Vulvar Leiomyoma Masquerading as Bartholin Cyst: A Case Report of Unveiled Diagnosis and Surgical Management.

Vulvar leiomyomas are rare benign tumors originating from smooth muscle cells of the vulvar tissue. We present the case of a 44-year-old female patient complaining of a painless vulval mass for 12 years, gradually increasing from 1x1 cm to 5x4 cm. Clinical assessment initially suggested a Bartholin cyst because of its non-tender and non-fluctuant nature. However, surgical intervention revealed an unexpected diagnosis of vulvar leiomyoma, measuring 5x5x4 cm. The patient underwent successful excision and repair under spinal anesthesia. This case underscores the significance of meticulous clinical evaluation and accurate histopathological examination in distinguishing vulvar masses. Accurate diagnosis guides appropriate management, and long-term follow-up prevents complications and recurrence. This report highlights the diagnostic challenges of rare vulvar lesions and the importance of a comprehensive approach to their evaluation and treatment.

Unusual Vulvar, Perineal, and Uterine Leiomyomas: A Case Report.

Vulvar leiomyomas are extremely rare smooth muscle tumors that are easily mistaken for other lesions, as the differential diagnosis must consider a wide spectrum of benign and malignant lesions. We present the case of a 52-year-old woman with a three-year history of progressive abdominal distension and pain and an enlarging vulvar mass distorting the labia majora and causing gait disturbance. Imaging confirmed an enormous pelvic mass originating in the uterus, compatible with a leiomyoma/sarcoma, and large perineal and vulvar masses with similar characteristics. Histopathology after surgical removal revealed benign abdominal, vulvar, and perineal leiomyomas. This case highlights the rarity and diagnostic challenges of extra-uterine leiomyomas, particularly those in the vulvar region.

Leiomioma vulvar de localización en la glándula de Bartolino: un dilema diagnóstico / Vulvar leiomyoma located in Bartholin's gland: a challenging clinical case

Resumen ANTECEDENTES: Los leiomiomas son tumores benignos que se originan en las fibras musculares lisas. La mayor parte de los leiomiomas del aparato genital femenino se localizan en el útero. La localización extrauterina es excepcional, la incidencia del leiomioma vulvar es del 0.07%. Estos tumores del músculo liso suelen ser indoloros, de crecimiento lento y pueden aparecer en mujeres de cualquier edad. OBJETIVO: Reportar un caso de leiomioma vulvar que, por su baja incidencia y similitud clínica con otras lesiones, como el quiste de la glándula de Bartolino, pueden conducir a un diagnóstico erróneo inicial. Además, efectuar una revisión bibliográfica que aporte conocimiento a su diagnóstico y tratamiento. CASO CLÍNICO: Paciente de 52 años, con una masa vulvar de años de evolución y un diagnóstico equívoco inicial de quiste de la glándula de Bartolino. La paciente fue intervenida mediante escisión quirúrgica y estudio histopatológico posterior. El diagnóstico definitivo fue de leiomioma vulvar con diferenciación simplástica. CONCLUSIONES: En contraposición con sus homólogos uterinos, la localización vaginal del leiomioma es excepcional. Si bien hasta ahora no ha podido demostrarse la efectividad de la biopsia preoperatoria se aconseja su toma porque podría tratarse de una masa de características malignas, lo que modificaría el tratamiento y su urgencia. La actitud quirúrgica es, quizá, la más acertada porque permite, además de un diagnóstico anatomopatológico definitivo, un tratamiento curativo. Se propone la escisión completa, mediante una incisión elipsoidal en la piel y asegurar la extirpación completa de la pseudocápsula.

