of admission, she had dysuria requiring catheterizing. HSV, chlamydia and gonorrhea were not detected on vaginal swabs, and serologic testing for syphilis was negative. Salmonella montevideo was detected on her blood cultures and she was started on intravenous antibiotics. Her vulvar ulcers improved with a conservative regimen of local hygiene, wound care, and pain control. The final diagnosis was of Lipschütz’s ulceration (LU). Discussion LU is characterized by the sudden onset of necrotic and painful genital ulcers, and typically occurs in young (< 20 years old), sexually inactive females who have no history of genital ulcers, and were not previously affected by a chronic inflammatory condition. In LU, there are usually 1-3 lesions that are large (>10 mm), shallow and well-delimited. These tend to occur on the medial aspects of the labia minora and vestibule and have a symmetric “kissing” distribution on opposing surfaces. Voiding disorders, aphthous ulcers and enlarged inguinal lymph nodes have also been reported in LU. The pathophysiology of LU is not well understood. It often occurs concomitantly with an infectious disease and develops before its resolution. LU is most associated with Epstein-Barr virus, but has also been described with cytomegalovirus, mycoplasma species, Toxoplasma gondii, and influenza A and B. LU is self-limited and generally resolves without recurrence or long-term sequelae within 3 weeks. For analgesia, topical lidocaine is recommended, especially 5-10 minutes before micturition. Sitz baths, application of a bland barrier cream prior to and after voiding, avoidance of pads and underwear, and maintenance of good hydration to minimize irritation by concentrated urine also constitute important components of supportive care for LU. Conclusion Lipschütz’s ulcers are poorly understood and therefore under-diagnosed, or mis-diagnosed as herpes simplex infection, in which case they are treated with acyclovir without benefit. Identification of an etiologic trigger, such as a viral or bacterial infection, can aid in their appropriate detection. To date, there is one other reported case of LU associated with salmonella. This case report aims to describe LU as an uncommon but important entity in the paediatric population. Images

An Account of a Giant Adolescent Vulvar Lipoma

AbstractThough they are commonly known as “universal tumors,” lipomas are rarely found in the vulva. In this report, we discuss the case of a 15-year-old girl who presented with an enormous (26.5 × 21.5 × 6.5 cm) left labial swelling that had been progressively enlarging for a year and had led to extensive distortion of the vulvar anatomy. Following imaging, surgical excision with vulvar reconstruction was performed focusing on esthesis and function. Pathological examination confirmed the clinical and radiological diagnosis of a lipoma. The patient is doing clinically well at 1 year of follow-up with significant improvement in her academic performance and self-esteem.

Upper Labial Mucosa Schwannoma: A Rare Case Report

An upper lip swelling, asymptomatic, and benign-looking lesion may be attributed to numerous aetiologies. About 25% to 45% of Schwannomas/Neurilemmomas occur in the head and neck region and are seldom seen in oral sites, accounting form only 1% of cases. Herein, the authors presented a case report of a 36-year-old female patient with a clinical appearance of upper labial mucosa swelling is mentioned, which mimicked a mucocele. It was a single, smooth, oval, fluctuant, and non tender swelling. Complete surgical excision was performed following proper protocol, and histological diagnosis revealed a well-outlined lesion enclosed within a fibrous capsule. The connective tissue mass of the tumour consisted predominantly of neural tissue arranged in Antoni A structures, characterised by a palisaded nuclear arrangement and the presence of distinctive eosinophilic Verocay bodies. Another area with a myxoid appearance, representing Antoni B structure, was also present, suggesting a Schwannoma/Neurilemmoma. During follow-up, complete healing with no recurrence of swelling was observed. Schwannomas/Neurilemmomas in the head and neck region are less common, particularly in the oral cavity. According to various studies, the occurrence of neurilemmomas in the intraoral aspect accounts for only 19.24% of cases, specifically involving the mucosa of the lip. Practitioners should consider this rare entity of Schwannoma/Neurilemmoma when evaluating an upper lip swelling routinely.

