Primary vulvar endometriosis in postmenopausal woman: a case report and review of the literature.

Endometriosis is a benign, estrogen-dependent condition that commonly affects women during the reproductive age. Postmenopausal endometriosis is a rare condition because of the absence of estrogenic hormone production. Furthermore, extrapelvic endometriosis is a rare and complex phenomenon. For this reason, it is usually a misdiagnosed disease. An 84-year-old female patient with no medical history of endometriosis or dysmenorrhea and no hormone replacement therapy was found to have a 4.4×3 cm tender, mobile mass on the left labium majus detached from the underlying perineal muscle. The patient underwent surgical excision under sedation and local anesthesia. The mass was easily removed intact and was not adherent to the vagina or the perineal muscles. Surgical resection of the lesion should be performed in order to remove the lesion and to confirm the diagnosis histologically. The diagnosis of long-standing endometriotic cyst was made. Primary vulvo-perineal endometriosis is a rare and difficult diagnosis especially in postmenopausal women without previous surgical procedures and no history of endometriosis. A better awareness of symptoms and signs of uncommon locations of extrapelvic endometriosis should be encouraged in order to optimize patient care. Finally, more research is needed to elucidate the pathogenesis of endometriosis in postmenopausal women.

Unexpected presentation of accessory breast: vulvar accessory breast tissue: a case report.

BACKGROUND: The accessory breast is composed of residual glandular mammary tissue that persists after normal embryonic development. The entity is so rare that it is easily neglected in the diagnosis of disease. CASE PRESENTATION: We report a 24-year-old virgin Persian woman with a left-sided vulvar mass and no pain or discomfort until shortly before her presentation at our department. Ectopic breast tissue in the vulva was diagnosed. We performed wide local resection of the lesion. Pathological investigation of the lesion confirmed the presence of ectopic breast tissue with secretory changes. She had no specific developmental abnormalities and had no relevant family history. She was followed up for 10 months and had recovered fully by this time. CONCLUSION: Accessory breast tissue should be considered as a diagnosis when a mass is seen along the embryonic milk line, especially if the clinical findings reveal changes in the mass accompanied by changes in sex hormones.

Outcomes After Lysis of Adhesions and Dilator Placement for Treatment of Vulvovaginal Agglutination Due to Lichen Planus.

OBJECTIVE: The aim of the study is to determine intraoperative and postoperative surgical outcomes for the treatment of vulvovaginal agglutination secondary to lichen planus (LP) following a standard protocol using intraoperative dilator placement and postoperative intravaginal steroid use. MATERIALS AND METHODS: This was a retrospective chart review of patients who underwent surgical management of vulvovaginal agglutination due to LP following a protocol that included surgical lysis of vulvovaginal adhesions, intraoperative dilator placement and removal 48 hours later, and high-potency intravaginal corticosteroid and regular dilator use thereafter. Demographic and clinical data were abstracted from the medical record and analyzed using descriptive statistics. RESULTS: Thirty-four patients, with mean age 51.2 ± 11 years and body mass index 32.8 ± 8.5 kg/m 2 , underwent lysis of vulvovaginal adhesions between 1999 and 2021 with 8 different surgeons at a single institution. The mean preoperative, immediate postoperative, and 6-week postoperative vaginal lengths were 2.8 ± 1.8 cm ( n = 18), 8.0 ± 1.9 cm ( n = 21), and 7.9 ± 2.2 cm ( n = 16), respectively. The mean estimated blood loss intraoperatively was 16 ± 15 mL. No patients had a documented surgical site infection or reoperation within 30 days after surgery. Of patients who had it documented ( n = 26), 70% (18/26) reported postoperative sexual activity. Where documented, 100% (18/18) reported preoperative dyspareunia, while 17% (3/18) did postoperatively. Six percent (2/34) had recurrent severe agglutination and 3% (1/34) underwent reoperation. CONCLUSIONS: Lysis of vulvovaginal adhesions, intraoperative dilator placement, and postoperative intravaginal corticosteroids with dilator use is a safe and effective treatment option to restore vaginal length for those with vulvovaginal LP.

Differentiated Exophytic Vulvar Intraepithelial Lesions: Case Reports and Review of Literature.

