Mons Pubis Research Articles

Cosmetic gynecology—a systematic review and call for standardized outcome measures

Cosmetic gynecology, a field which has garnered substantial attention over recent years, lacks a universally accepted nomenclature. The aim of this systematic review is to evaluate techniques, outcome measures reported, and adverse events in patients undergoing cosmetic gynecology procedures and offer recommendations to improve reporting metrics. A systematic literature search was performed using electronic databases from inception to April 2019. The search was based on 51 unique cosmetic gynecology keywords such as: "labiaplasty," "vaginal rejuvenation," and "liposuction mons pubis." All English full-text prospective and retrospective observational and interventional studies with at least five subjects that describe a cosmetic gynecology procedure were included. Only full-text articles were included. This protocol has been registered with PROSPERO (CRD 42019131860). A total of 1837 articles were identified from the search strategy with 42 included in the quantitative synthesis. Procedures described included: labia minora reduction with or without clitoral hood reduction, labia majora augmentation, surgical vaginal caliber reduction, mons pubis reduction/suspension, and energy-based therapy for vaginal laxity or vulvar laxity. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. Complication rates varied by procedure but were generally low and ranged between Clavien-Dindo grades I-III. Although there is a breadth of literature on cosmetic gynecology surgical techniques and short-term complication rates, the terminology and outcome measures utilized are heterogeneous. To address this, standardized terminology along with uniform cosmetic and functional endpoints must be developed.

MON-695 Multiple Recurrent Lipomatoses with Thiazolidinedione Therapy in Familial Partial Lipodystrophy, Dunnigan Variety (FPLD2)

Background: FPLD2, a rare autosomal dominant disorder due to heterozygous missense mutations in LMNA, is characterized by gradual loss of subcutaneous (sc) fat from the limbs starting during late childhood and predisposition to metabolic complications, such as diabetes, dyslipidemia and hepatic steatosis. Some patients, especially females, accumulate excess sc fat in the chin, neck, supraclavicular and perineal regions. We report disfiguring and disabling lipomatoses in unusual locations with thiazolidinedione therapy in two women with FPLD2. Clinical Cases: A 57-year-old white female with FPLD2, due to heterozygous p.R482Q LMNA mutation, developed recurrent large lipomatoses in the axillae at age 33 years, and later in the posterior neck (buffalo hump), mons pubis and above sacrum. She developed diabetes at age 30 and was started on pioglitazone 45 mg daily, which was switched to rosiglitazone 8 mg daily at age 43 years. Supra-sacral lipomatoses were approximately 40 cm X 20 cm bilaterally and continued to grow despite lipectomy and multiple liposuctions. Rosiglitazone was stopped at age 56 years, and she reported no further increase in the size of lipomatoses. Her other medications included colesevelam, atorvastatin, metformin, glimepiride, lisinopril, losartan, hydrochlorothiazide, aspirin, insulin and dulaglutide. Her 54-year-old younger sister with FPLD2 (heterozygous p.R482Q LMNA mutation) was treated with lisinopril, metoprolol, atorvastatin, liraglutide, and insulin glargine and aspart, but no history of taking thiazolidinediones, and she never developed any lipomatoses. Another 43-year-old white female with FPLD2, due to heterozygous p.S583L LMNA mutation, was noticed to have lipomatous deposits in the axillae, medial gluteal region, labia and perineal regions. She developed diabetes mellitus at age 36 years and took metformin for 6 years and pioglitazone 30 mg daily for one year before she noticed the lipomatoses. Her other medications included atorvastatin, aldactone and vitamin D3. Pioglitazone was stopped and after one year, she reported reduction in the size of lipomatoses. Conclusion: Thiazolidinediones are selective peroxisomal proliferator-activated receptor-γ agonists and induce weight gain by increasing fat mass, especially subcutaneous depots. Our cases suggest that thiazolidinediones can cause undesired growth of non-lipodystrophic adipose tissue in patients with FPLD2 and thus should be avoided.

