Fibroma mole gigante vulvar: relato de caso / Giant soft vulvar fibroma: case report

Fibroma mole, ou pólipo fibroepitelial, é uma lesão de proporções geralmente reduzidas, de cor hiperpigmentada ou igual à da pele, localizando-se frequentemente na face, pescoço, tronco e regiões intertriginosas. É um tumor classificado como benigno e pode acometer tanto homens quanto mulheres em idade reprodutiva e depois da quarta década de vida. Ocorre principalmente em obesos, diabéticos e durante a gestação. Com menor frequência, podem alcançar dimensões que excedem 5 cm. Seu crescimento pode ser lento ou rápido e comumente são assintomáticos, mas podem promover sangramentos por conta de ulcerações decorrentes de traumas repetidos. Apresentamos neste relato um fibroma mole, gigante, de localização vulvar, com 11 cm de comprimento, 11 cm de largura e 5 cm de espessura, pesando 500 g.

Giant soft vulvar fibroma is a fibroepithelial polyp lesion with generally reduced proportions, with a hyperpigmented color or similar to that of the skin, frequently located on the face, neck, trunk and intertriginous regions. It is a tumor classified as benign, can affect both men and women, of reproductive age and after the fourth decade, mainly obese, diabetic and during pregnancy. However, less frequently, they can reach dimensions that exceed 5 cm, may have a slow or accelerated evolution. They are commonly asymptomatic, but bleeding may be present due to ulcerations resulting from repeated trauma. In the current study, we describe a giant soft fibroma with a vulvar location measuring 11 cm in length, 11 cm in width, 5 cm in thickness and weighing 500 grams.

Abordaje de la enfermedad de Behçet vulvar: comunicación de caso

La enfermedad de Behçet (EB) es un trastorno inflamatorio, multisistémico, recidivante y remitente de etiología desconocida. Una característica clave de la enfermedad es la ulceración orogenital que provoca una morbilidad considerable con gran impacto en la calidad de vida de los pacientes. Su manejo médico consiste en un esquema con colchicina, esteroides o inmunomoduladores. Comunicamos el caso de una paciente con lesiones genitales quien consultó en múltiples ocasiones, recibiendo manejo antibiótico e incluso quirúrgico, con respuesta refractaria a estas intervenciones. Posteriormente, por las características de las lesiones y el comportamiento clínico se sospechó enfermedad de Behçet y se instauró manejo médico con esteroides orales y curaciones con fitoestimulina. Hubo resolución de las úlceras genitales y posteriormente la paciente fue llevada a cirugía para corrección de las sinequias vulvares.

Behçet's disease (BD) is an inflammatory, multisystemic, relapsing-remitting disorder of unknown etiology. A key feature of the disease is orogenital ulceration that causes considerable morbidity with great impact on patient's quality of life. Its medical management consists of a scheme with colchicine, steroids or immunomodulators. We report the case of a patient with genital lesions who consulted on multiple occasions, receiving antibiotics and even surgical management, with refractory response to these interventions. Subsequently, due to the characteristics of the lesion and clinical behavior, Behçet's disease was suspected and medical management with oral steroids and cures with phytostimulin was initiated. The genital ulcers were resolved, and the patient was subsequently taken to surgery for correction of the vulvar synechiae.

Detection rate and clinical characteristics of vulvar squamous intraepithelial lesion / 中华妇产科杂志

