Vulvar Swelling Research Articles

Childhood Asymmetric Labium Majus Enlargement: Is a Conservative Approach Available?

Unilateral vulva swelling during prepubertal period consists of a wide variety of inflammatory and neoplastic lesions. A group of labial lesions that showed normal radiologic, histopathologic and surgical findings are reported as childhood asymmetric labium majus enlargement. An 11-year-old girl with childhood asymmetric labium majus enlargement is presented to discuss the clinicopathologic features, differential diagnosis, and indications of conservative approach in the treatment of this rare entity.

Ancient Schwannoma of the Vulva

Ancient schwannoma, a variant of schwannoma (previously termed neurilemoma), arises from the Schwann cells of the nerve sheath. It presents with swelling, pain, or paresthesia. A 53-year-old woman presented with a history of a left vulvar swelling, which had been present for many years. The tumor was slowly increasing in size and affected activities such as sitting and walking. Occasionally, she experienced a burning sensation at the site of the swelling. Surgical excision was undertaken, and histology demonstrated an ancient schwannoma. The characteristic histological appearance seen in ancient schwannoma should prevent the erroneous diagnosis of a malignant tumor. Malignant change is exceedingly rare. Treatment is complete surgical excision.

Unilateral vulval swelling: What is the diagnosis?

Unilateral vulval swelling: What is the diagnosis?

Lymphangioma Circumscriptum Of Vulva Due To Tuberculosis

We report a case of a 17-year old female patient presented with huge swelling of the vulva following tubercular lymphadenitis of the inguinal region. The case was diagnosed as acquired lymphangioma circumscriptum of the vulva due to destruction of the inguinal lymph nodes by tuberculosis. The vulval swelling did not respond after antitubercular chemotherapy and required a cosmetic surgery. The role of surgery is emphasized in this case.

Vulval low-flow arteriovenous malformation

This case report refers to a 26-year-old woman who attended a gynaecological clinic with a painful vulval swelling. She underwent surgical excision, was found to have a rare vulval low-flow arteriovenous malformation and was treated with embolisation therapy.

Massive Vulval Edema Secondary to Obesity and Immobilization: A Potential Mimic of Aggressive Angiomyxoma

We report 2 cases of surgically resected vulval masses in women aged 27 and 40 years. One patient was wheelchair bound and the other was obese, both presented with bilateral vulvar swelling. One specimen measured 45 cm in maximum dimension and the other 5 cm and were described as grossly edematous or gelatinous. Histologically, in both cases, there was edema of the skin overlying the lesion. The lesion itself consisted of markedly edematous connective tissue with widely separated bland spindle-shaped cells and numerous dilated vascular channels, sometimes surrounded by cuffs of lymphocytes and plasma cells. In the larger of the 2 specimens, underlying edematous adipose tissue was present. To some extent, the appearances, especially the morphological features, mimicked aggressive angiomyxoma because of the presence of a mass, the lack of circumscription, the hypocellular, edematous appearance, and the presence of numerous vascular channels. However, a combination of clinical and pathological features, including bilateralism, lack of a true myxoid stroma, the presence of perivascular cuffs of lymphoid cells, and lack of staining with estrogen receptor, is against aggressive angiomyxoma. The appearances were interpreted as those of massive edema. In one case, there was recurrence of the mass after surgery. There has been a single previous report of a similar vulvar case in a quadriplegic female patient and of similar cases involving the upper and lower extremities of obese patients. Clinicians and pathologists should be aware of the existence of this lesion, which is likely due to lymphatic obstruction and lymphedema secondary to immobilization and obesity.

Vaginal oestrus during the reproductive and non-reproductive period in European ground squirrels

