Mammary type adenocarcinoma of the vulva: a rare case report

A primary vulvar mammary type of adenocarcinoma is an exceptionally rare malignancy that is thought to arise from mammary-like vulvar glands. Its low incidence is partly responsible for the lack of guidelines for patient management. We present a case of a 74-year-old woman who presented with a palpable mass in her vulvar region and was submitted to an excisional biopsy, which was diagnosed as mammary-type adenocarcinoma. The patient then underwent a partial vulvectomy with unilateral inguinal sentinel lymph node biopsy followed by adjuvant hormonal therapy. This case report highlights the challenges in diagnosing and managing this rare entity and emphasizes the importance of a multidisciplinary approach to providing optimal care for patients with a mammary type of adenocarcinoma of the vulva.

Vulval leiomyoma causing coital difficulty: report of two cases

Leiomyoma is a smooth muscle benign tumor and it is a common benign lesion of the uterus in women of the reproductive age group with a prevalence of about 30%. Though the prevalence of uterine fibroid was 6.5% in Ile-Ife, and 8.5% of gynecological admissions in Ilesha, Nigeria, vulval leiomyoma is very rare and often misdiagnosed as Bartholin cyst or with other differentials like lipoma, etc. It is usually not considered a differential of vulval masses, but with detailed examination and with the use of investigative tools, the diagnosis can become clearer. This paper presents 2 cases of histologically diagnosed vulval leiomyoma seen at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) between January 2017 and December 2021 with both patients complaining of coital difficulty. During this time, the prevalence of this lesion was calculated to be 0.092% of gynecology admissions and 0.17% of gynecological surgeries done in the hospital.

Vulval symptoms in female recreational cyclists

Background: Cycling is linked to altered genital sensation, numbness, pain and sexual dysfunction in males and the professional female cyclist. After noticing an increase in women presenting to gynaecology clinics with cycling related vulval symptoms, we aimed to identify the incidence, significance and management of vulval pathology among female recreational cyclists.Methods: An anonymous online questionnaire was distributed to 5 Devon cycling clubs and promoted on the 揝outh West Women抯 Cycling� Facebook group. Participants were asked about vulval symptoms, management and if these symptoms had affected their cycling.Results: 508 women responded to the questionnaire between the ages of 20 and 60+. Overall 221, 43.5% of women said they had been deterred from cycling due to vulval/perineal discomfort. The commonest symptom experienced was pain, 37.4%, followed by chafing, 33.3% and redness, 26.6%. Just over a fifth of women had experienced infections they attribute to cycling: 9.8% urinary tract infections, 7.5% vulvovaginal candida and 3.1% bacterial vaginosis. The most important recommendation for the management of vulval discomfort was to use a women-specific saddle with a central cut out. Other recommendations included the benefits of professional bike fit, use of chamois cream and avoidance of hair removal. The menopausal group (the modal group) also commented on the benefits of topical oestrogen to counter the effects of atrophy.Conclusions: Vulval/perineal symptoms are a significant problem for female recreational cyclists. Further research and randomised control trials into the prevention and management is required so that evidence-based guidelines can be developed.

Multi-disciplinary intervention for labial fusion in a case of vulval lichen planus.

Vulvo-vaginal lichen planus is a very distressing and rare forms of non-venereal genital dermatoses. Erosive variants of Lichen planus often have a protracted course and has a higher risk of malignant transformation. This case was a 53-year- old woman, previously diagnosed with lichen planus on conservative treatment, who now presented with symptomatic labial adhesions and urinary complaints like urgency, frequency and poor urine stream. Clinical examination revealed normally developed labia majora, partially but extensively fused labia minora including the clitoral hood. Urethral opening was not visualised, while a small vaginal orifice was seen with no ulcerations. A multi-disciplinary team consisting of urologist and plastic and cosmetic surgeon dissected out the labial adhesions with the electrocautery and reconstructed the vaginal and urethral openings. Cystoscopy followed by urethral dilatation was done for urethral narrowing. Postoperatively, on following up the patient the adhesions were completely separated, and the area healed well. No recurrences were noted. Though aggressive management with topical steroids and other measures often improves symptoms on short term basis, few patients may require long term management by multi-disciplinary team to optimize the outcomes.