Nonvirilized external genitalia in a Nigerian female neonate with salt-wasting congenital adrenal hyperplasia

Abstract A 3-week-old female neonate presented with complaints of weakness and inability to feed. She had been delivered at a general hospital with a birth weight of 3.3 kg. She had jaundice, which was treated with phototherapy and resolved after 3 days. Pregnancy and delivery were uneventful. Parents identified her as female. Examination revealed hanging skin folds, dehydration, tachycardia, hyperpigmentation and swelling of the labial folds, no clitoromegaly, and no palpable gonads. She had lost 30% of her birth weight and was hypoglycemic. Serum investigations showed hyponatremia, metabolic acidosis, hyperkalemia, and hypocortisolemia with elevated testosterone and 17-hydroxyprogesterone. Pelvic ultra sound scan showed normal-sized uterus and no testes suggesting a diagnosis of salt-wasting congenital adrenal hyperplasia (CAH). She is being managed with hydrocortisone, fludrocortisone, and added salt to feeds. Labial swelling and hyperpigmentation have resolved and external genitalia is typically female in appearance. She is gaining weight and thriving. Salt-wasting CAH can present with adrenal crisis without obvious virilization of the external genitalia in the female neonate and can be diagnosed by scrutiny of electrolytes in the sick neonate.

A case report of Actinomyces-associated vulvar necrotizing soft tissue infection: Aspects of multidisciplinary care.

Introduction and importanceNecrotizing soft-tissue infections are life-threatening infections with significant morbidity and mortality.Case presentationA 36-year-old female gravida 1 para 1001 with a history of intravenous drug use and homelessness presented to the emergency department for a three-day history of labial pain, swelling, and fevers. A contrast tomography scan revealed necrotizing soft tissue infection of the mons and vulva with subcutaneous gas. Empiric broad-spectrum antibiotics were initiated. She underwent an emergent two-staged surgical debridement and delayed primary closure after 1-month in the hospital. She was discharged to complete a 9 to 12 month course of antibiotics. Multidisciplinary team was central to patient care.Clinical discussionNecrotizing soft tissue infections are a diverse group of infections affecting the subcutaneous tissue, muscle, and fascia. Actinomyces is a rare cause and require long-term antibiotics. Early recognition and emergent surgical debridement has been shown to reduce morbidity and mortality. A multidisciplinary approach is critical for proper wound care and healing, pain management, and long-term follow up.ConclusionsActinomyces-associated vulvar NSTIs are life-threatening infections requiring early surgical debridement, long-term antibiotics, and multidisciplinary approach.

Persistent Unilateral Labial Swelling After Straddle Injury and Contralateral Hematoma Evacuation

Background: Blunt trauma to the external female pelvis or “straddle injury” can usually be managed conservatively. Emergent surgery is indicated for unstable bleeding, need for thorough exam with penetrative trauma or expanding hematoma. Long-term complications after a straddle injury may include pain, scarring, recurrent hematoma or persistent edema.

An unexpected finding in a labial swelling

An 18-year-old male was referred to our institution with a labial swelling of 45 days of evolution located on the upper lip. The patient was healthy, without systemic diseases or mental disabilities. No relevant family medical history was recorded during anamnesis. The patient mentioned that the lesion began as a painful small inflammation of the lip that increased in size. The patient consulted a general physician, who ordered laboratory tests to rule out syphilis diagnosis. Subsequently, the patient was treated with amoxicillin for 1 month with no improvement of the lesion.