MON-697 Necrotising Fasciitis- Importance of Glycemic Control

Introduction:Necrotising fasciitis is an infection of the deep soft tissues characterised by fulminant tissue destruction, systemic toxicity and high mortality. We report a case where accurate diagnosis, timely surgical intervention and antibiotic therapy along with strict glycemic control resulted in a favourable outcome.Case:A 74 year old woman with a history of type 2 diabetes mellitus, hypertension and end stage renal disease(ESRD) on peritoneal dialysis(PD) presented to the emergency department with the complaint of pain in the right lower quadrant of abdomen, right pelvis and right groin since 4 days which acutely worsened overnight. Of note the patient has Peritoneal catheter for dialysis and was last dialysed last night without any difficulty. Other associated symptoms were chills, nausea. The patient denied fever, skin changes in the affected area.On physical examination, the patient was awake, alert and oriented, in moderate distress. Abdomen was soft, non distended, PD catheter was in place with no surrounding skin erythema or tenderness. Genitourinary examination showed swelling of Mons Pubis with overlying erythema on the right side with extension to the right labia majora, exquisitely tender to palpation, no crepitus, no pustules, no palpable abscesses or visible wounds.Initial labs showed elevated WBC count(36.4K/UL; n<10.5K/UL) and Blood glucose of 361mg/dl(n 70-100mg/dl). CT scan of the abdomen and pelvis showed right anterior pelvic wall subcutaneous infiltration extending inferiorly into the mons pubis and right labial regions suspicious for cellulitis with no abscess. Broad spectrum intravenous antibiotics Meropenem, Vancomycin and Fluconazole were started and patient was taken to the operative room for debridement and approximately 25 cm long and 15 cm wide and 8 cm large abscess originating in the right labia extending up into her right groin was found along with necrotic skin, subcutaneous tissue and fat which was sharply excised. Peritoneal dialysis catheter site looked non infected and was left in place and fluid cultures were sent. Patient was switched to Hemodialysis while awaiting PD catheter fluid cultures. Hospital course was complicated by multiple debridements, severe septic shock requiring upto 4 pressors and intubation. She was started on insulin drip for glycemic control as the blood sugars were constantly ranging 300mg/dl(n 70-100mg/dl). HbA1C was 10.9% (n 5.7-6.4%). After 10days she was extubated and off pressors and was stable to be transferred to subacute rehab facility for diligent wound care for the next few weeks before she could go home.Conclusion:In patients with uncontrolled diabetes mellitus who present with critical illness like necrotising fasciitis, strict glycemic control with insulin drip yield favourable outcomes.

Tracing the Route of the Dorsal Nerve of the Clitoris

OBJECTIVELiterature indicates an increasing number of complications following the labiaplasty procedure which is a surgery with a known problem of underreported and understudied long‐term outcomes and complications such as loss of sensation in the female pudendum. The aim of this study was to determine the course and any variations of the dorsal nerve of the clitoris (DNC) after it pierces the perineal membrane to generate a surgical safe zone for procedures involving the female pudendum.METHODSCadavers from the University of Nebraska Medical Center, Creighton University, and Kansas City University anatomy labs were dissected for this study. A shallow vertical incision was made from the pudendal cleft superiorly through the mons pubis. The glans clitoris was identified and used as a landmark while the fascia surrounding the body of the clitoris was carefully removed. The DNC was located where it pierces the perineal membrane and traced distally. The following measurements were taken: 1. from the point where the DNC pierces the perineal membrane to the urethra, 2. from the point where the DNC pierces the perineal membrane to the pubic bone, 3. from the angle of the clitoris to where the nerve branches on the dorsum of the body of the clitoris and 4. from that branch point to the distal most portion of the glans clitoris. Any anomalous branching patterns were noted.RESULTSSpecific branching patterns were identified, mapped out and characterized into individual types. In addition to the patterns, the measurements described above were used to generate a surgical safe zone which can be used to avoid injury to the DNC during procedures involving the female pudendum. The variance was also calculated for each point of measurement to describe how much variation there is within a specific measurement to identify where the most caution is needed during surgery. Furthermore, it was determined if there were statistically significant differences between the right and left sides with regards to the nerve.CONCLUSIONSThe findings of this study have allowed the investigators to map out a surgical safe zone for procedures involving the female pudendum to avoid injury to the DNC. Furthermore, multiple anomalous branching patterns were identified and the frequency of those patterns were reported. This information should be useful to physicians performing procedures near the DNC. Some of the specimens displayed anomalous branching patterns which did not fit any of the other types identified and physicians performing procedures should be aware of those patterns as well.Support or Funding InformationThere is no support or funding information.

