Vulvar Mass Research Articles

Case report: A Large Fibroepithelial Polyp of the Vulva

Fibroepithelial polyps are one of the most common benign masses of the vulva and are characterized by relatively small size, vague symptomatology, and morphological diversity. These lesions mainly affect women of reproductive age and are hormone dependent. They are usually found around the urogenital area. A biopsy and histological examination are necessary to exclude the possibility of malignant neoplasm. The pathophysiology of the disease appears to be associated with the coexistence of diabetes mellitus, chronic inflammation and chronic friction. Below we will describe the case of a 17-year-old Somali patient who had undergone female genital mutilation type IIb tyand who presented to the regular clinic with a reported unspecified vulvar mass with coexisting chronic lower limb lymphedema.

Primary mucinous adenocarcinoma intestinal type of the vulva arising at site of prior vulvar Crohn’s disease: A case report and review of the literature

Introduction: Vulvar mucinous adenocarcinoma is a rare subtype that likely arises from atopic gastrointestinal tissue. The evaluation and treatment of this condition often requires a multidisciplinary approach. Case Report: Our patient is a 55-year-old female with a history of Crohn’s disease who initially presented with a painless vulvar mass associated with occasional bleeding. Notably, the mass presented at the site of a prior rectovaginal fistula. A vulvar biopsy was performed with pathology consistent with intestinal type mucinous adenocarcinoma. Further workup was notable for imaging showing retroperitoneal and pelvic metastatic lymphadenopathy, hypermetabolic liver and bony metastases, and pulmonary nodules concerning for metastases. Following discussion at tumor board, the patient was recommended treatment with 5-fluorouracil, leucovorin, oxaliplatin (FOLFOX), and bevacizumab. Unfortunately, prior to starting chemotherapy, the patient presented to the emergency department with dizziness and weakness and was found to have brain metastases. She ultimately elected to be discharged home on hospice care. Conclusion: Vulvar mucinous adenocarcinoma is a rare subtype tumor with limited literature on treatment options. For these rare cases, clinicians can consider treatment modalities for colon carcinomas rather than vulvar carcinomas.

Soft Tissue Sarcomas at Atypical Locations in Gynecologic Oncology: A Series of 3 Cases

PurposeThe most frequent primary site of sarcomas in gynecologic oncology is uterus (83%) followed by ovary (8%), vulva and vagina (5%). We present three cases of sarcomas at atypical locations.MethodRecords of cases were retrieved from electronic medical records, and telephonic follow-up was done to know their current status.ResultCase 1: A 26-year-old parous lady presented with complaint of recurrent vulvar mass. Biopsy at our institute revealed myxoid liposarcoma. Metastatic workup was negative. She underwent radical local excision with VY-plasty and bilateral ovarian transposition (BOT) followed by concurrent chemo-radiotherapy. She is disease free at 12 months. Case 2: A 29-year-old lady presented with large bleeding mass arising from right wall of vagina. Histopathology report of vaginal biopsy was high-grade leiomyosarcoma. MRI pelvis with thorax and abdomen scan, examination under anesthesia and cystoscopy revealed non-metastatic operable disease. She underwent radical hysterectomy with vaginectomy with BOT followed by pelvic radiotherapy. At 4-month follow-up, she presented with scalp lesion. Further workup revealed disseminated metastatic disease. She is on palliative chemotherapy at the time of submission or article. Case 3: A 54-year-old lady underwent evaluation for pain abdomen with contrast-enhanced computed tomography which revealed a large omental mass. She had past history of carcinoma cervix 6 years back treated outside with surgery and chemo-radiotherapy. Image-guided biopsy was reported as leiomyosarcoma. Metastatic workup showed no disease elsewhere. She underwent omental mass excision followed by chemotherapy. She is disease free at 13 months.ConclusionSurgery remains the mainstay of treatment in non-metastatic sarcomas. Long-term follow-up of patients is needed in view of their atypical presentation.

Vulvar leiomyosarcoma: A clinical image

Medical record analysis and literature review at scientific Database. MP, a 48-year-old female, presented with a 3-month history of a ten-centimeter vulvar mass on the left major labia, adhered to a deep plane, and associated with local pain (Figure 1).

