|
 
 |
| CASE REPORT |
|
| Year : 2015 | Volume
: 12
| Issue : 1 | Page : 63-64 |
|
Leiomyoma of the vulva; a rare occurrence
Karima Abubakar Tunau1, Abubakar Panti1, Constance Shehu1, Sadik M Sahabi2
1 Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Sokoto and Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, Nigeria
2 Department of Histopathology, Usmanu Danfodiyo University Sokoto and Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, Nigeria
| Date of Web Publication | 8-May-2015 |
Correspondence Address:
Karima Abubakar Tunau
Usmanu Danfodiyo University Teaching Hospital Sokoto
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0331-8540.156695
Leiomyoma are known to occur in the uterus. It is unusual to find these benign smooth muscle tumours anywhere else. We report the occurrence of a swelling that appeared like a huge Bartholin's cyst in the vulva of a 30 year old married nulliparous woman. She had successful excision and histology confirmed it to be a leiomyoma. Keywords: Vulva, leiomyoma, Bartholin′s cyst
How to cite this article:
Tunau KA, Panti A, Shehu C, Sahabi SM. Leiomyoma of the vulva; a rare occurrence. Niger J Basic Clin Sci 2015;12:63-4 |
| Introduction | |  |
Leiomyoma is a benign smooth muscle tumour that usually develops during the reproductive age and regress after menopause. It is commonly found in the myometrial layer of the uterus. [1] It may also be rarely found in other genital organs.
The extrauterine leiomyoma originate from smooth muscle and can involve the vulva or scrotum and nipple tissue. They can pose a great diagnostic challenge to the clinician. Vulva leiomyoma are located in the labia major; it is relatively rare and often resemble other soft tissue tumours of the vulva leading to diagnostic difficulties. [2],[3] It usually presents like a Bartholin's cyst.
Vulva leiomyoma are well-circumscribed lesions characterized by fascicles of spindle and myxomatous degeneration. The management is usually by surgical excision and definitive diagnosis is confirmed by histological examination. [4],[5],[6],[7],[8] Only few cases have been reported in the literature. [2],[3],[4],[5],[8]
| Case report | | |
A 30 year old lady presented with a swelling on the vulva of 12-months duration. The swelling was painless and had gradually increased in size. There was no associated pain or swelling on any other part of the body and no history of trauma on the affected side. There was no history of fever or vaginal discharge. Her last menstrual period was 2 weeks prior toPresentation. The swelling interfered with penetration during coitus; however, there was no history of infertility. The past medical history was not significant. Her systemic examination was unremarkable. She has not had any form of treatment for the swelling. There was a large, non-tender, solid swelling involving the right labium majus and minor. It measured about 8 × 4 cm and both labia were distorted. It was not attached to overlying skin [Figure 1]. The pelvic examination revealed normal findings only. Her packed cell volume and urinalysis were normal. Transperineal ultrasonography confirmed a solid mass and an elective excisional biopsy was performed under general anaesthesia.
An incision was made at the mucocutaneous junction and a firm encapsulated mass was enucleated after dissection along its capsular plane. The base was obliterated with interrupted sutures and overlying skin incision was closed after excision of redundant skin. Blood loss was minimal. The sample was sent for histological analysis. The postoperative course was unremarkable.
Histology revealed a benign, mesenchymal neoplasm that was composed of spindle-shaped cells arranged in whorls and had inter-secretory fascicles. There were coma-shaped nuclei and moderate amount of eosinophylic cytoplasm [Figure 2]. Features were those of a benign mesenchymal neoplasm and the conclusion therefore was a leiomyoma. | Figure 2: Microscopy showing a benign tumour composed of sheets and fascicles of oval- to spindle-shaped cells with abundant dense cytoplasm
Click here to view |
| Discussion | | |
Most cases of vulval leiomyoma are misdiagnosed as Bartholin's cyst or abscess at presentation 1 . Hence, the importance of a detailed history and examination of vulval masses cannot be overemphasized. Although a Bartholin's cyst is common in sexually active patients like ours, it is unusual for the cyst to attain such a size and remain painless. Youssef et al. [2] reported a case of a 39-year-old lady, who had a 2-3 cm solid mass on her external genitalia for 4 years which enlarged to 15 cm in 6 months. This lesion was excised and on histopathological examination was diagnosed as leiomyoma of the vulva. In the case presented, the lesion did not display such a rapid growth probably because she presented within a year of its appearance. Pardet et al. [8] in their case report of vulval leiomyoma in a young virgin suggested that an inverted labia minor, firm consistency and intact hymen point towards reconsidering a diagnosis of Bartholin's cyst especially in patients who had no coital exposure. In our case, however, she was married and sexually active.
These cases suggest that where a vulval mass appears painless, firm or solid on palpation, a biopsy should be performed, rather than a drainage procedure. The same applies if the mass is ulcerated instead of smooth or presents in a slightly different location than the usual region of the Bartholins ducts. [4],[5],[6]
It is important to rule out leiomyosarcoma especially in the elderly as it may present in a similar manner. [5]
| References | | |
| 1. | Kumar V. The female genital tract. In: Kumar V, Abbas AK, Fausto N, Aster J, editors. Robbins and Cotran Pathologic Basis of Disease. 8 th ed. Vol 7. Philadelphia: Saunders Elsevier; 2010. p. 1005-62.  |
| 2. | Youssef A, Neji K, M'barki M, Ben Amara F, Malek M, Reziga H. Leiomyoma of the vulva Tunisian Medical Journal 2013;91:78-80. |
| 3. | Tone HW. Benign disorders of the vulva. Novak's textbook of gynaecology. Ch 14, Vol 14. Philadelphia: Williams and Wilkins; 1988. p. 920-96. |
| 4. | Lombardo F, Percolla R. Large pendulous fibroma of the vulva. A clinical case. Minerva Ginecol 1994:699-700. |
| 5. | Dewdney S, Kennedy CM, Galask RP. Leiomyosarcoma of the vulva: A case report. J Reprod Med 2005;50:630-2. |
| 6. | Nielsen GP, Rosenberg AE, Koerner FC, Young RH, Scully RE. Smooth-muscle tumors of the vulva. A clinicopathological study of 25 cases and review of the literature. Am J Surg Pathol 1996;20:779-93. |
| 7. | Fasih N, Prasad Shanbhogue AK, Macdonald DB, Fraser-Hill MA, Papadatos D, Kielar AZ, et al. Leiomyomas beyond the uterus: Unusual locations, rare manifestations. Radiographics 2008;28:1931-48. |
| 8. | Pandey D, Shetty J, Saxena A, Srilatha PS. Leiomyoma in vulva: A diagnostic dilemma. Case Rep Obstet Gynecol 2014;2014:386432. |
[Figure 1], [Figure 2]
|
Search Pubmed for