Most hibernating animals are thought to be monoestrous because reproductive activity is subject to strong time constraints. In previous studies, female European ground squirrels ( Spermophilus citellus) turned out to have elevated oestradiol levels during late lactation and after weaning, indicating ovarian activity during summer. Therefore, we monitored vaginal cytology, endocrine changes, and vulval development in semi-free-living female European ground squirrels throughout one active season. Vaginal oestrus, defined by the predominance of cornified cells in smear samples, was found during the mating period shortly after vernal emergence. This phase was followed by metoestrus, characterised by the appearance of leukocytes, and a subsequent anoestrous phase. During weaning or postlactation, a second vaginal oestrus was documented in all experimental females, again followed by a metoestrous and an anoestrous phase lasting until hibernation. In line with the second vaginal oestrus, plasma oestradiol concentrations peaked during postlactation. Progesterone levels were elevated from gestation to postlactation, and titres were marginally higher during vaginal oestrus in summer than in spring. Vulval swelling was more pronounced during the first than the second vaginal oestrus. The second oestrous cycle was non-reproductive, as males were sexually inactive with regressed testes during summer. We assume that the second oestrous cycle and the accompanying endocrine changes have beneficial effects on prehibernatory fattening and reproductive performance in the subsequent season. This might allow females to become oestrous immediately after emergence from hibernation in spring.

Ulcus Vulvae Acutum in a 13‐Year‐Old Girl After Influenza A Infection

A 13-year-old otherwise healthy premenarchal girl presented with acute onset of painful vulvar ulcerations. One day before developing vulvar ulcerations, she experienced flu-like symptoms, including a low-grade fever, cough, sore throat, and myalgia. Results of a throat swab were positive for influenza A infection (polymerase chain reaction [PCR] assay), and the patient was treated with oseltamivir. The patient's constitutional symptoms improved slightly, but within 2 days after her initial presentation, she returned to her primary care provider and described 24 hours of dysuria and vulvar swelling. She had a history of herpes labialis (cold sores) and rare episodes of minor oral aphthae (canker sores) that occurred less than twice a year. The patient denied a history of sexual activity, sexual abuse, or physical trauma. Physical examination showed ulceration and swelling of the labia minora, and the patient received an empiric dose of acyclovir (200 mg 4 times daily) for presumed autoinoculated herpes simplex virus (HSV) infection. An ulcer swab was performed, and urinalysis revealed no evidence of infection. Two days later, the patient presented to the emergency department with increasing vulvar pain and vaginal discharge. The previous ulcer swab findings were negative for HSV (PCR assay), and consequently, acyclovir was discontinued after 1 day of therapy. She received topical viscous lidocaine and an empiric dose of oral fluconazole. The lidocaine provided temporary symptomatic relief. Results of DNA amplification studies were negative for Chlamydia trachomatis and Neisseria gonorrhoeae. A potassium hydroxide preparation was negative for fungi, and an ulcer swab for bacterial culture revealed usual flora. Of note, the PCR assay for Epstein-Barr virus was not performed on ulcer cells. The patient was referred to the department of dermatology, and results of a physical examination showed copious white mucoid discharge and a 2-cm ulceration of the left labia minora (Figure, panel A). Two smaller pinpoint ulcerations and swelling of the left labia minora were also noted. The lesions were clinically indistinguishable from the genital aphthous ulcers of patients with complex aphthosis (recurrent, severe aphthous ulcers on oral or genital mucosa). A diagnosis of ulcus vulvae acutum was made, and treatment was started with clobetasol 0.05% ointment (4 times daily) and lidocaine gel as needed. Four days later, the patient reported marked symptomatic improvement. Physical examination showed near resolution of the large vulvar ulceration (Figure, panel B). The patient tapered use of clobetasol ointment over the next several days until the ulcerations healed completely. Two months after her initial episode, the patient again had 3 small vulvar erosions after symptoms that included low-grade fever, malaise, and vomiting. She did not receive oseltamivir for this illness; clobetasol ointment was applied 4 times daily, and the vulvar erosions ameliorated within a few days. Her constitutional symptoms resolved without treatment. The patient has not experienced any further episodes of vulvar ulcerations in the 18 months after the most recent treatment.

Gross Vulval Edema After Laparoscopic Instillation of 4% Icodextrin Solution

Severe vulval edema after laparoscopic ovarian cystectomy with instillation of adhesion-prevention solution (4% icodextrin) is a rare complication. A 17-year-old girl was readmitted to the hospital 2 days after laparoscopic ovarian cystectomy with massive vulval swelling, pain, and anxiety. Gross swelling was potentially caused by accumulation of fluid 4% icodextrin in the labia. The condition resolved spontaneously with application of ice packs and bed rest. Possible mechanisms of this complication are discussed as is the importance of adequate counseling and consent before surgery when adhesion prevention solutions are to be administered.