A case report of urethral prolapse in young girls: Clinical manifestations and surgical management

Background and importanceUrethral Prolapse (UP), first described by Solinger in 1732, is a rare condition characterized by the circular protrusion of the distal urethral mucosa through the external meatus, forming a hemorrhagic, sensitive vulvar mass. This condition is most commonly observed in prepubertal black females. This case report details the clinical manifestations and surgical management of UP in three young girls. Cases presentationThree girls, aged 4, 5, and 6 years, were admitted with symptoms of vaginal blood spotting. Physical examinations revealed moderate bleeding and a red ring of congested, edematous tissue prolapsing through the urethral meatus. Diagnostic procedures confirmed UP, and surgical management was undertaken. The surgical approach involved the complete excision of the prolapsed tissue and mucosal-to-mucosal anastomosis under general anaesthesia. Postoperative follow-up over a mean period of 11 years showed no recurrence or urethral stricture. Clinical discussionUP is a rare benign condition primarily affecting the female urethra, with several hypothesized etiologies, including weak pelvic floor structures and increased intraabdominal pressure. The typical presentation includes vaginal bleeding and a doughnut-shaped mass around the urethral meatus. Conservative management may be considered for mild cases, but surgical excision is recommended for severe cases, offering a safe and effective solution with low recurrence rates. ConclusionsUP in children, although rare, should be considered in cases of unexplained vaginal bleeding. Diagnosis is primarily clinical, and surgical resection provides a definitive and cost-effective treatment.

Lymphomas of the Vulva: A Review of the MITO Rare Cancer Group.

Since they are very rare tumors, lymphomas of the vulva are often not properly recognized. Patients with vulvar lymphoma are generally elderly and the classical manifestation of the disease is a vulvar mass. No significant age differences have been found between primary and secondary lymphoma. To make a correct diagnosis, it is therefore necessary to use not only histological examination but also the genetic and molecular profile in order to establish optimal therapeutic management. Literature analysis confirm the good prognosis of this disease.

A CASE REPORT ON ANGIOMYXOMA OF VULVA - A RARE MESENCHYMAL TUMOR IN REPRODUCTIVE AGE GROUP WOMEN

Aggressive angiomyxoma (AAM) is a mesenchymal tumor that arises from perineal or lower pelvic connective tissue. This tumor is locally aggressive. It has mostly been found in reproductive age group females. The correct diagnosis and follow-up of this tumor are very important, as it has similar presentation to many other vulvar masses and it tends to recur due to its locally aggressive nature. We report here a case of 40-year-old female P2L2, who presented with a soft, non-tender swelling on the left labia majora.

Round Ligament Fibroid: A Case Report

Background: Round ligament fibroids are rare benign tumors that might manifest as vulvar, adnexal, or inguinal masses primarily because of their anatomical extension. Case Report: A 44-year-old lady who was not a known case of any medical illness was referred to the outpatient clinic in May 2022, after an incidental ultrasound finding of a subserosal fibroid. Upon examination, a hard mass was felt in the suprapubic area around 12 weeks size, yet due to the obese body type, proper examination was not possible. An ultrasound scan of the pelvis revealed multiple fibroids in the uterus, measuring 7x6 cm anteriorly, 4.5x3.5 cm posteriorly, and fundal 4.2x2.4 cm. After 12 months of conservative follow-up, another pelvic ultrasound scan was done, which revealed an anteverted bulky uterus measuring 11.9 x 8 cm, with multiple fibroids, the largest measuring 4.8x 4.5 cm at the lower uterine segment and 5.5x 4 cm at the fundus. These findings suggested a growing sessile subserosal uterine fibroid with extensions, dimensions, and relations. Finally, the patient was diagnosed with leiomyoma with cystic and hyaline degeneration, negative for atypia and malignancy. Laparotomy myomectomy was done, and the specimen consisted of a single oval mass weighing 410 gm and measuring 11x8x7.5 cm. Conclusion: The diagnosis of round ligament fibroid is often challenging due to its anatomical position. Keywords: Round ligament fibroid, laparotomy myomectomy, leiomyoma, case report