A 28 Day Clinical Assessment of a Lactic Acid-containing Antimicrobial Intimate Gel Wash Formulation on Skin Tolerance and Impact on the Vulvar Microbiome.

While intimate feminine hygiene products are widely used as part of daily cleansing routines, little is known about how these products impact the vulvovaginal area and its microbiome stability. This 4 week clinical study assessed tolerance of a novel gel wash containing lactic acid (pH 4.2) for external daily use when used on the external genital area and its effects on skin moisturization, vulvar skin pH, and the vulvar microbiome. After a 7 day pre-study conditioning period, 36 healthy females in three balanced age groups (18–29, 30–44, and 45–55 years) used the gel wash to cleanse their external genital area (mons pubis and vulva) and entire body at least once per day for 28 days. Skin tolerance of the gel wash was assessed by the gynecologist. Effects of the gel wash on vulvar skin microbiota were studied by performing bacterial 16S rRNA and fungal internal transcribed spacer (ITS) microbial richness and diversity analysis. Based on gynecologic assessment after 28 days of use, the gel wash showed acceptable tolerance, with no signs of increased dryness, redness, edema, itching, stinging, or burning. Use of the gel wash was associated with a significant increase in both short-term (single application) and longer-term (daily use for 28 days) skin moisturization. There was no significant change in vulvar skin pH over time with daily product use, and the gel wash did not significantly affect the natural vulvar microbiome species richness or diversity for bacteria or fungi. Results showed that this gel wash is a mild, moisturizing cleanser that maintains the natural pH and microbial diversity of vulvar skin. To our knowledge, this was the first study to assess the effect of an antimicrobial feminine gel wash on the natural pH and vulvar microbiome habitat of the skin using bacterial 16S rRNA and fungal ITS genetic sequencing techniques.

Island Abdominal Skin Flap For Reconstruction Post Excision Defect Of Arterio-Venous Malformation In Labia Majora: A Case Report

&#x0D; &#x0D; &#x0D; &#x0D; Background : Arterio-venous malformations (AVMs) defined as high-flow vascular malformations of dysmorphic arterial and venous vessels. And connected directly to one another without an intervening capillary bed. The incidence is higher in females than male (3-5:1). Globally, there are only 5 cases of genital hemangiomas reported. Various treatment has been investigated, a recent topical treatment is the application of timolol. It has minimal adverse effects, easy administration, and good cosmetic outcomes. However, the effectiveness of timolol in vulvar cases remains unclear.&#x0D; Case Report : A one-year-old girl was brought by her mother with complaint of a lump in her child's genitals. The lump was appeared during the early days of her life and it was getting bigger gradually. A plastic surgeon performed excision and reconstruction procedure using the island abdominal flap technique.&#x0D; Discussion : Preserving vaginal function and perineal integrity is quite challenging, and cosmesis correspondingly less important. The patient underwent surgical excision and primary closure procedure in the labia majora region, followed with abdominal flap tunneled through the mons pubis.&#x0D; Conclusion: Surgical excision and primary closure are the most recommended procedure for overcoming genital lesion. A reconstruction using flap following the procedure resulted in a normal contour and well functioned genital.&#x0D; &#x0D; &#x0D; &#x0D;

A rare case of proliferating trichilemmal tumour of mons pubis in an elderly male

Proliferating trichilemmal tumour (PTT) is a rare skin lesion arising from the isthmus region of the hair follicle, with a potential for a malignant transformation. It has a predilection for the scalp (90%) and commonly occurs in elderly females after the age of 50. However, there are various case reports suggesting that PTT can rarely arise from other areas. Here we present the case of an elderly male who came to us with an ulceroproliferative lesion in the mons pubis. A wedge biopsy suggested that the lesion was a PTT. Histopathological examination following a wide local excision confirmed the diagnosis of PTT without any foci of malignant changes. We feel this case is of interest and deserving to be reported on account of the unusual location and differential diagnosis from other diseases.