Ectopic breast tissue presenting as a persistent vulval swelling in a primary care minor surgery clinic: A case report and review of the literature

Ectopic breast tissue presenting as a persistent vulval swelling in a primary care minor surgery clinic: A case report and review of the literature

Candida meningitis in a suspected immunosuppressive patient - A case report

Meningitis due to fungal agents represents an AIDS-defining event and occurs typically with very low CD4+ lymphocyte count. Candida meningitis is still a rare clinical condition, although it is becoming frequently reported in the background of immune suppressive states such as: drug addicts, cancer patients, organ transplant recipients and HIV/AIDS patients. In this report we highlight a case of candida meningitis, in a 25- year old female patient. She presented with vulva swelling, vaginal discharge and fever, with rapid progression to tonic-clonic convulsions and loss of consciousness. She fully recovered after treatment with fluconazole.

Acute cytomegalovirus infection presenting with severe vulvar swelling

Acute cytomegalovirus infection presenting with severe vulvar swelling

Etiology and Clinical Profile of Non-Ulcerative Vulval Swellings in Young Girls

Background: Non-ulcerative vulval swellings are rare in young girls but may be a harbinger of serious underlying disease. There is a paucity of data about the etiology and clinical profile of vulval swellings in young girls. We conducted this study to evaluate clinical profile and etiology of chronic non-ulcerative vulval swellings in young girls. Methods: Retrospective chart review of girls presenting with chronic non-ulcerative vulval swellings to the Pediatric and Adolescent Gynecology clinic of our institution from 2001e2006. Results: Of the ten girls included in our study (mean standard deviation age 12.2 3.5 years, range 7e16 years), serious underlying diagnosis was identified in six (60%, Crohns disease in four, Turners syndrome and Ewings sarcoma in one each. Other diagnosis included localized vulvar angioedema, Turner syndrome, vulval hamartoma, lymphangioma and angiomyxoma in one each. The presentation was sub acute in two (duration less than six months; Ewings sarcoma and lymphangioma in one each) and chronic in four (duration more than six months, crohns disease in all). One girl each with cyclical localized vulvar angioedema associated with menstruation and infiltrative benign angiomyxoma had recurrent vulval swellings. Pubertal enlargement of pre-existing vulvar swelling was observed in one girl each with turner syndrome and vulvar hamartoma. Of the six girls presenting with painless vulvar lumps, Crohns disease was identified in four. Importantly all these girls had long standing vulval lesions which predated gastrointestinal symptoms. Only one girl had gastrointestinal symptoms at diagnosis. Conclusions: Vulvar swelling in young girls is frequently associated with serious underlying disease and merits meticulous evaluation. Crohns disease should be considered in all girls with slowly progressive painless vulval swelling even in the absence of gastrointestinal symptoms. Malignant etiology is likely in girls with recent onset rapidly enlarging vulval swelling.

Vulval lymphangiectasia secondary to tubercular lymphadenitis

A 25-year-old married woman presented with swelling of vulva with oozing of watery fluid from vulval skin surface for the past 8 years. She also complained of swelling in the inguinal region (occasionally painful) on both sides for the past 8 years. Local genital examination revealed diffuse indurated swelling of the labia majora with overlying skin studded with papulo-vesicles and oozing of milky fluid. Nontender, firm, matted lymph nodes involving both horizontal and vertical groups of inguinal lymph nodes were found bilaterally. Histopathology of the lesion was consistent with lymphangiectasia. Fine needle aspiration cytology from the right inguinal lymph node showed caseating epitheliod cell granulomas with calcification consistent with tuberculosis. Acid-fast bacilli and parasites were not seen. Hemogram was normal except for raised erythrocyte sedimentation rate (35 mm in the first hour). Mantoux test was highly reactive (15 × 15 mm). A final diagnosis of lymphangiectasia of the vulva secondary to tubercular lymphadenitis was made. The patient was started on anti-tubercular drug therapy. There was a partial recovery in the genital lesions.