A rare case report of large bilateral vulval elephantiasis

Elephantiasis, the result of chronic lymphedema, is characterized by gross enlargement of the limbs or genitalia. It occurs because of obstructive diseases of the lymphatic system. Genital elephantiasis is a common result of filariasis. Other causes are lymphogranuloma venereum. granuloma inguinale, carcinomas, lymph node dissection, irradiation and tuberculosis. Filarial elephantiasis of the female genitalia is extremely uncommon, about 1-2% of the total cases of filarial elephantiasis. Mrs. X, 25 years old female, P1L1, resident of a village in Bihar presented to gynaecology OPD of ABVIMS and Dr. RML Hospital on 06th January 2020 with complaint of huge progressively increasing vulval swelling since 3 years. Patient had come from Bihar for treatment. She had been showing in her native place for 2 years but now the lump had made her walking difficult. She did not give history of any drug given for treatment for filariasis. She gave history of being treated for pulmonary Koch 10 years back. On examination, there was a non- ulcerative, polypoidal growth of around 20×14×11 cm arising from bilateral labia majora and minora obstructing the vulval cleft. There was no associated lymphadenopathy or limb oedema. All the investigations were within normal limits. Microfilaria antigen testing done at night was negative. Patient was given diethylcarbamazine and excision of the lump was done on 14th February 2020. Histopathological report showed dilated lymphatics with non-caseating granulomas, consistent with filariasis. In endemic countries like India, filariasis is the commonest cause of elephantiasis; however genital filariasis in woman is very rare. Other cause could be tuberculosis which is still rarer. Early diagnosis and treatment of filariasis can eradicate this neglected tropical disease which causes disfigurement and severe morbidity as its sequelae.

Vulval carcinoma at the site of recent Bartholin gland excision: a rare case report

Around 2-7% of all vulvar cancers are represented by primary carcinomas of Bartholin gland. Here we are presenting such a rare case of carcinoma of Bartholin gland. 45/F P2L2 presented in our OPD with non-healing lesion in vulva for 2 months. She had history of Bartholin’s cyst excision (elsewhere), 2 months back (the exact time since when she is having the non-healing lesion in vulva). Diagnostic biopsy revealed it to be vulval squamous cell carcinoma. She was given two cycles of Neo adjuvant chemotherapy (Inj. Paclitaxel and Carboplatin). In view of better response to the treatment patient was planned for surgery. Patient underwent wide local excision with bilateral inguinofemoral lymphadenectomy. Although the majority of vulvar lesions are benign, especially in women younger than 50 years of age, any solid mass should be carefully evaluated for malignancy. Preferably biopsy of Bartholin gland should be considered if the patient is more than 40 years of age and should be mandatory in a menopausal woman.

Labial hypertrophy as a cause for vulvae pruritis

Labia minora hypertrophy is a relatively uncommon surgical condition being popularised in the realm of vulvovaginal plastic surgeries. Apart from the unaesthetic appearance of the hypertrophied minora, these cases are also associated with itching, hygiene problem, pain while sitting down, sports activities, difficulty in wearing tight clothing, bleeding and discomfort while or after sexual intercourse, social embarrassment, insecurity and psychological diminution of confidence and self‐esteem. In a country like India, due to sociocultural reasons, patients hesitate to consult a doctor for such deformities. Most of the patients suffer in silence for years. Although common in the west, very few surgeons in the country perform this simple and rewarding surgery. Here, presenting a case of married women of reproductive age group presented to the study side with complains of severe vulvar itching, the cause of itching was labia minora hypertrophy.

A rare case of hydrocele in a female

Vulval swellings have always been a case of a difficult and a puzzling situation and more so when they are huge in size. Vulvar swellings are of various types such as Bartholin cyst, sebaceous cyst, cyst of canal of nuck, inguino-labial hernia and vulval varicosities. Most common vulvar cysts are epidermal inclusion cysts. Usual location is beneath the epidermis. An alternative histogenesis is embryonic remnants or occlusion of pilosebaceous ducts of sweat glands. Cutaneous cysts which are lined by ciliated epithelium are very rare, and authors present a rare case of a cyst arising from a left labium majus resembling a hydrocele seen in males with histopathology suggestive of ciliated cyst of the vulva.

Ultrasonography of benign vulvar lesions

With the increasing applications of ultrasonography in the field of dermatology, this imaging modality can be extended to identify and characterize common vulvar lesions, with a particular focus on their location, size, vascularity, and content. This pictorial essay provides an introduction to vulvar ultrasonography, including technical considerations, ultrasonographic anatomy, and the ultrasonographic appearances of some vulvar conditions.

A Study of Patients Treated for Primary Squamous Cell Carcinoma of the Vulva in the Regional Cancer Centre in Cardiff, UK.

Objective: Review of patients operated for primary squamous cell carcinoma (SCC) of the vulva in the Department of Gynaecological Oncology, University Hospital of Wales in Cardiff, to determine factors related to recurrence as well as survival of disease. Material/Methods: A retrospective review using details obtained from patients’ records. Hazard ratio estimation was carried out with Cox Regression analysis and survival plots were determined using Kaplan-Meier plots. Results: 144 women with primary vulval SCC were operated from 2002-2010. Commonly, radical wide local excision (49.3%) and radical vulvectomy (46.5%) were carried out, apart from ano-vulvectomy (1.4%) and local excision biopsies (2.8%). In 77.1% lympnode dissection was performed and inguinal metastasis was diagnosed in 28.8%, bilaterally in 68.8%. Histologically, 64.4% were moderate/poor differentiation and 30.9% were advanced disease (FIGO III and IVA). The 5-year survival rate (OS) was 61.1%. Stratified by FIGO classification, the 5-year OS for stages IA, IB, II, III and IVA were 72.7%, 86.0%, 50%, 34.4% and 45.5% respectively. Age >70 years was an important prognostic factor (51.9% OS) compared to 71.6% in patients 70 years. Patients with grade 1 disease survived in 72.5%, grade 2 in 58.8% and poorly differentiated cancer in 41.7%. Presence of inguinal metastasis was associated with a 40.6% 5-year OS, absence with 74.7%. Conclusions: Cox regression analysis confirms that age, presence/bilaterality of inguinal lymphnode metastasis, high-grade tumour differentiation, tumour size, FIGO stage and adjuvant therapy are important prognostic factors for 5-year survival.