The use of high-frequency ultrasonography in the assessment of selected female reproductive structures: the vulva, vagina and cervix.

IntroductionHigh-frequency ultrasonography enables visualization the layered structure of the skin and shows the epidermis, dermis, subcutaneous tissue and skin appendages: hair follicles, sebaceous glands, sweat glands and blood vessels. The aim of this study was to apply high-frequency ultrasonography to evaluate the structure of the vulva, vagina and cervix, and to describe their anatomy in ultrasound.Material and methodThe examinations were conducted with the use of high-frequency probes: DermaView 48 MHz and Episcan 50 MHz, by three operators experienced in performing classical ultrasound scans (with 30-, 10- and 9-year experience). The study involved 50 women aged 20–80 years who reported for a periodical gynecological check-up and presented no symptoms within the reproductive system.ResultsIn this study, the individual layers of the skin in the area of the mons pubis, labia majora (together with hair follicles and sweat glands) and labia minora were successfully visualized in all the patients. The subepidermal low-echogenicity band was seen in the area of the mons pubic and labia majora in 40 cases. This concerned 100% of women who underwent cosmetic skin treatments. In all the patients, HFUS demonstrated the layered structure of the anterior and posterior vaginal walls, the walls of the urinary bladder and rectum, layers of the vaginal portion of the cervix and the external opening of the cervix.ConclusionsHigh-frequency ultrasonography offers new quality of vulvar, vaginal and cervical imaging. It can be used for evaluation of the vulva and vagina, and confirms their layered structure. It also enables accurate measurements of the thickness of the vulvar epidermis and dermis as well as the thickness of the vaginal walls.

Multi-Polar RF &amp; PEMF Technologies for Treatment of Vaginal Laxity, Mons Pubis &amp; Labia for Improvement of Skin Laxity:12-Month Safety &amp; Efficacy

Multi-Polar RF &amp; PEMF Technologies for Treatment of Vaginal Laxity, Mons Pubis &amp; Labia for Improvement of Skin Laxity:12-Month Safety &amp; Efficacy

Management of Fournier gangrene in perineal region by negative-pressure wound therapy combined with delayed repair

Objective: To explore the effects of negative pressure wound therapy (NPWT) combined with delayed repair on Fournier gangrene in perineal region. Methods: During July 2010 to September 2018, 16 patients with Fournier gangrene in perineal region were admitted to our center, with 13 males and 3 females, aged 30 to 76 years. In the first stage, the necrotic tissue of the wound was completely removed according to the scope of the lesion, and NPWT was applied. After the operation, general anti-infection and nutritional support were performed. In the second stage, the local flaps, free flaps, or skin grafts were chosen to repair the wounds according to the specific condition of wounds. The average length of stay and pathological diagnosis were recorded, and the survival and follow-up of skin grafts and flaps were recorded. Results: All the 16 patients were cured and discharged, with an average of 29.6 days in hospital. The pathological diagnosis of biopsies were necrotizing inflammation. The wound of 1 patient was healed directly after only NPWT, the skin grafts of 5 patients, local flaps of 9 patients, and anterolateral thigh island flap of 1 patient who had NPWT combined with delayed repair survived well. Sixteen patients were followed up for 1 to 2 years after discharge, and no recurrence of Fournier gangrene was found. Among them, 5 patients with wounds involved perineum and scrotum had good appearance and function of scrotum and mons pubis. Conclusions: NPWT combined with delayed plastic repair have great effects on Fournier gangrene.

Anatomical Dissection of the Dorsal Nerve of the Clitoris.