Objective:To explore the detection rate, clinical characteristics of vulvar squamous intraepithelial lesion (SIL).Methods:Women diagnosed with vulvar high-grade squamous intraepithelial lesions (HSIL) through colposcopy-guided biopsy from January 1, 2018 to August 31, 2022 in Obstetrics and Gynecology Hospital of Fudan University were included in a 1∶1 ratio with patients diagnosed with vulvar low-grade squamous intraepithelial lesions (LSIL) during the same period. Clinical characteristics including human papillomavirus (HPV) infection rate, genotype, cytology result, colposcopy impression, and lesion location were retrospectively analyzed.Results:(1) The proportion of vulvar SIL detected by colposcopy-guided biopsy increased annually from 2018 to 2022, with rates of 1.64% (740/45 057), 2.34% (1 110/47 402), 2.68% (1 108/41 335), 3.26% (1 536/47 078), 3.31% (667/20 155), with an average rate of 2.57% (5 161/201 027). (2) A total of 1 096 cases of vulvar HSIL and 1 096 cases of vulvar LSIL were included. The overall infection rate of HPV was 92.7% (1 993/2 150), with higher infection rate in vulvar HSIL patients than that in vulvar LSIL patients [96.0% (1 012/1 054) vs 89.5% (981/1 096); χ2=33.62, P<0.001]. Among vulvar HSIL patients, the common HPV genotype from high to low were HPV 16 (66.7%), HPV 52 (14.3%), and HPV 58 (10.0%). For vulvar LSIL patients, the most common HPV genotype were respectively HPV 16 (24.9%), HPV 6 (20.1%) and HPV 52 (17.1%). The overall sensitivity rate of cytology was 53.6%, with no significance difference between vulvar LSIL and HSIL groups (54.3% vs 52.9%; χ2=0.40, P=0.526). The accuracy of colposcopy impression for vulvar HSIL was lower than that for vulvar LSIL [40.2% (163/405) vs 81.7% (380/465); χ2=158.72, P<0.001]. About 57.3% (1 257/2 192) of the patients had concomitant cervical and vaginal lesions, with a higher rate in vulvar HSIL group than that in vulvar LSIL group [62.6% (686/1 096) vs 52.1% (571/1 096); χ2=24.67, P<0.001]. Unifocal lesion was the main type, with no significance difference between vulvar LSIL and HSIL groups [81.4% (381/468) vs 82.5% (386/468); χ2=0.18, P=0.671]. The most common lesion locations were the posterior commissure, followed by labia minora, vaginal vestibule, labia majora, perianal and clitoris. Conclusions:The detection rate of vulvar SIL under colposcopy is about 3%, and the infection rate of HPV is 92.7%. Vulvar SIL, especially vulvar HSIL, is likely to cause concomitant cervical and vaginal lesions. The accuracy of colposcopy in diagnosing vulvar HSIL is low. Therefore a comprehensive and careful examination of the vulva is necessary and suspicious vulvar lesions should be undergone colposcopy-guided biopsy for diagnosis.

Vulvar dermatoses: a cross-sectional 5-year study. Experience in a specialized vulvar unit

Abstract Background: Vulvar diseases are common in the general population and have a negative impact on the quality of life. Objectives: To describe our experience as dermatologists in the management of vulvar dermatosis consultations. Methods: A retrospective observational study was conducted with patients who attended monographic vulvar consultations over a 5-year period. Clinical information was obtained from the patient's charts. Results: 148 women were studied. Their mean age was 43.24 years (standard deviation: 15.15 years), with ages ranging from 4 months to 80 years. 53.4% of patients took between 2 and 5 years to seek medical attention for the first time. The most frequent diagnosis was lichen sclerosus (41.9%), irritative eczema of the vulva (14.9%), and lichen simplex chronicus (10.1%). 83.8% reported anogenital itching, 66.2% pain, and 45.9% dyspareunia. The most frequently prescribed treatment was ultra-potent topical corticosteroids (clobetasol propionate; 41.2%). Patients with lichen sclerosus were significantly older than those who presented with any of the other diseases. No differences were found in terms of either the time of disease evolution or in symptom presentation. Study limitations: Retrospective study. Vulvar diseases with an infectious cause are usually managed in primary care, therefore, were not included. All patients were recruited from a single private hospital which limits the comparisons with the public health system. Conclusions: Vulvar diseases frequently occur and are associated with high morbidity. It is essential to promote the development of specific vulvar consultations in hospitals. Specialties such as dermatology, gynecology, urology, or physiotherapy must be part of these units.

COVID-19 related acute genital ulcer: a case report

ABSTRACT Acute vulvar ulcer (Lipschütz's ulcer) is a rare lesion with local hyperimmunoreactivity triggered by infection, which is characterized by acute, painful, and necrotic ulcerations. This condition is usually found in non-sexually active adolescents, and it resolves spontaneously. We report a case of a 35-year-old woman who was diagnosed with COVID-19 who did not have severe symptoms, but had high levels of D-dimer for 9 days. The COVID-19 diagnosis was followed by the appearance of an acute, necrotic, extremely painful vulvar ulcer, although symptoms caused by COVID-19 had improved. We emphasize the importance of the differential diagnosis to exclude diseases such as Behçet's syndrome, Sexually Transmitted Infections, as well as the presence of viruses that generally trigger Lipschütz's ulcer, such as Epstein-Barr virus and cytomegalovirus. No treatment is usually necessary, however, in the present report due to the pain experienced by the patient, we successfully used oral prednisone.