26118 Cutaneous Crohn masquerading as hidradenitis suppurativa

A 20-year-old female presented for possible hidradenitis suppurativa. She had an itchy, painful lesion on her labia majora for >2 years, with flares every few weeks. Physical examination was significant for hyperpigmented and erythematous plaques with fissuring of the labia majora and perianal region. She also reported constipation and abdominal pain but denied bloody stools. Previously worked up by pediatric gastroenterology (GI) 2 years prior for a 15-lb unintentional weight loss and constipation. Constipation had been ongoing for >10 years. Esophagogastroduodenoscopy, colonoscopy, and CT enterography were unremarkable other than anal papillomas. On physical examination, she had hemorrhoids, rectal fissures, and labial swelling. Inflammatory bowel disease (IBD) was ruled out by GI. She was prescribed polyethylene-glycol-3350 by GI for constipation. General surgery also excised the anal papillomas. Based on history and clinical exam, we were concerned for cutaneous Crohn disease. We started her on adalimumab, slow prednisone (40 mg) taper, and silver sulfadiazine. We also referred her back to GI for re-evaluation for IBD. Patient now reported blood associated with straining during bowel movements. GI noted perianal inflammation and repeated a colonoscopy, which showed a benign anal stricture, anorectal ulcers, and sigmoid ulcers. Rectal and sigmoid biopsies showed acute and chronic colitis with ulceration. She was formally diagnosed with Crohn disease. Patient reported full resolution of her cutaneous lesions over a 4-month period on adalimumab and the prednisone taper. Cutaneous genital and perianal fissures in the setting of gastrointestinal symptoms warrant evaluation for IBD even with prior negative workup.

P507 Vulvar Crohn’s disease: A challenging diagnosis

Abstract Background Crohn’s disease is an inflammatory bowel disorder with several well-known extraintestinal manifestations, such as erythema nodosum, uveitis, and arthritis. Less commonly observed are cutaneous, so-called metastatic lesions of the vulva, which represent a diagnostic and therapeutic dilemma and require a multidisciplinary approach. The objective of this study was to report a case series of patients with vulvar Crohn’s disease (VCD), describe its clinical features, histopathologic characteristics and therapeutic management. Methods In this retrospective study, we reviewed all cases of VCD seen in our department between 2008 and 2016. Data concerning age at diagnosis of VCD, vulval symptoms at presentation, histologic findings, and different treatment modalities were recorded. Only patients with both clinical features of VCD [knife-cut fissures, edema, ulceration] and histologic confirmation were included. A total of 3 cases were identified among 106 female patients with CD. Results Case 1: A 58-year-old patient, presented with a 4-year history of vulvar pain and itching. She had no bowel complaints. Clinical examination revealed hypertrophic exophytic lesions associated with linear ulcearations involving the vulva. A biopsy from the lesional skin showed non caseating gigantocellular granuloma. In view of the clinical and histopathological features, a diagnosis of Crohn’s disease of the vulva was made. Anti TNF treatment with adalimumab was started, resulting in a significant regression of the lesions. Case 2: A 47-year-old patient presented to our department with complaints of painful, persisting vulvar ulcers, and resulting dysperunia for 2 years. On clinical examination she had unilateral vulvar oedema with multiple “knife-cut” linear ulcers. A skin biopsy was done which revealed dense inflammatory lymphocytic infiltrate with non caseating granulomas. Treatment with adalimumab was initiated. An improvement of symptoms was noted. Case 3: A 16-year-old patient with no remarkable medical history, presented with a 2-year- history of persistent cheilitis and vulvar pain. Clinical examination of the external genitalia revealed ‘knife-cut’ vulvar fissures with important bilateral labial swelling and multiple papules on the surrounding skin. Histological analysis showed chronic inflammatory infiltrate with noncaseating tuberculoid granulomas. Anti-TNF treatment with infliximab was started with partial regression of lesions. Conclusion Our findings highlight the importance of keeping VCD on the differential diagnosis when faced with a range of vulvar symptoms. Anti-TNF agents seem to be an efficient treatment strategy for this particular localization.

XY female with complete androgen insensitivity syndrome with bilateral inguinal hernia

The complete androgen insensitivity syndrome (AIS), previously called testicular feminization syndrome, is an X-linked recessive rare disorder. AIS is the most common male pseudohermaphrodite. Patient has 46, XY chromosome and testis. The individual is phenotypically female and genotypically male. Antimullerian hormone is produced by the testis. So, uterus and fallopian tubes do not develop in fetus. The fault lies with androgen receptors which are mutated. Male differentiation of external genitals does not occur. The individuals are reared as girls and the condition is suspected when the individual is evaluated for primary amenorrhea, infertility or when unilateral/bilateral inguinal hernia is diagnosed in girls. This disorder includes a spectrum of changes ranging from male infertility to completely normal female external genitalia in a chromosomally male individual. These cases need proper diagnosis and appropriate management. We report this case for its interesting presentation. The patient is a 23 year old female, presented with bilateral labial swellings and primary amenorrhoea. Subsequent investigations were done which revealed that the patient is a genetically male with absence of female internal genitalia but presence of testes. Proper psychological support was also given to her, which is more important.