The clitoris is the primary somatosensory organ of female sexual response. Knowledge of its neural anatomy and related landmarks is essential for safe genital surgery. The aim of this study was to describe the distal course of the dorsal nerves of the clitoris and associated structures. Clitorises of 10 fresh cadavers were dissected. Measurements of the dorsal nerves, suspensory ligament, clitoral body, clitoral hood, and clitoral glans were obtained. The course of the dorsal nerves was examined. The dorsal nerves of the clitoris were larger than expected, ranging from 2.0 to 3.2 mm in diameter, on average, along their course in the clitoral body. In 9 of 10 specimens, the dorsal nerves could be traced to within 6 mm of the glans. They traveled deep to a superficial clitoral fascia but superficial to the tunica albuginea, were variably located between 10 and 2 o'clock, and were separated by the deep suspensory ligament (DSL) of the clitoris. The mean length of the descending clitoral body, from the angle to the base of the glans, was 37.0 mm. The mean distance from the pubic rim to the DSL was 37.7 mm. The clitoral body is substantial in length, mostly lying superficially under the clitoral hood and mons pubis. The dorsal nerves of the clitoris are large and superficial, terminating at or near the base of the clitoral glans. Knowledge of this anatomy is critical prior to performing surgery near the clitoris.

A case of cutaneous metastatic adenosquamous carcinoma of the cervix

Introduction:Cutaneous metastasis of cervical carcinoma is very rare, with a reported incidence of .1 to 2%. The adenosquamous carcinoma subtype has been reported the least.3-5 We present a case report of ulceronodular cutaneous metastasis of adenosquamous carcinoma of the cervix.Case Description:A 50-year-old African American female with an eleven-year history of metastatic adenosquamous carcinoma of the cervix presented to the emergency department with an asymptomatic rash in her groin for one-month duration. On physical exam, there were hyperpigmented to violaceous papulonodules across the mons pubis and three ulcerated plaques of the left mons pubis. Punch biopsy was consistent with metastases of cervical adenosquamous carcinoma. No disease specific interventions were taken, and the patient passed away five weeks later.Discussion:Cervical cancer rarely metastasizes to the skin, with a reported incidence of .1 to 2%. Among the subtypes, cutaneous metastasis of cervical adenosquamous carcinoma has been reported the least. In a review of 1185 cases of cervical cancer, Imachi et al found that only 15 cases spread cutaneously, none of which were adenosquamous carcinoma.5 Cutaneous metastases of cervical carcinoma predict a poor prognosis, with an average length of survival of three months.6Our patient developed cutaneous metastases eleven years after diagnosis, which is to our knowledge the longest reported interval from initial diagnosis to development of cutaneous metastases. Although rare, it is important to recognize cutaneous metastases of adenosquamous carcinoma of the cervix as it predicts a poor prognosis and treatment has not been shown to improve outcomes.

Exploring Hygienic Behaviors and Vulvodynia.

Vulvodynia is common and characterized by vulvar discomfort and pain. However, few studies have assessed hygienic practices in relation to onset. We investigated whether hygienic behaviors were associated with the onset of vulvodynia. We assessed a self-reported history of personal hygienic behaviors, including wearing tight-fitting clothing, vulva care and genital washing, pubic hair removal, douching, and powdering, a year before first reported onset of vulvar pain among 213 clinically confirmed cases and a similar time period among 221 general population controls. Compared with women who reported never wearing tight-fitting jeans or pants, women wearing tight-fitting jeans or pants 4 or more times per week had twice the odds of vulvodynia (95% CI = 1.14-3.95). Relative to controls, women with vulvodynia were substantially less likely to report use of soaps and gels to cleanse the vulva (95% CI = 0.17-0.63). Among women who chose to remove pubic hair, those who removed pubic hair from the mons pubis compared with bikini-area only hair removal, were 74% more likely to have vulvodynia (95% CI = 1.05-2.89). Finally, compared with women who reported bikini-area only hair removal less than monthly, those who removed hair from the mons pubis weekly or more were nearly 2 times more likely to be vulvodynia cases (95% CI = 0.83-3.49). Wearing tight-fitting jeans or pants and removing hair from the mons pubis area were associated with increased odds of vulvodynia. Research on how hygienic practices could influence vulvar pain in larger and more temporally addressed populations is warranted.