Management of Vulvar Cancer Our Clinical Experiences

Background/Aim: Vulvar cancer is a rare malignancy. It frequently affects postmenopausal women. There is no specific screening for vulvar cancer. Treatment is often surgical. The risk of recurrence is high. Lymph node involvement is an important prognostic factor in vulvar cancer. The primary purpose of this study is to share our institutional experience in managing vulvar cancer patients. Materials and Methods: This study is a retrospective study. The study was ultimately conducted with 39 participants. Descriptive analyzes are frequency, percentage, minimum/maximum values, mean, standard deviation, and median. Risk factors for relapse were evaluated by binary logistic regression analysis. Cox regression analyses analyzed analyzes of factors related to survival. Survival analyzes were calculated using the Kaplan-Meier method, and significant differences were determined by the Log Rank (Mantel-Cox) test. P<0.05 was considered statistically significant in the analyses. Results: Half of the patients (n=19; 50.0%) had vulvar mass complaints. While lesions related to vulvar cancer were observed in 13 participants before cancer diagnosis, no lesions were observed in 25 participants (65.8%). Squamous cell carcinoma was detected in 31 (81.6%) participants. Eleven (28.2%) participants had a recurrence. According to the logistic regression analysis, it was determined that the risk factors included in the model did not have statistically significant effects. Cox regression analysis was performed to determine the effects of factors on overall survival. It was determined that the factors included in the models did not have a statistically significant effect. Conclusion: Vulvar cancer is a type of cancer with limited prospective data. Therefore, it poses severe difficulties in treatment. Limited data on vulvar cancer necessitates the development of treatment paradigms. This means that we need to continue to study the disease.

A Surgical Management and Histopathological Study of an Extensive Perianal Sebaceous Gland Adenitis in a Jersey Crossbred Cow

Introduction: Sebaceous gland adenitis is a rare condition found in large ruminants, eluding diagnosis and potentially progressing into neoplastic states if left untreated. The aim of the current study was to indicate the benefits of surgical excision of sebaceous gland adenitis in a Jersey crossbred cow. Case report: A 6-year-old Jersey crossbred cow weighing 300 kg was admitted to the Teaching Veterinary Clinical Complex, Mannuthy, Thrissur, Kerala, India, in December 2022 with a soft tissue mass in the right vulval lip. Initially observed as a small skin bump, the condition had progressively worsened over 2 months, becoming an extensive mass contaminated with external debris and live maggots. Palpation revealed the mass to be firm without eliciting pain. The physiological parameters, such as rectal temperature, heart rate, and respiratory rate were within normal limits. The hematological and serum biochemical parameters were normal. The mass was resected surgically, and the vulval lip was reconstructed. Postoperatively, the cow received a 5-day course of enrofloxacin (Enro, India) at a dosage of 5 mg/kg body weight, along with 3 days of intramuscular meloxicam at a dosage of 0.2 mg/kg body weight and topical application of antiseptic ointment (Lorexane, India). The animal had an uneventful recovery after 2 weeks. Histopathological analysis confirmed the diagnosis as sebaceous gland hyperplasia and chronic adenitis. Conclusion: This study demonstrated that timely diagnosis and excision of the vulval tissue mass resulted in a complete recovery and preserved the animal's value. Chronic sebaceous gland adenitis may have a tendency to transform into a benign tumorous condition. The early presentation of the animal and successful surgical intervention prevented this transformation of sebaceous gland adenitis to a benign or malignant condition.

Retrospective analysis of vulvar benign masses: 5-year single center experience

Aim Although benign lesions in the vulva occur rarely, they are one of the reasons for women to apply to the hospital. Although the most common benign masses in the vulva are bartholin cysts; First of all, it is necessary to rule out malignancy. Our aim is to analyze the demographic and presentation characteristics, clinical and laboratory findings, and surgical operation results of women who applied to a tertiary center with a vulvar mass. Materials and methods All women who had vulvar mass in a tertiary perinatology center between January 2016 and January 2021 were retrospectively included in this study. The demographic data of the patients (age, gravida, parity, abortus numbers), complaints and comorbidities were analyzed. Clinical findings, hospitalization times, treatments and surgery results were recorded. Results Overall, 198 patients who had vulvar masses were included in this study. The median age was 35.0 years. While 15.2% of the patients were nulliparous; 51.1% (n=135) had at least one abortion history. The most common complaints were genital swelling/mass in 77.8% and pain in 36.9%. The most common diagnoses were “bartholin cyst/abscess” in 89.9% and vulvar mass in 6.6%. Cyst excision, abscess drainage and mass excision were performed in 59.6%, 30.3% and 6.6%, respectively. No morbidity or mortality was observed in any of the patients. Conclusion Bartholin's cysts/abscesses are the most common cause of benign masses of the vulva. However, in all women presenting with a vulvar mass, malignancies should be excluded and a biopsy should be obtained if necessary.