OBJECTIVES: The aims of this article were to describe 2 patients with a pathological diagnosis of differentiated exophytic vulvar intraepithelial lesion and to summarize the literature regarding this relatively new diagnosis. MATERIALS AND METHODS: The existing literature was searched on December 1, 2021, using the MEDLINE database (1966-2021), and all combinations of the following search terms were used: "differentiated exophytic vulvar intraepithelial lesion" and "differentiated vulvar intraepithelial neoplasia." RESULTS: Patients were postmenopausal and reported persistent vulvar itch associated with white hypertrophic plaques. Initial biopsies did not identify differentiated exophytic vulvar intraepithelial lesion. Invasive squamous cell carcinoma was found in both cases after surgical excision. CONCLUSIONS: Differentiated vulvar intraepithelial lesions and invasive squamous cell carcinoma should be considered in the differential diagnosis of vulvar itch associated with hypertrophic plaques in postmenopausal women. Excision of suspicious plaques is recommended for definitive diagnosis.

Postpartum spontaneous vulvar hematoma as a cause of maternal near miss: a case report and review of the literature.

BACKGROUND: Postpartum spontaneous vulvar hematoma is a rare complication of childbirth that can potentially cause maternal death if not managed properly and in a timely manner. We present the case of maternal near miss secondary to postpartum hemorrhage secondary to vulvar hematoma after home delivery in a 28-year-old para IV mother from rural Ethiopia. The case was surgically managed under spinal analgesia. The mother and her newborn were discharged on the fourth postprocedure day. CONCLUSION: Neglected and inappropriately managed postpartum vulvar hematoma can cause significant maternal morbidity; therefore, timely surgical exploration, ligation of bleeding vessels, and obliteration of dead space can avert severe maternal complications.

Reconstruction of congenital rectovestibular fistula in an adult. Case report.

Anorectal malformations are common congenital anomalies but diagnosis and treatment in adulthood are quite rare. Treatment during adulthood may be challenging due to anatomic and physiologic changes. Posterior sagittal anorectoplasty may provide good cosmetic and functional results even in adult patients. KEY WORDS: Congenital malformations, Rectovaginal fistula, Rectovestibular fistula.

Management of non-obstetric traumatic vulvar haematoma: a retrospective review of 33 cases.

The cases of non-obstetric traumatic vulvar haematomas are rare, and there is a lack of consensus statements for the necessity of surgical intervention. We retrospectively analysed the data of 33 cases (mean age: 25.7 years) of non-obstetric traumatic vulvar haematoma (mean haematoma size: 8.4 cm). Women who underwent surgery (surgery group) were compared to those who received conservative management (conservative group). Twenty-four patients underwent surgery; most cases were of haematoma removal and primary closure. Nine patients received conservative management, such as ice bag application, antibiotics, or analgesia. The rate of deviation of the contralateral vulva because of haematoma was higher (54.2% versus 11.1%, p = .047) and the mean haematoma size was larger (9.5 versus 5.2 cm, p = .004) in the surgical than in the conservative group. While conservative management affects cases of minor vulvar haematoma, surgical evacuation of haematoma can be performed in cases of large haematoma (mean size: 9.5 cm), severe pain, distorted vulvar anatomy, and invisible urethral opening for indwelling urinary catheter.IMPACT STATEMENTWhat is already known on this subject? Cases of non-obstetric traumatic vulvar haematomas are rare. There are no consensus statements for the necessity of surgical intervention.What do the results of this study add? The study showed that surgical evacuation of haematoma can be performed in cases of large haematoma (mean size: 9.5 cm), severe pain, distorted vulvar anatomy, and invisible urethral opening for indwelling urinary catheter. Moreover, surgical management could hasten recovery.What are the implications of these findings for clinical practice and/or further research? The results of this study can be used in counselling non-obstetric traumatic vulvar haematomas. Further research is needed to confirm these findings.

Ectopic mammary tissue in vulva: case report and systematic literature review / Tejido mamario ectópico en vulva: reporte de caso y revisión sistemática de la literatura

Objective: To report the case of a patient diagnosed with ectopic mammary tissue in the vulva, and to conduct a literature review of the diagnosis, treatment and prognosis of this condition in that location. Materials and Methods: A 49-year-old patient who presented with a painful vulvar mass to a private intermediate complexity center in Bogotá, Colombia. The lesion was assessed on ultrasound and then surgically excised; histopathology showed ectopic mammary tissue with absence of malignancy. A search was conducted in the PubMed, Embase, Cochrane, LILACS and Scielo databases using the keywords "Vulva," "Breast" and "Ectopic." Case reports and case series of women with histopathology-confirmed mammary tissue in the vulva were included. Results: Overall, 184 titles were identified and, of these, 94 were ultimately included, for a total of 126 cases, with 57.9% being benign tumors, 95% in women under 50 years of age, and 42.06% being malignant tumors, 92% in women over 50 years of age. Diagnosis was made on the basis of the clinical findings, with ancillary diagnostic imaging, tumor markers and immunohistochemistry in some cases. Local excision was performed in 91% of cases with benign pathology and in 43% of cases with malignant pathology, with the diagnostic method being therapeutic. Conclusions: Ectopic mammary tissue in the vulva must be considered as part of the differential diagnosis of vulvar masses, prognosis being different in pre and postmenopausal women. Further studies are needed to enhance the characterization of this condition and define the ideal course of treatment in terms of relapse and survival.