Hidradenoma papilífero de la vulva con componente de carcinoma in situ: reporte de caso y revisión de la bibliografía / Papilliferous hidradenoma of the vulva with carcinoma in situ component: case report and literature review

Resumen ANTECEDENTES: El cáncer de vulva es relativamente raro, representa menos del 1% de los tumores malignos de la mujer; su incidencia aumenta con la edad. La variedad más frecuente es el carcinoma escamoso (80 al 90%), seguido del melanoma. En este reporte se revisa un carcinoma de origen glandular, como el hidradenoma papilífero del tipo glándula mamaria (mammary-like) de la vulva. CASO CLÍNICO: Paciente de 50 años, con una lesión papular en la vulva de dos años de evolución, con crecimiento lento y progresivo, ocasional sensación de masa y dolor, con colposcopia negativa, sin antecedentes de patología mamaria y con una biopsia previa que reportó hidradenoma papilífero vulvar. Se trató con resección completa de la lesión, con anestesia regional, con bordes libres, no se identificó algún componente infiltrante. En la actualidad permanece sin evidencia de recaída ni requerimiento de tratamientos adicionales durante el seguimiento. CONCLUSIÓN: El hidradenoma papilífero es una lesión benigna, poco frecuente, relacionada con las glándulas anogenitales de tipo mammary-like, con buen pronóstico. El tratamiento recomendado es la escisión quirúrgica, que casi siempre es curativa.

Abstract BACKGROUND: Vulvar cancer is relatively rare, representing less than 1% of malignant tumors in women; its incidence increases with age. The most frequent variety is squamous cell carcinoma (80 to 90%), followed by melanoma. In this report we review a carcinoma of glandular origin, such as papilliferous hydradenoma of the vulva of the mammary gland (mammary-like) type. CLINICAL CASE: We present a 50-year-old patient with 2 years evolution of a papular lesion on the vulva with slow and progressive growth, intermitent sensation of mass and pain, with negative colposcopy, no history of breast pathology and with a previous biopsy that reported vulvar papilliferous hydradenoma. She was treated with complete resection of the lesion under regional anesthesia, with free margins, without identifying an infiltrating component and currently without evidence of relapse or requirement of additional treatments. CONCLUSION: Papilliferous hidradenoma is a rare benign lesion related to the mammary-like anogenital glands, with a good prognosis and its recommended treatment is surgical excision, which is generally curative.

Siringomas vulvares: comunicación de un caso / Vulvar syringomas: case report

RESUMEN Los siringomas son tumores anexiales benignos raramente encontrados a nivel vulvar. Se comunica un caso y se realiza una revisión bibliográfica ante la presentación de una mujer de 33 años con múltiples lesiones papulares en labios mayores, de larga data, con diagnóstico anatomopatológico y tratamiento mediante escisión quirúrgica bajo sedación y vaporización con láser CO2.

ABSTRACT Syringomas are benign adnexal tumors rarely reported at the vulvar area. A case is reported and a literature review is performed for the presentation of a 33-yearold woman with multiple papular lesions in labia majora, of long standing, with anatomopathologic diagnosis and treatment by surgical excision under sedation and CO2 laser vaporization.

Gangrena de Fournier vulvar

La gangrena de Fournier es una enfermedad infecciosa rara y potencialmente fatal, caracterizada por fascitis necrótica rápidamente progresiva de la región genital, perineal y/o perianal. Afecta cualquier edad y género. La gangrena de Fournier vulvar tiene baja incidencia en las mujeres, pero tasa alta de mortalidad, debido a las diferencias en la anatomía genital femenina. La sospecha clínica es fundamental para el diagnóstico, debido a la baja frecuencia de presentación. El tratamiento debe ser agresivo, con administración rápida de antibióticos de amplio espectro y enfoque interdisciplinario temprano por parte de múltiples especialidades médicas. Por ello, es necesario comprender completamente la fisiopatología de la condición para aumentar la tasa de supervivencia del paciente. Se presenta un caso de gangrena de Fournier vulvar.

Fournier's gangrene is a rare and potentially fatal infectious disease characterized by rapidly progressive necrotic fasciitis of the genital, perineal and/or perianal region. It affects any age and gender. Vulvar Fournier's gangrene has a low incidence in women, but a high mortality rate, due to differences in female genital anatomy. Clinical suspicion is essential for diagnosis, due to the low frequency of presentation. Treatment should be aggressive, with prompt administration of broad-spectrum antibiotics and early interdisciplinary approach by multiple medical specialties. Thus, a complete understanding of the pathophysiology of the condition is necessary to increase the patient's survival rate. A case of vulvar Fournier's gangrene is presented.