Knife Cut Fissures

Crohn's disease is an inflammatory bowel disorder with various extraintestinal manifestations. Vulva is rarely involved in Crohn's disease and occasionally may constitute the only sign of the disease. It is often unrecognized and can be confused with various disorders involving the vulva. Vulval Crohn's disease is often refractory to treatment. We describe a case of 30-year-old female presented with labial swelling, discharging sinuses and knife cut fissures and diagnosed as a case of vulval Crohn's without intestinal involvement, that was managed with oral steroids, sulfasalazine, and metronidazole.

Pediatric granular cell tumor of vulva: A rare benign tumor

We present a rare case of a school-aged girl with granular cell tumor of the vulva. The patient presented with a right labial swelling of unknown duration. Initial diagnostic workup with ultrasound suggested a gonadal structure in the right labia, which was read as ovarian herniation through the Canal of Nuck into the right labia majora. Given concerns for a concurrent Mullerian dysgenesis syndrome predisposing the patient to ovarian herniation, the patient was scheduled for a diagnostic laparoscopy and hernia repair with possible excision of vulvar mass. Laparoscopy revealed normal reproductive anatomy with two visualized normal appearing pelvic ovaries. Subsequent excision of the mass was determined to be granular cell tumor by pathology. There are fewer than 20 reported cases of pediatric vulvar granular cell tumors in the literature and no reports of granular cell tumors presenting as ovarian structure on imaging. This case highlights the importance of including this rare tumor in the differential diagnosis for vulvar mass which may be misread as ovary on ultrasound. • Granular cell tumors of the vulva are extremely rare, especially in children. • Ultrasound imaging of the tumor may present as ovarian structures. • Clinicians should include granular cell tumors within the differential for a vulvar mass. • In children wide local excision is curative and follow up is necessary for minimum of two years due to high recurrence rates.

Infant With Labial Swelling

Infant With Labial Swelling

Photobiomodulation and Miescher\u2019s cheilitis granulomatosa: case report

BackgroundMiescher’s cheilitis granulomatosa (MCG) is a rare chronic inflammatory disease and is known as the monosymptomatic clinical form of Melkersson-Rosenthal syndrome (MRS). It is characterised by swelling of one or both lips and more frequently affects the upper lip. Histopathological findings show the presence of numerous inflammatory infiltrates and granuloma formations. Pharmacological treatments and surgery have provided results that are positive yet insufficiently stable in the long term. The clinical case described is of a 68-year-old female patient with a diagnosis of MCG of the upper lip.Case presentationThe patient was diagnosed and treated at the Oral Medicine and Oral Pathology outpatient clinic of Maxillofacial and Odontostomatology Unit, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico. The patient was recommended localised treatments of photobiomodulation (PBM) using a diode laser with a 635 nm and 980 nm dual-wavelength (λ) approach, a 600-micron fibre, and a handpiece with a 1-cm-diameter lens at 300 mW. Three treatments a week were administered for four weeks for a total of 12 treatment sessions (T1–T12). After that, the patient had a long follow-up period of about 2 years. The therapeutic results were clear from the initial stages of treatment. There was an immediate, gradual, and consistent reduction in labial swelling. A reduction in the size of the lip by about 35% at T10–T12 was observed, returning the size and volume of the upper lip within the normal clinical range. The painful symptoms subsided after the seventh treatment (T7). The histopathological check at 3 months and the follow-up in particular confirmed the disease was in remission with satisfactorily stable treatment results. Moreover, the patient did not use any other treatments on the area from the early laser treatments through to the end of the follow-up period.ConclusionsOur experience describes a clinical case of MCG treated with PBM and effectively resolved with a reduction of the lip swelling. The real success of the treatment emerged over time, showing that the tissue healing was stable. In absence of any collateral phenomena, this confirms the effective and documented therapeutic potential of PBM for chronic inflammatory infiltrates.