Acquired lymphangioma circumscriptum of the vulva

Lymphangiomas are rare benign proliferations of the lymphatic system. Acquired lymphangioma circumscriptum of the vulva is induced by impaired lymph flow. We describe a new case of lymphangioma circumscriptum resulting from tuberculosis involving a lymph node. A 45-year-old female presented with swelling of the vulva for the past 8 years. She had a history of multiple left inguinal swellings successfully treated with four antituberculosis drugs. Her vulval swelling did not respond and was diagnosed as acquired lymphangioma circumscriptum. She becomes the fifth reported case of acquired lymphangioma circumscriptum of the vulva with tubercular lymphadenitis. The single antituberculosis treatment is insufficient to control lymphangioma. Ablative methods seem encouraging.

Estrous Cycle Based on Blood Progesterone Profiles and Changes in Vulvar Appearance of Malayan Tapirs (Tapirus indicus)

The progesterone (P(4)) profiles and macroscopic vulvar changes of female Malayan tapirs were investigated in order to understand their fundamental reproductive physiology and to search for visual indicators of estrus. Blood was collected once or twice a week from seven female Malayan tapirs kept at four zoos. Serum or plasma P(4) concentrations were determined by radioimmunoassay. The P(4) concentrations changed cyclically throughout the years, and a total of 56 cycles was confirmed in the seven females. The length of the estrous cycle based on the P(4) profiles was 43.6+/-2.0 days; however, this mean includes great variation in length, from 21 to 84 days. Mucous discharge from the vulva and vulvar swelling were seen when the P(4) concentrations were low before the beginning of a rise in most cases. In conclusion, captive female Malayan tapirs have variations of approximately 1 to 3 months in estrous cycle length, and visual changes in the vulva are helpful in estimating estrus in female Malayan tapirs.

Ovarian cycle of the captive formosan gem‐faced civets (Paguma larvata taivana)

Formosan gem-faced civets are classified to be endemic sub-species of Paguma larvata in Taiwan. Little about their reproductive physiology has been reported. This study was designed to characterize the ovarian activity throughout the year and define ovarian cycle length and the lengths of its component phases. Serum samples were collected for enzyme immunoassay (progesterone and estradiol) from seven captive civets twice weekly for 1 year. Meanwhile, periodic changes in external genitalia (vulva swelling) and vaginal cytology were examined and recorded. Results showed estrous cycles exhibited two types: 18-day (18.5+/-1.1, n=64) and 28-day (27.6+/-1.0, n=28) as shown by progesterone and estradiol fluctuations and corresponding changes in vulva morphology and vaginal cytology. Both types showed a similar 7-day follicular phase, peaking progesterone at Day 7. The 18-day cycle type prevails in the spring and summer whereas the 28-day cycle type is significant in the autumn. In summary, female gem-faced civets are polyestrous (approximately 13 cycles/year), and non-typical seasonal breeders, with follicular phase and two distinct durations of luteal phases (diestrus) cycling throughout the year, but the frequency of ovarian cycles was remarkably gradually decreased from September to February of next year. Zoo Biol 0:1-11, 2007. (c) 2007 Wiley-Liss, Inc.

Oestrous Behaviour and Timing of Ovulation in Relation to Onset of Oestrus and LH Peak in Mithun (Bos frontalis) Cows

The objectives of the study were to evaluate the oestrus behaviour and to determine the timing of ovulation in relation to onset of oestrus and the pre-ovulatory LH surge in mithun (Bos frontalis). For this purpose, the blood samples collected at 15-min intervals for 9 h period following onset of oestrus and thereafter, at an interval of 2 h till 4 h post-ovulation for three consecutive cycles from 12 mithun cows were assayed for plasma LH and progesterone. Ovulation was confirmed by palpation of ovaries per rectum at hourly intervals. Various signs of behavioural oestrus were also recorded. The common signs of oestrus and their frequency of occurrence in mithuns were following and mounting by male mithuns (100%), standing to be mounted (100%), frequent urination (62.33%), raising of tail (65.23%), swelling of vulva (54.26%) and congestion of vulvar mucous membrane (69.87%). The pre-ovulatory LH surges consisted of several pulses (2.92 +/- 0.26 pulses/animal; range, 1-4). The mean (+/-SEM) peak level of LH for individual mithun varied from 6.99 +/- 0.44 to 12.69 +/- 2.10 ng/ml and the mean pooled LH peak concentration was 9.10 +/- 0.60 ng/ml. The highest peak (highest amplitude of LH during LH surge) was 10.83 +/- 0.76 ng/ml (range, 8.07-16.49 ng/ml). The duration of LH surge was 6.98 +/- 0.22 h (6-8 h). Onset of LH surge was at 1.23 +/- 0.17 h post-oestrus onset (range, 0.25-2.25 h). Mean plasma progesterone stayed low (<0.24 ng/ml) during the entire duration of sampling. Ovulation occurred at 26.92 +/- 0.31 (range, 26-29 h) after the onset of oestrus and 18.63 +/- 0.35 h (range, 17-20.75 h) after the end of LH surge. The occurrence of the highest LH peaks within a narrow time frame of 2- to 5-h post-oestrus onset in mithuns could have contributed to the animals ovulating within a narrow time interval. These results are very promising from a practical standpoint of potential success when AI program in this species is implemented in a big way. Furthermore, the results of the occurrence of LH pulses during pre-ovulatory LH surges, which are required for ovulation in this species of animals, is unique and species specific.