Objetivo: reportar el caso de una paciente con diagnóstico de tejido mamario ectópico en vulva, y realizar una revisión de la literatura acerca del diagnóstico, tratamiento y pronóstico de esta condición en esta localización. Materiales y métodos: paciente de 49 años consulta por masa vulvar dolorosa a un centro privado de nivel medio de complejidad ubicado en Bogotá, Colombia. Se realizó ecografía de la lesión y posteriormente escisión quirúrgica; la histopatología mostró tejido mamario ectópico sin malignidad. Se realizó una búsqueda en las bases de datos PubMed, Embase, Cochrane, LILACS y Scielo, con las palabras clave "Vulva", "Glándulas mamarias", "ectópico", "Vulva", "Breast" y "Ectopic", y se incluyeron reportes y series de caso de mujeres con tejido mamario en vulva confirmado por histopatología. Resultados: se identificaron 184 títulos, de los cuales 94 fueron finalmente incluidos para un total de 126 casos. El 57,9% eran tumores benignos, con un 95% en mujeres menores de 50 años; y el 42,06% eran tumores malignos, el 92 % en mujeres mayores de 50 años. El diagnóstico se realizó por clínica, con imágenes diagnósticas complementarias, marcadores tumorales e inmunohistoquímica en algunos casos. Se realizó escisión local en el 91% de los casos de patología benigna y 43% de patología maligna, siendo el método diagnóstico y terapéutico. Conclusiones: el tejido mamario ectópico en vulva debe ser considerado como parte del diagnóstico diferencial de masas a nivel vulvar con diferente pronóstico en mujeres pre y posmenopáusicas. Se requieren más estudios para una mejor caracterización de la patología y definir el tratamiento ideal en términos de recaída y supervivencia.

Vulvar Crohn's disease in an adolescent diagnosed after unsuccessful surgical treatment.

BACKGROUND: This case report presents a case of Vulvar Crohn's disease (VCD) in an adolescent, that is an uncommon manifestation of Crohn's disease (CD) without gastrointestinal symptoms. Before treating CD itself with proper medication, vulvar abscess continued to recur without improvement. CASE PRESENTATION: We report the case of an 18-year-old woman with VCD. After treatment with azathioprine 50 mg daily and mesalazine 1 g three times daily, vulvar lesions resolved after 6 weeks. We collected electronic medical data on patient characteristics, and evaluated findings of physical examinations, pelvic MRI, and biopsy specimen obtained from gastroduodenoscopy/colonoscopy. CONCLUSIONS: VCD is a rare manifestation of CD that may be misdiagnosed in the absence of gastrointestinal symptoms leading to delayed treatment. If a patient has an unexplained vulvar inflammatory lesion and with repeated failed surgical treatment, gynecologists should consider the possibility of a VCD.

Manual separation of labial synechiae: A cost-effective method in prepubertal girls.

BACKGROUND: Labial synechiae is a fairly common gynaecological problem that occurs as a result of inflammation leading to fusion between the labia minora. Being in a developing country with limited resources and poor compliance of patients to prolonged treatments, we are faced with immense challenges in the management of these girls. AIMS: We wanted to evaluate the efficacy and the cost-effectiveness of manual separation and topical antibiotics with perineal hygiene in the management of pre-pubertal girls with labial synechiae. MATERIALS AND METHODS: Design.Prospective, non-randomised interventional study. Participant: Pre-pubertal girls presenting with the diagnosis of labial synechiae in the period from September 2015 to January 2018. Interventions: Manual separation followed by topical antibiotic ointment application for 1 week with local hygiene. Outcomes measure: Complete release of the synechiae and no recurrence up to 6 months. RESULTS: Out of the total 55 patients, only 48 patients were included, their age ranged from 3 months to 7 years (mean 2.8 years). Almost half of our patients were asymptomatic, and other half had symptoms (urinary tract infection, dripping of urine and itching). Majority of our patients belong to low middle class status. We had 100% complete release of synechiae and no recurrence on 6 months follow-up. CONCLUSION: Manual separation followed by topical antibiotics is a cost-effective method of the treatment of labial synechiae with immediate response and low recurrence rate.