Genitourinary involvement in pediatric patients with Klippel-Trenaunay Syndrome

BackgroundKlippel-Trenaunay Syndrome (KTS) is a genetic vascular malformation disorder which induces a variety of phenotypic expression in patients which differ in terms of severity/location. While previous studies have documented genitourinary (GU) complications in adult KTS patients, documentation of the scope and incidence of GU involvement in the pediatric population with imaging findings is currently limited. This study represents the largest KTS genitourinary review to date. ObjectiveTo assess the incidence, scope, clinical findings and imaging characteristics of GU pathology in pediatric KTS patients. Materials/MethodsUsing a retrospective data analysis design, the charts and imaging studies of pediatric KTS patients were reviewed. All patients received care at a specialized vascular clinic within a multicenter tertiary care system. Variables studied included age, age at KTS diagnosis, gender, urologic involvement, and age of urologic complication. Results58 patients were identified. 33 were male and 25 were female. 10 patients had GU findings. Three of these patients had multifocal GU involvement (greater than 1 finding). Urologic manifestations were diverse with 9 distinct diagnoses involving 6 unique organs. Renal, vesical and scrotal pathologies were most common. Hematuria was the most common presenting symptom in 30% (3/10). Previously unreported findings (labial swelling, renal lymphatic cysts) were identified. The average age of KTS diagnosis was 4.9 years. The average age of documented GU complication and involvement was 7.6 years. ConclusionSignificant GU complications due to KTS can occur in the pediatric population. Early clinical and imaging characterization of these conditions is important for management, family education and early intervention strategies.

61: Complex labioplasty in patient with congenital primary lymphedema

This video summarizes the diagnosis, evaluation, underlying anatomy, surgical intervention, and follow-up in a patient with congenital primary lymphedema undergoing complex labioplasty. We present a case of a 17 year old female with a history of congenital primary lymphedema who underwent complex labioplasty. At birth the patient had thigh and labial swelling increasing in size over time. Imaging was unremarkable. No intervention was felt possible by vascular surgery. After puberty, the left labia minora enlarged to 9 x 7 x 4 cm, the left labia majora to 7 x 3 x 3 cm. This interfered with ADL's including dressing, walking, and pain on sitting. Patient had significant mental stress. Primary lymphedema affects 1 in 100,000 individuals, caused by abnormal development of the lymphatic system (primary) or an insult after birth (secondary). The majority have lower limb involvement, the left leg more often involved. This patient had no prior history of infection, radiation, surgery, or trauma. An awareness of the blood supply of the labia was critical in creating flaps. The initial flap extended from the introitus in a narrow to wider configuration, the lateral portion of labia minora tissue was included to match the color and texture of the right, the pedicle coming from 5 to 7 o'clock with deep dissection 3.5 cm at the base preserving the blood supply. Dissection to the level of the left frenulum. Underlying excess tissue excised allowing the skin flap to be placed in a normal configuration. Left labia majora reduced with an elliptical incision and underlying tissue excised to reduce the bulk. Postoperatively the patient had minimal separation of the superior aspect of labia minora resutured in the office setting with marked improvement in the overall appearance. This case illustrates the importance of conserving the blood supply to the labia in the creation of viable flaps in complex labioplasty.

Orofacial Granulomatosis in a Child

Orofacial granulomatosis (OFG) is a rare, idiopathic disorder of the orofacial region. It is clinically characterized by persistent and/or recurrent enlargement of the soft tissues of the oral and maxillofacial region, often manifesting as labial enlargement and swelling of intraoral sites such as the gingiva, tongue, and buccal mucosa. Full-thickness mucosal biopsy reveals noncaseating granulomatous inflammation, similar to Crohn's disease and sarcoidosis. Thus, OFG must be distinguished from other chronic granulomatous disorders. We report a case of a young female patient who presented with labial and maxillary gingival enlargement without any identifiable systemic causes, with suggested involvement of environmental triggers.