Vulvar leiomyosarcoma: A case report

Vulvar leiomyosarcoma is a rare malignant smooth muscle tumor and the most common type of vulvar sarcoma. It can mimic benign tumors, and misdiagnosis may delay appropriate treatment. A 35-year-old woman presented to the outpatient gynecology clinic at the Mirebalais Teaching Hospital for a right vulvar mass. A complete excision of the mass was performed. Histopathology with immunohistochemistry demonstrated leiomyosarcoma. We describe the contextual challenges that ultimately compromised her care, highlighting the challenges to safe delivery of cancer care in our setting.

Vulvar sarcoma in a young patient with neurofibromatosis syndrome with missed opportunities: A case report

Background: Vulvar malignancies are the fourth commonest of genital malignancies. The sarcoma type is associated with neurofibromatosis disease.
 Case presentation: A 29-year-old nulliparous presented to the outpatient gynecological clinic with a five-year history of a recurrent right vulvar mass. The mass was initially excised without histological analysis. Histological examination of a reexcised mass diagnosed a spindle cell sarcoma. She was then lost to follow-up for one year. The mass recurred and she received external beam radiation. On admission, she was in good general status with generalized café-au-lait spots and neurofibromas. Perineal examination revealed an ulcerated right vulvar mass. Toilet vulvectomy and diversion colostomy were performed followed by chemotherapy. She was discharged after five months with a well-granulated wound. Colostomy was reversed six months later.
 Conclusion: Vulvar sarcoma is a rare vulvar malignancy type usually associated with neurofibromatosis. This case highlights the missed opportunities in its management. A high suspicion threshold is critical for early diagnosis and management to curb the morbidity and mortality rate.

An unusual manifestation of neurofibromatosis – A case report of a vulval mass

Neurofibromatosis (NF) of the female genitalia is an uncommon manifestation. Selective involvement of the labium majus is quite rare. We describe a rare manifestation of a vulval plexiform neurofibroma without clitoral involvement in a post-pubertal girl. The patient had multiple café-au-lait spots over the neck, back, buttocks and thighs, a patch of pigmentation over the pelvis and inguinal region, axillary freckling, and a large hanging left vulval mass. On ultrasound, it showed hypoechoic nodules on a hyperechoic background with significant vascularity. Magnetic resonance imaging revealed T1-weighted (T1W) hypointense and T2-weighted (T2W) hyperintense, diffuse infiltrating lesion with few T2W hyperintense tubular and nodular areas, presence of “target sign,” and intense post-contrast enhancement. A biopsy confirmed it to be neurofibroma. The patient was diagnosed with NF type 1 and underwent surgical resection.

Vulval Fibroadenoma Presenting as a Unilateral Vulval Mass—A Report of a Common Neoplasm Present at an Uncommon Site

ABSTRACT Vulval fibroadenoma is a rare benign tumor arising from the ectopic breast tissue or mammary-like anal glandular tissue. Although it is a common breast neoplasm, its genital location makes it notable, with less than a hundred cases being reported in the literature so far. It is commonly known to present in the reproductive age group, similar to its breast counterpart, with its histogenesis being a frequent topic of discussion. Despite being benign and largely infrequent, these vulval neoplasms continue to be important reasons for medical consultation. We present one such case of vulval fibroadenoma presenting as an enlarged lymph node in a 37-year-old female.

Unexpected presentation of accessory breast: vulvar accessory breast tissue: a case report

BackgroundThe accessory breast is composed of residual glandular mammary tissue that persists after normal embryonic development. The entity is so rare that it is easily neglected in the diagnosis of disease.Case presentationWe report a 24-year-old virgin Persian woman with a left-sided vulvar mass and no pain or discomfort until shortly before her presentation at our department. Ectopic breast tissue in the vulva was diagnosed. We performed wide local resection of the lesion. Pathological investigation of the lesion confirmed the presence of ectopic breast tissue with secretory changes. She had no specific developmental abnormalities and had no relevant family history. She was followed up for 10 months and had recovered fully by this time.ConclusionAccessory breast tissue should be considered as a diagnosis when a mass is seen along the embryonic milk line, especially if the clinical findings reveal changes in the mass accompanied by changes in sex hormones.