Extensive Squamous Metaplasia in Hidradenoma Papilliferum of Vulva: Illusion of Squamous Cell Carcinoma

Hidradenoma papilliferum is a rare, slow-growing, benign, cystic, papillary tumour occurring in middle-aged females, in the anogenital region commonly. It involves the anogenital mammary-like glands and is usually asymptomatic. Simple excision is curative. We present a case of hidradenoma papilliferum of long-standing duration with extensive squamous metaplasia. A post-menopausal lady presented with an exophytic growth on the left labia majora and part of mons pubis. It was initially misdiagnosed on the basis of vulvar biopsy and managed as squamous cell carcinoma of the vulva. The final histopathology revealed an epithelial tumour involving the vulva with extensive squamous metaplasia. The tumour involved mainly the dermis and the subcutaneous tissue. This is the first case in the literature where the diagnosis of hidradenoma papilliferum was confused with squamous cell carcinoma of the vulva due to its clinical presentation and extensive squamous metaplasia. Diagnosis of hidradenoma papilliferum should be kept in mind if a woman presents with vulval papillary or nodular lesions. An expert clinical and histopathological review should be done to avoid misdiagnosis.

ABDOMINOLABIAL HYDROCELE OF THE CANAL OF NUCK: A RARE ENTITY

Hydrocele of the canal of Nuck also called the “female hydrocele” is a rare entity in females. The processus vaginalis peritonei is a tubular fold of peritoneum that invaginates into the inguinal canal along with the round ligament. It usually gets obliterated by birth or during early infancy, but if this communication remains patent, it may lead to the development of an indirect inguinal hernia or hydrocele. Here, we present the case of a 32-year-old female who complained of swelling in the right inguinal region. Contrast-enhanced computed tomography scan of abdomen and pelvis was suggestive of a cystic lesion in the right inguinal region which was seen extending from mons pubis up to the right iliac fossa in the retroperitoneum likely suggestive of hydrocele of the canal of Nuck. Surgical excision of the cyst was done.

Metastatic vulvar Crohn’s disease preceding intestinal manifestations: a case report and short review

Crohn's disease (CD) is a multi-systemic chronic granulomatous inflammatory disease with a constellation of extraintestinal manifestations affecting various organs, including the skin. Metastatic CD (MCD), defined as granulomatous lesions of the skin occurring at sites separate from the gastrointestinal (GI) tract in patients affected with CD, is the least common cutaneous manifestation, and it is occasionally the primary manifestation of the disease. It may precede any symptoms from the GI tract by months or even years, and it often remains undiagnosed. We present the case of a 42-year-old woman with a rare cutaneous manifestation of MCD involving the external genitalia. The cutaneous lesions of the mons pubis and vulva preceded GI manifestations of CD by 2 years. The patient was treated with azathioprine, oral steroids, and antibiotics. Reduction of the cutaneous nodules, discharge, and erythema was achieved, accompanied by relief of GI symptoms. Response to treatment was maintained during a follow-up of 6 months. In MCD, involvement of the external genitalia is exceedingly rare, with few documented cases in the literature. The integration of clinical information, microscopic findings, and exclusion of other cutaneous granulomatous processes is necessary in order to accurately diagnose this rare dermatologic entity and provide an opportunity for successful therapeutic intervention.