Carcinoma basocelular na vulva: um relato de caso de neoplasia cutânea em área especial / Basal cell carcinoma of the vulva: a case report of cutaneous neoplasia in a special area

O carcinoma basocelular (CBC) é o câncer de pele mais comum.¹ Entre os fatores de risco para seu desenvolvimento estão a exposição a radiações ionizantes e não ionizantes, alguns produtos químicos e cicatrizes prévias.² Porém, o fator mais importante é a exposição à radiação ultravioleta, o que explica a maior incidência dessa neoplasia em áreas fotoexpostas. O CBC em áreas não expostas é incomum. O objetivo deste relato é descrever um caso de CBC recorrente na vulva, demonstrar a importância do exame dermatológico em áreas incomuns e relatar a aplicação da cirurgia micrográfica de Mohs.

Basal cell carcinoma (BCC) is the most common skin cancer¹. Among the risk factors for its development are exposure to ionizing and non-ionizing radiation, some chemicals, and previous scars.² However, the most important factor is exposure to ultraviolet radiation, which explains the higher incidence of this neoplasm in photo-exposed areas.¹ BCC in unexposed areas is uncommon. The purpose of this report is to describe a case of recurrent BCC in the vulva, to demonstrate the importance of dermatological examination in unusual areas, and to report the application of Mohs micrographic surgery

Síndrome de Behçet ou úlcera de Lipschütz: desafio diagnóstico / Behçet's syndrome or Lipschütz ulcer: diagnostic challenge

A ocorrência de úlceras genitais em adolescentes e mulheres jovens tem impacto emocional para as pacientes e seus familiares, pela frequente associação com uma possível etiologia de transmissão sexual. Porém, úlcera de Lipschütz e síndrome de Behçet não têm etiologia infecciosa e devem ser lembradas como possíveis diagnósticos diferenciais. O diagnóstico dessas duas patologias é clínico e pode ser desafiador. Dessa forma, foi realizada uma revisão na literatura com o objetivo de comparar as duas entidades. A úlcera de Lipschütz é causada por uma vasculite local e caracteriza-se pelo surgimento súbito de úlceras na vulva ou vagina inferior. Já a doença de Behçet é causada por vasculite sistêmica, com episódios de remissão e exacerbação, que pode envolver quase todos os sistemas orgânicos. Em ambos os casos, é essencial o referenciamento para reumatologia. O tratamento objetiva suprimir exacerbações, controlar a dor e prevenir infecção secundária.(AU)

The occurrence of genital ulcers in adolescents and young women have an emotional impact for the patient and their families, due to the frequent association of its etiology with a sexually transmitted disease. However, Lipschütz ulcer and Behçet's syndrome do not have an infectious etiology and should be remembered as a possible differential diagnoses. As the diagnosis of these two pathologies is clinical and can be challenging, a review of literature was carried out. The objective of this review of literature was to compare both diseases. Lipschütz ulcer is caused by local vasculitis and is characterized by the sudden appearance of ulcers in the vulva or lower vagina. Behçet's syndrome is caused by systemic vasculitis, with episodes of remission and exacerbation, which can affect almost all organ systems. In both cases, referral to rheumatology is essential. Treatment aims to suppress exacerbations, control pain and prevent secondary infection.(AU)

Clinical analysis of vulvar lichen simplex chronicus / 中华皮肤科杂志

Objective To investigate clinical features of vulvar lichen simplex chronicus (VLSC).Methods Clinical data were collected from 137 VLSC patients who visited a Vulvar Clinic in the Department of Dermatology,Beijing Hospital from 2017 to 2018,and analyzed retrospectively.Non-normally distributed measurement data (age and disease duration) were described as median (P25,P75),and analyzed by using rank sum test,and enumeration data were compared by using chi-square test.Results Among the 137 patients with VLSC,the age at onset was 32.0 (25.5,40.0) years,and the disease duration was 36.0 (15.0,72.0) months.Thirty-two (23.4％) patients had a history of atopic diseases,and the age at onset of VLSC was significantly lower in these patients with a history of atopic diseases (29.5 [25.0,35.8]years) than in those without a history of atopic diseases (33.0 [27.0,41.0] years,Z =2.03,P =0.042).The most frequently involved site was the labia majora (130/137,94.9％),and the labia minora was rarely involved (13/137,9.5％).Bilateral lesions were observed in 103 (75.2％) patients,and hypopigmentation occurred in 8 (5.8％) patients.All the patients experienced itching to different extents,including moderate itching in 44 (32.1％) cases and severe itching in 80 (58.4％).The ratio of patients with severe itching to those with disease duration ＞ 2 years (68.1％) was significantly higher than that of patients with severe itching to those with disease duration ＜ 2 years (47.7％,x2 =5.830,P =0.016).Patients reported that local wetness and sweating (55 cases,40.1％),spicy diet (41 cases,29.9％) and mental stress (36 cases,26.3％) could aggravate itching,Conclusions VLSC commonly occurs in patients aged 20-39 years,and atopic predisposition may be an important factor for VLSC.VLSC mostly involves bilateral labia majora,and the longer the disease duration,the more severe the itching.