Huge Rare Vaginal Fibromatosis in Postmenopausal Woman, Case Report and Literature Review, 2022

Background: Pelvic fibromatosis or desmoids tumor is an uncommon benign mesenchymal tumor that usually involves the vulvo-vaginal area in women of reproductive age, which are slow growing and painless mass. Case Report: A 70-year post-menopausal woman from Asmara presented with genital swelling which grows gradually over 15 years. She had history of trans-abdominal hysterectomy for abnormal uterine bleeding before 20 years. She had also history of right sided body weakness due to cerebro-vascular accident for the last10 years. She had no known chronic diseases such as hypertension or diabetes mellitus. On physical examination, she is a wheelchair patient with right sided hemiplegia and old midline abdominal scar. On genitourinary examination, patient had a large, about 20x18cm, non-tender, irregular, nodular mass, that hangs from the right side of the labia majora to the level of one third of upper thigh. She had also multiple nodular lesions around the ano-genital area. Different laboratory baseline investigations revealed normal finding. She was operated on 30/10/2022 and a 4kg vulvar mass was resected with right partial hemi-vulvoctomy and sample was sent for pathology which revealed fibromatosis. She was discharged with full improvement and currently on follow-up for possible recurrence. Conclusion: This is reported for its rarity and its enormously large size, slow growing and non-invasive nature. Besides, this was atypical being in a postmenopausal woman, and it’s important to highlight that desmoids tumors should be included in the differential diagnosis of any vulvar mass. She was managed with surgical intervention as it was extremely big. Enhancing community and health professionals’ awareness on similar health problems is crucial for early intervention of similar r conditions.

Renal transplantlı bir hastada hızlı gelişen dev kondiloma akuminatum: olgu sunumu

Giant condyloma acuminatum (GCA) usually occurs on a set of human papillomavirus (HPV) subtype 6 or 11 infections and is characterized by cauliflower-like aggressive growing mass over the anogenital region. Lesions are more often observed in immunocompromised patients since host immunity is one of the main risk factors of the disease. We report a case of a GCA in a sexually inactive renal transplant recipient. A 25-year-old patient who had renal transplantation four years prior and has been receiving immunosuppression therapy since presented with the rapid growth of a vulvar mass noticed. A wide surgical excision was performed and the patient had no recurrence at her follow-ups. Surgical excision is the definitive treatment in immunocompromised patients with the rapid growth of vulvar condylomas.

Vulvar Leiomyoma Mimicking a Bartholin’s Gland Tumour

Bartholin's cyst is frequently the cause of unilateral vulval enlargement in a woman of reproductive age. We discuss a noteworthy occurrence of vulval leiomyoma that was initially misdiagnosed as a recurrent Bartholin's cyst in this article. Intraoperatively, it was observed that the 35-year-old lady who had been scheduled for marsupialization really had a tumour of vulvar or bartholin's gland origin rather than a cyst. It was discovered to be rather hard in consistency and well encapsulated intraoperatively. The vulvar leiomyoma was proven to be the diagnosis by histopathology. Extrauterine leiomyomas are uncommon and more challenging to diagnose. Bartholin's cysts, fibromas, lymphangiomas, soft-tissue sarcomas, and neurogenic tumours are among the differential diagnoses. Following surgery, it is advised that all patients have long-term follow-up. Keywords: Vulvovaginal leiomyoma, Vaginal wall mass, Benign tumor, Bartholin’s gland, Vulvar mass, Misdiagnosis, Excision, Enucleation, Bartholin’s cyst

Giant pedunculated angiomyofibroblastoma in young

Angiomyofibroblastoma (AMF) is an uncommon benign mesenchymal tumor that primarily affects women's vulvovaginal tissue but can sporadically affect male inguinoscrotal tissue. It is a well-circumscribed lesion that typically does not become a pedunculated hanging mass and is frequently believed clinically to be a Bartholin's gland cyst. A very few cases of vulvar AMF with pedunculated mass have been reported in the literature, and all cases involve the labia majora and middle-aged women. Here, we describe a case of a 22-year-old woman who experienced pedunculated mass in vulva involving the left labia majora. The differential diagnosis for the pedunculated vulvar mass in this young woman with a labial lesion was pedunculated AMF after excluding the most frequent illnesses.