Giant Vulval Lipoma in a Post Menopausal Woman.

Lipoma is the second most common mesenchymal tumour in the vulva. It is rare and not commonly seen at the Gynaecological clinic. Perineal lipomas have been reported in females with accessory labioscrotal folds. The site of the tumour and its painless nature delays patient’s presentation. Giant tumours in the perineal region can be uncomfortable and may even obstruct flow of urine and vaginal penetration. Surgical excision and cosmetic approximation of the skin is the treatment of choice for giant vulval lipomas. We present a case of giant vulval Lipoma in a 60-year-old woman. She presented because of embarrassing sexual relationship and urinary difficulties. She had surgical removal of a 900 gms mass.

Aggressive Angiomyxoma of the Vulva: Libyan Female Case Report.

Aims and Background: Aggressive angiomyxoma is rare tumor of pelvic and perineal organs, occurring usually in women of reproductive age, and carrying a high tendency to local infiltration and relapse. Most literature about Aggressive angiomyxomaconsists of isolated case reports. Presentation of Case: We reported a case of 41-year-old Libyan woman complaining of a slow and progressive growth of a right vulvar labia major a pedunculated tumor with long a stalk was detected, measuring of 12.0x8.0 cm. Wide surgical resection of the tumor were performed. Histopathology diagnosed a large aggressive angiomyxoma with uninvolved resection margins. Patient remains without recurrence at 8.0-months followup. Discussion and Conclusion: Non Aggressive angiomyxomais rare but should be excluded in any large vulval mass. We expect that awareness accompanied with wide free safe margin excision has important role to prevent the recurrence of tumor.

Necrotising fasciitis complicating vulval ulcer - A case report.

Necrotizing fasciitis, NF, is also known as the flesh eating disease. The incidence is rare. Infection. Mortality is a high as 40%. Very few cases have been reported in English literature and also very few cases of necrotizing fasciitis of female perineum in India have been reported. Here we report a case in India who recovered well with repeated debridement and dressing.

A Case of Prepubertal Vulval Fibroma / 대한산부인과학회지

Prepubertal vulval fibroma is a very rare tumor arising at vulva. Iwasa firstly reported 11 cases of prepubertal vulva fibroma in 2004 and until recently no case was reported in literature. A 8-year-old girl complained the painless growing mass at the left labium major. The mass was excised and confirmed as prepubertal vulval fibroma by immunohistochemistry. We report the first case of prepubertal vulva fibroma in a 8-year-old Korean female with a brief review of the literature.

Clinical and pathological analysis of vulval condyloma acuminatum treated with focused ultrasound / 重庆医科大学学报

Objective:To investigate the clinical curative effect of focused ultrasound on vulval condyloma acuminatum.Methods:108 cases of vulval condyloma acuminatum confirmed by pathology were randomly divided into two groups with the same number in each group:ultrasound group and laser group(controls).54 cases in the ultrasound group were treated with focused ultrasound,other 54 cases underwent laser treatment.The symptoms and local changes of the patients were observed before and after the treatment.The warts were obtained for pathological analysis to evaluate the efficacy of focused ultrasound treatment.Results:1.In the ultrasound group,49 cases recovered after the first treatment,the efficacy rate was 90.7%(49/54),while in the laser group,the rate was 68.5%(37/54).There was significant difference between the two groups(P

Changes of VEGF protein and mRNA in the vulva of rabbits after ultrasound irradiation / 中华物理医学与康复杂志

Objective To investigate ultrasound as a therapy for white lesions of the vulva.Methods Immunohistochemistry and hybridization in situ were used to study changes in VEGF protein and mRNA in the vulva skin of rabbits after ultrasound irradiation.Results After irradiation,VEGF protein and mRNA had increased markedly after 4 and 7 days,but their levels recovered by day 14.Conclusion Ultrasound irradiation causes local edema and hypoxia which enhance production of VEGF.VEGF promotes growth of local microvessels and increases the permeability of the endothelial cells of blood vessels.These changes improve nutrition of the mierovessels and nerve endings and ameliorate the microenvironment for tissue growth.One could speculate that ultrasound irradiation helps rehabilitation and regeneration of pathologic vulva skin.

Crohn's Disease of the Vulva Occurring in Siblings

Occasionally, patients with gastrointestinal Crohn's disease (CD) develop granulomatous skin lesions at sites remote from the gastrointestinal tract, separated from other ulcerations by normal skin, a phenomenon that has been referred to as metastatic cutaneous CD. Although metastatic CD of the vulval region has been often reported in English literature, we could not find such cases with family history. We report a case of vulval CD occurring in siblings.