Vulvar tuberculosis-A rare manifestation of the disease / Tuberculose vulvar - Uma manifestação rara da doença

Abstract Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.

Resumo A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas demorte nomundo. Embora afetemais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis pormeios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.

Recurrent vulvar condiloma treatment in infant: a case report / Tratamento de condiloma vulvar recorrente em lactente: um relato de caso

Introduction: Anogenital warts are one of the major clinical manifestations of the Human Papillomavirus (HPV). Case reports in children have grown in the last decades; however, there are still difficulties in determining the virus epidemiology and the best therapy for this age group. Objective: To report a case of recurrent vulvar condyloma in a sexually abused infant who presented complete resolution of the lesions after the use of topical imiquimod. Methods: Data research and medical record review were performed in addition to a qualitative study consisted of a wide literature appreciation on the subject. Results: After undergoing extensive therapy, the patient was successfully treated using topical imiquimod. Conclusion: Observation of this particular case suggests that imiquimod may be a safe and effective therapeutic alternative for the treatment of condyloma in the pediatric population. However, theoretical foundations for such conduct are scarce. Thus, the need for further studies on the subject is reinforced.

Introdução: As verrugas anogenitais constituem uma das principais manifestações clínicas da infecção pelo vírus do Papiloma Humano (HPV). Relatos de casos em crianças têm crescido nas últimas décadas; contudo, ainda há dificuldades em determinar a epidemiologia do vírus e definir a melhor terapêutica para essa faixa etária. Objetivo: Relatar um caso de condiloma vulvar recorrente em uma lactente abusada sexualmente que apresentou resolução completa das lesões após o uso de imiquimode tópico. Métodos: Foi realizado levantamento de dados e revisão de prontuário, além de estudo qualitativo composto por apreciação ampla da literatura acerca do tema em questão. Resultados: Depois de ser submetido à extensa terapêutica, a paciente foi tratada com sucesso utilizando imiquimode tópico. Conclusão: A observação desse caso específico sugere que o imiquimode pode ser uma alternativa terapêutica segura e eficaz para o tratamento de condiloma na população pediátrica. Entretanto, embasamentos teóricos para tal conduta são escassos. Assim, reforça-se a necessidade do desenvolvimento de mais estudos sobre a temática.

Donovanosis in a child victim of sexual abuse: response to doxycycline treatment

Abstract: Donovanosis is a chronic infectious disease caused by the Gram-negative bacteria Klebsiella granulomatis, which mainly affects the skin and mucous membranes of the genital, perigenital, and inguinal regions. Also known as venereal granuloma or granuloma inguinale, it is endemic in tropical and subtropical regions of the globe and often associated with sexual transmission. We report the case of an 11-year-old female victim of chronic sexual abuse, who was diagnosed with donovanosis and presented a good therapeutic response to doxycycline.

Most frequent dermatoses at a vulvar pathology outpatient clinic

Abstract: The vulva corresponds to the external female genitalia. Special features of this region favor a wide range of diseases, whose knowledge allows for better clinical management, impacting on the quality of life. This is a cross-sectional and descriptive study carried out at a vulvar pathology outpatient clinic, between May and December/ 2015. Data obtained from a standard form included demographic parameters, habits, and vulvar dermatosis and allowed to identify the epidemiological profile of patients with vulvar dermatosis treated in this outpatient clinic and to determine the most prevalent dermatoses. Our results, partially concordant with the literature, provide original data that should stimulate further studies