Abstract BACKGROUND: Leiomyomas are benign tumors that originate in smooth muscle fibers. Most leiomyomas of the female genital tract are located in the uterus. Extrauterine localization is exceptional; the incidence of vulvar leiomyoma is 0.07%. These smooth muscle tumors are usually painless, slow growing and can occur in women of any age. OBJECTIVE: To report a case of vulvar leiomyoma that because of its low incidence and clinical similarity to other lesions, such as Bartholin's gland cyst, may lead to an initial misdiagnosis. In addition, a review of the literature should be carried out in order to contribute to its diagnosis and treatment. CLINICAL CASE: A 52-year-old patient with a vulvar mass of years of evolution and an initial misdiagnosis of Bartholin's gland cyst. The patient was operated by surgical excision and subsequent histopathological study. The definitive diagnosis was vulvar leiomyoma with symplastic differentiation. CONCLUSIONS: In contrast to its uterine counterparts, the vaginal location of leiomyoma is exceptional. Although the effectiveness of a preoperative biopsy has not been demonstrated so far, it is advisable to take a biopsy because it could be a mass with malignant characteristics, which would change the treatment and its urgency. The surgical approach is perhaps the most appropriate because it allows, in addition to a definitive anatomopathological diagnosis, a curative treatment. Complete excision is proposed, by means of an ellipsoidal incision in the skin and ensuring complete excision of the pseudocapsule.

[Metastatic leiomyoma or synchronous lesion of the uteri corpus and vulva?] / Metastaziruiushchaia leiomioma ili sinkhronnoe porazhenie tela matki i vul'vy?

OBJECTIVE: To reveal the morphological characteristics of simultaneously diagnosed leiomyoma of the corpus uteri and vulva. SUBJECT AND METHODS: The paper describes a case of multiple uterine leiomyomas concurrent with vulvar leiomyoma in a 39-year-old patient with progressive tumor nodule growth over 2 years. Vulvar tumor was biopsied simultaneously with extirpation of the uterus; vulvar leiomyoma was removed six months later. Histological and immunohistochemical studies: such as hematoxylin and eosin staining, the expression of smooth muscle actin, desmin, and progesterone and estrogen receptors, S100, CD10, and determination of Ki-67 proliferation index, were conducted. RESULTS: The largest (14-cm) multiple tumor nodule in the corpus uteri had the structure of leiomyoma of uncertain malignant potential; the large (8-cm) vulvar tumor was a leiomyoma with hyalinosis. The immunohistochemical profile of uterine and vulvar leiomyoma (smooth muscle actin+, desmin+, progesterone+, estrogen+ receptors, CD117-, and Ki-67) was the same (1-3%). The vulvar leiomyoma was assumed to be a tumor of metastatic origin. CONCLUSION: Vulvar leiomyoma is rare; it can arise from smooth muscle tissue of various anatomical structures of the skin and soft tissues. The pathogenesis of the so-called metastatic leiomyoma is unclear; there are concepts of a metaplastic transformation of subcelomic mesenchyme and multifocal smooth muscle proliferation. The presented case demonstrates the synchronous development of uterine and vulvar leiomyoma.

Review of the pathophysiology, diagnosis, and therapy of vulvar leiomyoma, a rare gynecological tumor.

The objective of this article is to discuss the pathophysiology, diagnosis, differential diagnosis, and therapy of vulvar leiomyoma. We performed a review of all English-language reports of vulvar leiomyoma published in PubMed from 1978 to 2015 using the following search terms: "vulval leiomyoma," "vulvar leiomyoma," "vulval smooth muscle tumor," and "external genitalia smooth muscle tumor." Vulvar leiomyomas, which are rare benign monoclonal tumors, most commonly occur in the fourth and fifth decades of life. The genetics of vulvar leiomyoma remain undefined. Three principal histological patterns have been identified: spindled, epithelioid, and myxoid. Imaging tests such as ultrasound, endoscopic ultrasound, and magnetic resonance imaging are used in diagnosis. Surgical excision is the only curative treatment for vulvar leiomyomas. Establishment of a full differential diagnosis list and correct final diagnosis before surgery are essential for optimal clinical management. Although recurrence of vulvar leiomyoma is extremely rare, long-term follow-up of all cases is advisable.

A Case of Vulvar Leiomyoma / 대한산부인과학회잡지

Vulvar leiomyoma is a rare benign solid tumor of the vulva. Their incidence is not known as most reports are of a single case or small series, and their origin is not known exactly. Most cases are asymptomatic and local excision is recommended as initial therapy and also for recurrences. We have experienced vulvar leiomyoma (the labia majora and vestibule of the vagina) in a 51 years old woman and present it with a brief review of the literatures.