Recurrence rates after surgical management of labial adhesions.

INTRODUCTION: Labial adhesions (LA) involves fusion of the labia minora in the midline. LA can range from involving just a small portion of the labia minora or the entire length, covering the urethra and vaginal opening. Treatment for labial adhesions includes the use of topical creams, manual lysis or surgical separation. The recurrence rate has been reported as 55%, 33% and 0% respectively. Only one study with a cohort of 9 patients examines recurrence rates after surgical release (0%). OBJECTIVE: To verify the previous findings that surgical repair has low recurrence rate. We hypothesize the recurrence rate of LA after surgical repair to be lower than more conservative methods but that the recurrence rate is not 0%. STUDY DESIGN: A retrospective review was performed of consecutive cases of LA that were treated surgically from August 2018 to October 2020. The surgical technique used involved opening the LA bluntly then oversewing each labia with fine absorbable suture. All patients were scheduled for clinic or telephone follow up 3 months postoperatively. Patient demographics, indication for procedure, history of prior treatment, operative time, complications, recurrence and length of follow up were recorded and are described using non-parametric methods. RESULTS: Thirty-two female patients underwent surgical treatment of LA using the above-described technique. Median age at surgery was 3.7 y (IQR 2.7-5.3). Most patients (78.1%) had failed prior initial treatment, most commonly topical estrogen creams. Median follow up was 4.3 mos with 10 patients being lost to follow up. Only 2 patients experienced a recurrence at a median of 3.5 months. CONCLUSIONS: This series verifies prior findings that, in the short-term, surgical repair has a lower recurrence rate than topical treatment or manual lysis. However, the recurrence rate is 9%, higher than previously reported. Further studies into longer-term follow up are underway.

Surgical management and clinical follow-up of post-coital severe vulvar hematoma in a 14-year-old adolescent girl: A case presentation.

BACKGROUND: Vulvar hematoma is often puerperal. A case of non-puerperal vulvovaginal hematoma is rare in the literature. There is no consensus on the management of vulvovaginal hematoma. In this study, we discussed the approach to a rare case of non-puerperal vulvar hematoma. CASE: We present the case of a 14-year-old adolescent female with a severe vulvar non-obstetric hematoma that occurred after she had been illegally and voluntarily married. CONCLUSION: In conclusion; vulvar hematoma is the most common non-obstetric cause of perineal trauma and carries the risk of mortality by causing hypovolemic shock. The conservative approach is preferred for small and non-growing hematomas; however, surgical hematoma drainage is used for large and enlarging hematomas. Selective arterial embolization procedure is not common as the required equipment is not available in all healthcare facilities.

[Physiopathology of vulvar elephantiasis of filarial origin. A case report]. / Fisiopatología de la elefantiasis vulvar de origen filarial. A propósito de un caso.

Genital filariasis is an uncommon infectious entity in the western world. It has characteristic clinical features and a well-recognized endemic area that causes typical histological alterations. We report a case of a 32-year-old woman, a native of Mozambique, who presented with vulvar elephantiasis as a pendulous tumor with a maximum diameter of 15cm. A large part of the genital mass was resected. Microscopically, hyperkeratosis with irregular acanthosis, a notable thickening of dermis with dense fibrosis and inflammatory clusters of patchy distribution, mostly made up of plasma cells, was seen. Since the parasite was not observed, an exclusion diagnosis was made, as frequently happens with this lesion.

A Review of Reconstruction for Vulvar Cancer Surgery.

IMPORTANCE: Vulvar reconstruction may be required after vulvectomy or any vulvar surgery. Providers should be familiar with techniques for reconstruction to improve clinical outcomes. OBJECTIVE: This article reviews the different techniques for reconstruction after vulvectomy and describes the decision-making process for selection of appropriate techniques, postoperative care, and expected outcomes. EVIDENCE ACQUISITION: A literature search was conducted, focusing on the plastic surgery and gynecologic oncology literature, using the following search terms: "vulvar reconstruction," "perineal reconstruction," "vulvectomy," and "vulvar cancer." The search was limited to English publications. RESULTS: Reconstruction after vulvectomy can be performed using a variety of techniques ranging from simple or complex closure to adjacent tissue rearrangement to skin grafting, locoregional, and free flaps. The appropriate technique is best chosen based on the characteristics of the patient and postablative defect, as well as the reconstructive goals. Postoperative complications are usually minor. CONCLUSIONS: Vulvar reconstruction techniques vary widely and offer patients improved outcomes. RELEVANCE: Knowledge of vulvar reconstruction techniques is necessary for gynecologists performing vulvar surgery to ensure optimal patient outcomes.