Clinical analysis of 11 cases of vulvovaginal-gingival syndrome / 中华皮肤科杂志

Objective To investigate clinical features and therapeutic protocols of vulvovaginal-gingival syndrome(VVGS). Methods Clinical data were collected from 11 female patients with VVGS and analyzed. Results Among the 11 patients, the mean and median ages at a definite diagnosis of VVGS were both 46 years, and the average disease duration was 4 years. Painful erosive erythema was found on the vaginal vestibule in 7 patients, on the gingiva in 10, as well as on the bilateral buccal mucosa in 5. Additionally, 8 and 4 patients reported dyspareunia and vaginal hemorrhage, respectively. Seven patients were treated with low-dose oral methylprednisolone combined with hydroxychloroquine or colchicine, and the other 4 were treated with oral hydroxychloroquine alone. Furthermore, all of the 11 patients applied topical tacrolimus 0.1%ointment. Finally, 8 patients were cured or markedly improved. No obvious adverse reactions were observed in any of the patients. Conclusions VVGS mostly occurs in middle-aged women, with the vaginal vestibule and gingiva as predilection sites of painful erythema and dyspareunia as common symptoms. Patients have good responses to methylprednisolone combined with hydroxychloroquine, and hydroxychloroquine alone also shows good efficacy in patients with mild VVGS. Tacrolimus 0.1%ointment can be one of drugs for topical maintenance treatment of VVGS.

Zoon vulvitis

Abstract Zoon vulvitis or vulvitis chronica plasmacellularis is a rare, chronic benign inflammation of the vulvar mucosa, diagnosed histologically, with variable therapeutic responses. It is important to be diagnosed because it mimics the presentation of other genital conditions, such as lichen planus and squamous cell carcinoma, which require specific treatment. We report a case of a female patient with three asymptomatic shallow ulcers on the labia minora. Laboratory tests ruled out infectious diseases and the biopsy was consistent with Zoon Vulvitis.

Clinical effect of focused ultrasound on the treatment of nonneoplastic epithelial disorders of vulva: A retrospective study of 583 cases / 解放军医学杂志

Objective To evaluate the short and long-term effect and explore the potential influential factors of focused ultrasound in the treatment of nonneoplastic epithelial disorders of vulva (NNEDV). Methods Clinical data of 583 patients suffering from NNEDV which was treated with focused ultrasound admitted from Jan. 2004 to Jun. 2014 to the hospital the authors served were collected. The treatment effects, complication rate, and potential influential factors were retrospectively analyzed. Results The total effective rate of focused ultrasound in treating NNEDV was 97.43%, the recurrence rate was 28.65%, and the complication rate was 9.09%. The effective rate was significantly increased after a course of strengthened treatment (P<0.05). The incidence of complications of CZF300 (high-power and short term model) treatment was significantly higher than that with CZF- 1(low-power and long term model, P<0.001). Conclusions A good clinical effect is predictable with focused ultrasound in the treatment of NNEDV. More promising results could be attained with multiple strengthened treatment, and a lower complication rate can be obtained with a low-power and long term treatment strategy.

Doença de Paget extramamária vulvar e unilateral - Relato de Caso / Vulvar extramammary and unilateral Paget's disease: a case report

A doença de Paget extramamária é neoplasia cutânea rara, ocorrendo tipicamente na vulva de mulheres caucasianas na pós-menopausa. Clinicamente, o sintoma mais comum é o prurido, observando-se lesão eritematosa, descamativa e eczematosa. Devido à raridade da doença e a sua aparência inespecífica, pode ser confundida com outras condições dermatológicas, retardando o diagnóstico. O presente caso demonstra uma forma de doença de Paget extramamária vulvar unilateral confirmada por estudo anatomopatológico e imunohistoquímico. O tratamento-padrão da doença é cirúrgico, e a paciente foi submetida à exérese completa da lesão, continuando em acompanhamento semestral.

Extramammary Paget's disease is a rare cutaneous neoplasm typically occurring in the vulva of Caucasian women after menopause. Clinically, the most common symptom is pruritus, when an erythematous, desquamative and eczematous lesion can be observed. Due to the rarity and nonspecific appearance of the disease, it can be confused with other dermatological conditions, delaying diagnosis. The present case demonstrates a form of vulvar extramammary unilateral Paget's disease confirmed by anatomical pathologic and immunohistochemical study. The standard treatment used for the disease in this case was surgical and the patient underwent complete excision of the lesion, with continued monitoring every six months.

Fibroma mole gigante de localização vulvar: relato de caso / Giant soft fibroma located in the vulva: a case report

É apresentado caso de fibroma mole na vulva de tamanho e evolução incomuns em uma mulher na pós-menopausa.

This article describes the case of a soft fibroma of unusual size and development located in the vulva of a post-menopausal woman.