Benign vulvar tumors

Spontaneous cutaneous endometriosis in Mons Pubis: review of literature

Cutaneous endometriosis is not a very often seen condition and is broadly classified as primary (spontaneous) and secondary. While perineal endometriosis arising in a previous scar has been reported, spontaneous cutaneous endometriosis in perineum is extremely rare and only three cases occurring in mons pubis have been reported in literature. We report a case of 34-year-old lady presented with a swelling in pubic region and associated dull aching pain of 1-year duration with no history of cyclical variation of symptoms. Investigations finally concluded a diagnosis of endometriosis and a Complete excision with clear margins. Clinicians should be aware that a spontaneous endometriosis in the perineum can occur and can have atypical presentation with no increase in size or pain during menstruation.

Benign "lumps and bumps" of the vulva: A review

Vulvar dermatology represents a challenge for many providers. Given that the vulva is both a gynecologic and dermatologic organ, patients with cutaneous lesions involving the vulva may present to primary care, gynecology, or dermatology. Particularly within dermatology, the vulva remains understudied, which can lead to anxiety among providers regarding appropriate next steps in the diagnosis and management of vulvar lesions. Thus, the purpose of this review is to highlight commonly encountered anatomic variants and benign neoplasms of the vulva, distinguish them from key pathologic mimickers, and provide guidance to practicing dermatologists on what may constitute normal vulvar variations.

Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

Objective: To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate.

Methods: We followed the PRISMA guidelines for Systematic Reviews and our study was prospectively registered with PROSPERO (CRD42020202441). The terms “Endometriosis” and “Perineum” or “Vulva” were used as keywords. Cochrane Library, Medline/Pubmed, Embase and Clinicaltrials.gov were searched. Papers in English, Spanish, Portuguese, French or Italian from inception to July 30, 2020 were considered. Reference lists of included articles and other literature source such as Google Scholar were also manually scrutinized in order to identify other relevant studies. Two independent reviewers screened potentially eligible studies according to inclusion criteria.

Results: Out of 539 reports, 90 studies were eligible including a total of 283 patients. Their mean age was 32.7 ± 7.6 years. Two hundred sixty-three (95.3%) presenting with vulvo-perineal endometriosis have undergone either episiotomy, perineal trauma or vaginal injury or surgery. Only 13 patients (4.7%) developed vulvo-vaginal endometriosis spontaneously i.e., without any apparent condition favoring it. The reasons that motivated the patients to take medical advice were vulvo-perineal cyclical pain increasing during menstruations (98.2% of the patients, n = 278). Out of the 281 patients for whom a clinical examination was described, 274 patients (97.5%) showed a vulvo-perineal nodule, mass or swelling while six presented with bluish cutaneous lesions (2.1%) and 1 with bilateral polyps of the labia minora (0.4%). All but one patients underwent surgical excision of their lesions but only 88 patients (28.1%) received additional hormonal therapy. The recurrence rate was 10.2% (29 patients) considering a median follow-up period of 10 months (based on 61 studies).

Conclusion: In conclusion, vulvo-perineal endometriosis is a rare entity with approximately 300 cases reported in the literature since 1923. With the available knowledge shown in this systematic review, we encourage all practitioners to think about perineal endometriosis in case of perineal cyclical pain with or without previous perineal damage. Diagnosis should be done with clinical exam, perineal ultrasound and pelvic MRI when available. In case of anal sphincter involvement, perianal ultrasound should be performed. Surgical excision of the lesion should be realized in order to remove the lesion and to confirm the diagnosis histologically. Hormonal treatment could be proposed to attempt to decrease the size of a large lesion before surgery or to avoid recurrence of the lesion. As evidence-based approach to the diagnosis, treatment and recurrence rate of affected patients remains a challenge given its low prevalence, the variations in management found in the articles included and the limited quality of available studies, we suggest that a prospective database on vulvo-perineal endometriosis should be generated to increase knowledge but also awareness among healthcare professionals and optimize patients' care.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202441.