Angiomyofibroblastoma and Aggressive Angiomyxoma

In Brief Angiomyofibroblastoma and aggressive angiomyxoma are 2 very rare mesenchymal tumors found in the vulva. Both generally present as a nontender vulvar swelling. They are usually benign, but aggressive angiomyxoma is locally invasive and has a high rate of recurrence. We report 2 cases with similar presentations, both preoperatively diagnosed as a Bartholin's cyst. Both tumors were large, measuring 20 and 14 cm, respectively. They were excised in their entirety and there has been no sign of recurrence. Both shared similar clinical and histopathologic features causing diagnostic problems, which is often the case. Angiomyofibroblastoma and aggressive angiomyxoma are 2 rare, benign, mesenchymal tumors of the vulva, which are treated by simple excision.

212 EFFECT OF OVULATION STATUS ON PREGNANCY RATES IN RECIPIENT GILTS TRANSFERRED WITH CLONED EMBRYO TRANSFER

This study was conducted to determine the optimal stage of the estrus cycle to achieve the highest pregnancy rates in surrogate recipient gilts receiving somatic cell nuclear transfer (SCNT) embryos. Potential surrogate gilts over 7 months of age were checked at Day 21 of their estrus cycle for their estrous status by observing external signs: vaginal fluid, vulva redness, vulva swelling, and standing response to back pressure. Viscosity of vaginal fluid was evaluated and classified as none, medium, and strong. Vulva redness and swelling were respectively assessed as none or shrink, medium, and strong. Back pressure was estimated by an immediate move, standing less than 10 s, and standing over 10 s. Ovulation status was observed when surrogates had SCNT embryos transferred into their oviducts, and then ovulation status of each surrogate was classified depending on the follicular diameter, as follows: preovulation (PO – 17 surrogates; follicular diameter of PO was 3 to 5 mm), just prior to ovulation (JPO – 20 surrogates; follicular diameter of JPO was 6 to 8 mm), ovulating (IO – 12 surrogates; ovulation mark with JPO follicles), just after ovulation (JAO – 14 surrogates; ovulation mark without follicles), and after ovulation (AO – 24 surrogates; ovaries showed only corpora lutea). Real-time ultrasonograpy was used for pregnancy diagnosis by observing amniotic vesicles. All data were subjected to analysis of variance (ANOVA) and protected least significant difference (LSD) test using general linear models in a statistical analysis system (SAS Institute, Inc., Cary, NC, USA) program to determine differences among experimental groups. The first pregnancy diagnosis was done on Day 30 after ET and then repeated in 2-week intervals until Day 114. SCNT embryos transferred into JPO surrogates gave better pregnancy rates (9/20, 45%) than others (4% to 11%) on Day 30 after ET (P &amp;lt; 0.05). These results suggest that ovulation status of surrogate gilts is an important critical factor for pregnancy. This information indicates that surrogate gilts implanted with SCNT pig embryos just prior to ovulation can achieve optimal pregnancy rates. In conclusion, the JPO surrogate selected should strongly show all parameters (vaginal fluid, vulva redness, vulva swelling, and standing response to back pressure) for the preparation of surrogates. This study was supported by the bio-organ production research grant (No.06020602) of the NLRI.