Standardized Photographic Documentation of Hidradenitis Suppurativa/Acne Inversa

Background: Despite existing guidelines and methods for standardized clinical photography in dermatology and plastic surgery, human skin exhibits exquisite site-specific morphologies and functions, and each body region can exhibit an individual pathologic phenotype. The aim of this work was to develop a standardized, representative and reproducible documentation of the multilocular hidradenitis suppurativa/acne inversa (HS) lesions, a disease mostly occurring in skin folds. Method: Optimal body positions for medical photography of candidate areas for HS involvement were evaluated. Pictures of volunteers were taken, and indicative scientific graphics were designed. Results: Due to the variability of HS lesions and the fact of their localization in skin folds, a standardized, reproducible photographic documentation of HS candidate skin areas (50 cm from the skin surface) is proposed. The photographic series includes: (1) right armpit, (2) left armpit, (3) right groin, (4) left groin, (5) genital area, (6) anal area and anal fold, (7) right buttock, (8) left buttock, (9) chest area, (10) mons pubis, (11) right submammary area (females), (12) left submammary area (females). The protocol is accompanied with indicative scientific graphics for photography-proper positioning of the relevant body parts for documentation of potentially flat skin areas. In addition, former proposals for technical standardization of photography in dermatology, regarding instrumentation, environmental lighting and background colour, have to be respected. Conclusion: Standardized photography of candidate skin areas for HS involvement will allow longitudinal intraindividual and interindividual evaluation of the disease course as well as prospective and retrospective comparative studies.

Heinrich Kornmanns Mons Veneris (1614) als mythologisches Handbuch in der Tradition von Lilio Gregorio Giraldi (De Dei Gentilium, 1548) und Johann Herold (Heydenweldt, 1554)

The aim of the study is to show that Heinrich Kornmann’s Mons Veneris (1614) contains a translation of Lilio Giraldi’s mythological compendium De Dei Gentilium (1548). However, Kornmann is not a translator but rather a copyist, since his translation turns out to be an excerpt of the Heydenwelt (1554) by Johann Herold, who was the first to ever transfer Giraldi into German. To prove Kornmann’s dependency on Herold and Giraldi, the article elaborates on Kornmann’s strategies of adapting his models.

Surgical management of a huge post-circumcision epidermoid cyst of the vulva presenting unusually in a postmenopausal woman: a case report

BackgroundEpidermoid cysts of the external genitalia are one of the late complications of female genital mutilation. These cysts are usually small and painless. The presentation of a giant vulvar cyst in a postmenopausal woman has not been reported; the surgical management of a large cyst is often challenging.Case presentationA 60-year-old, para VI, Ethiopian woman presented with an 18 cm by 12 cm sized, fluctuant, multi-lobulated, mobile, non-tender vulvar mass involving the mons pubis. She had undergone genital cutting and sewing during her childhood. Informed consent was obtained for surgery and the vulvar cyst was excised successfully without any significant bleeding or injury to the adjacent structures. Her postoperative course was smooth and histopathology confirmed epidermoid cyst of the vulva.ConclusionsHuge epidermoid vulvar cysts following genital mutilation are rare and presentation in a postmenopausal woman has not been reported. Practitioners in areas where female genital mutilation is prevalent should be aware of the peculiar anatomic and technical aspects of the surgical removal of these giant vulvar cysts for successful therapeutic and cosmetic outcomes.

Malignant Transformation of Pleomorphic Adenoma of Vulva: Report of a Rare Case and Review of Literature

Pleomorphic adenomas are mixed tumors with epithelial and stromal elements and commonly arise in the salivary glands, particularly in the parotid. Pleomorphic adenomas of the vulva are very rare, and less than ten cases have been reported in the literature. We report a rare case of carcinoma expleomorphic adenoma, which we believe is the second such reported case in the world. A 65-year-old postmenopausal woman presented with vulval mass arising from mons pubis involving the left labia. Preoperative biopsy showed features of adenocarcinoma. She underwent a radical vulvectomy with bilateral groin node dissection. Histology revealed a low-grade epithelial–myoepithelial carcinoma expleomorphic adenoma. No adjuvant therapy was given. Patient is disease free at 6-months of follow-up. Carcinoma expleomorphic adenoma is defined as a pleomorphic adenoma in which an epithelial malignancy is derived. It commonly arises in the salivary glands, mainly the parotid. The most important factor predisposing to recurrence is positive surgical margins. Hence treatment is wide excision aiming at negative margins to avoid both the risk of recurrence and malignant transformation. Available evidence from the treatment of salivary tumors suggests that adjuvant radiotherapy may improve local control in high-risk cases.