Diagnosis and treatment of perineal endometriosis: review of 17 cases

PURPOSE

To demonstrate the appropriate diagnosis and treatment of perineal endometriosis.

METHODS

Seventeen patients who presented with a tender perineal mass coinciding with the menstrual cycle on the scar of a previous vaginally procedure were examined retrospectively. Their clinical features and treatment were analyzed.

RESULTS

All patients presented with a palpable painful lesion. All of them had had vaginal delivery with episiotomy. The mean age of the patients was 34.35 years. The mean latent period was 46.82 months. The mean size was 2.38 cm. Thirteen patients presented with one subcutaneous nodule and four had multiple nodules. Color Doppler ultrasound revealed a subcutaneous nodule with an irregular outline and echo-complex density underlying the episiotomy scar. Only one patient suffered from perineal endometriosis combined with pelvic endometriosis. All endometriotic masses in perineum were completely excised and cured, and confirmed by the microscopic examination.

CONCLUSIONS

A detailed history and thorough pelvic examination are essential in diagnosing perineal endometriosis. Surgical intervention is the first choice of treatment.

Neurofibroma at unusual locations: report of two cases in teenage girls

Solitary neurofibromas are rare occurrence in salivary gland region as well as mons pubis of females. We present two cases of teenage girls with swelling in parotid region and mons pubis. Fine needle aspiration cytology was inconclusive in both cases. They were both managed surgically and a diagnosis of neurofibroma was ascertained histopathologically and also confirmed with S-100 immunohistochemistry. The patients were followed up for a period of six months, however, no recurrence was noted. Though, one patient had a previous history of recurrence. We report these cases in view of their rarity of site and age as well as no correlation with neurofibromatosis and clitoromegaly.

Carvenous lymphangioma of the vulva

Lymphangioma is a rare proliferation of the lymphatic system which is classified as either lymphangioma circumscription or carvenous lymphangioma. The involvement of the vulva is very rare and only a small number of case reports have been made on carvenous lymphangioma of the vulva. We herein report a case of 20-year-old unmarried girl presented with gradually expanding and painless tumor of the left labium majus. The mass was removed surgically and pathology confirmed as carvenous lymphangioma, with no recurrences to date.

Giant vulvar lipoma in an adolescent girl: a case study and literature review

A rare case of a giant vulvar lipoma that developed in an adolescent is presented. A review of the world literature of 15 cases that occurred prior to adulthood confirmed that they tend to occur on the right side of the vulva.

Unusual benign polypoid and papular neoplasms and tumor-like lesions of the vulva

We aimed to investigate the prevalence and spectrum of unusual benign neoplasms and tumor-like lesions presenting as vulvar polyps and papules, to study their clinical, pathologic, hormonal, and developmental features and whether they have important associations with other pathologic lesions or clinical diseases. We conducted a retrospective review study of 115 vulvar specimens over 7 years. Common lesions, for example, fibroepithelial polyps, skin tags, papillomas, abscesses, viral warts and common cysts, were excluded. We found 21 cases (18%) with uncommon benign vulvar lesions. They included 7 epithelial cysts, 3 vascular lesions, 3 glandular neoplasms, 3 endometrioses, 1 caruncle, 1 pilonidal sinus, 1 prolapsed urethra, 1 seborrheic keratosis, and 1 granular cell tumor. The age range was between 1 and 64 years with a mean age of 33 years. Most (86%) were 2.5 cm or less. Many were asymptomatic incidental pathologic findings that can be missed clinically. Nine cases have important clinical associations or coexisting incidental pathologic lesions. Some lesions demonstrated hormone receptors. Some were clinically confused with fibroepithelial polyps, abscesses, warts, melanocytic lesions, and tumors. In conclusion, although the vulva is a small compartment, its developmental and histologic complexity can result in a variety of unusual and rare benign polypoid and papular lesions, some unique to the vulva, which might present diagnostic challenges to the clinicians and pathologists. In addition, many bear controversy regarding their histogenesis and origin of development in the vulva.

Angiolipoma of the labia majora: MR imaging findings with histopathological correlation

Benign soft tissue tumors of the vulva are relatively rare in adult patients. We present the magnetic resonance (MR) imaging features of an angiolipoma of the labia majora that developed in a 58-year-old woman. MR imaging showed a well-circumscribed lesion that was hyperintense on T1-weighted and T2-weighted MR images, and hypointense on fat-suppressed MR images, consistent with fat content. High apparent diffusion coefficient was noticed on diffusion-weighted MR images. Dynamic gadolinium-chelate enhanced MR imaging showed progressive enhancement. Histopathologically, the lesion was predominantly made of mature adipose tissue and contained thin walled vascular channels consistent with angiolipoma.

Endometriosis of the perineum

Endometriosis of the perineum and vulva is extremely rare, with the most common site being episiotomy scars. We report here a case of spontaneously developing perineal endometriosis successfully treated with local excision. A 39-year-old woman was admitted complaining of a painful vulvar lump with cyclic swelling. She had first noticed the mass 7 years before, and it had gradually increased in size. Gynecological examination showed a walnut-size, painful, subcutaneous mass in the left perineum. Magnetic resonance imaging revealed a multilobular cystic mass with inner hemorrhage, suggesting vulvar endometriosis. The patient was treated by local excision of the vulvar mass, and complete excision was achieved. The pathological diagnosis of the excised tissue was endometriosis. The patient is well without evidence of disease 5 months following the local excision. Spontaneous perineal and vulvar endometriosis is extremely rare. However, any lesion that evolves in response to the menstrual cycle should be considered endometriosis.

Giant neurofibroma of labia major

A 21-year-old woman presented with a large, slowly growing, pedunculated mass from her right labia major interfering with her physical activity. Surgical excision was performed, and pathologic evaluation confirmed the diagnosis of neurofibroma.

Large vulvar lipoma in an adolescent: a case report

Lipomas are the most common benign tumors of soft tissues. However, conventional lipomas have been reported only rarely as presenting in the vulva. We present a case of vulvar lipoma in a 17-yr-old woman, possibly caused by chronic intermittent irritation.

Sonographic findings of a large vulvar lipoma

Lipomas of the vulva are rare benign tumors that consist of mature fat cells often interspersed with strands of fibrous connective tissue. They arise from the vulvar fatty pads and present as soft, multilobulated subcutaneous neoplasms. Histological examination reveals a thin capsule surrounding a lobular proliferation of lipocytes. Liposarcomas of the vulva have been described rarely. We present the sonographic findings of a large lipoma of the vulva, and demonstrate the contribution of topical application of a high-frequency transvaginal transducer in depicting lobular structural features, characteristic of this soft tissue tumor.

Inverted follicular keratosis of the vulvar skin: a lesion that can be confused with squamous cell carcinoma

Although seborrheic keratoses of the vulva are described in textbooks, to our knowledge, inverted follicular keratosis has not been reported. A 27-year-old woman underwent an excisional biopsy for a small lesion of the left labium majus. Squamous cell carcinoma was considered in the clinical differential diagnosis. The initial pathologic diagnosis suggested squamous cell carcinoma in situ, and the consultation diagnosis was superficially invasive squamous cell carcinoma. On pathologic examination, a symmetrical, endophytic, epithelial tumor was observed consisting of a proliferation of basaloid cells with many areas of reactive squamous cells showing numerous squamous eddies, focal reactive nuclear atypia, and occasional mitotic figures. After the pathologic diagnosis of inverted follicular keratosis was made, a history of close perineal shaving and total body tanning was obtained. Because inverted follicular keratosis is postulated to be related to follicular injury, it is likely that the trauma of close shaving is a significant etiologic factor. There is less evidence that ultraviolet ray exposure is of etiologic importance.