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A 37-year-old woman presented with a right labium majus thickening with no palpable mass, which had been evolving for a few months. A partial right labium majus ablation was performed at the request of the patient for esthetic reasons. The lesion was most histologically similar to CALME (childhood asymmetric labium majus enlargement). The lesion was benign, but several other differential diagnoses were considered. Two years after the surgery, there had been no recurrence. To our best knowledge, this is the first such case reported in an adult., Highlights • A woman presented with a labium majus thickening with no palpable mass. • Based on its histological characteristics, the lesion was similar to CALME (childhood asymmetric labium majus enlargement). • The lesion was benign, but several differential diagnoses were important to consider. • A conservative approach with close follow-up is preferred to surgery in such cases.

Introduction and importance Non-obstetric vulvar hematoma is a rare condition. With only few cases reported, no standard consensus exists on the best management of vulvar hematomas. Herein, we report the successful management of a large trauma-induced vulvar hematoma through a simple incision under local anesthesia. Localized large vulvar hematomas can be treated with this simple procedure. Case presentation A 38-year-old woman presented with vulvar pain following a fall. Investigations revealed a large painful hematoma in the right labium majus. Imaging revealed that the hematoma was localized and the pelvic structure was normal. We successfully treated the hematoma by making an incision in the right labium majus under local anesthesia to evacuate the clot and ligate the bleeding points. She was discharged in a good condition after two days. Discussion Non-obstetrics vulvar hematoma is rare particularly the large hematoma. A blunt trauma may cause a large vulvar hematoma. There is no standard management of vulvar hematomas since the incidence is very low. The important step in managing vulvar hematoma is detecting the localization of the hematoma and evaluating other pelvic structures. Most of vulvar hematoma is isolated in the soft tissue around the labium majus and the vagina without further extension. After confirming that the large vulvar hematoma is localized and there are no injuries to the other pelvic structures, a simple incision and bleeding points ligation under local anesthesia can be performed to relieve the pain and prevent pressure necrosis. Conclusion Simple incision under local anesthesia is effective for managing large vulvar hematomas and reduces the recovery time., Highlights • Blunt trauma may cause a large vulvar hematoma • Large vulvar hematoma is commonly localized and should be confirmed by imaging • Incision for large localized vulvar hematoma will relieve the pain quickly and may prevent necrosis

Lipoma is the most common soft-tissue tumor of mesenchymal tissue origin although very rarely found in the vulva. The present study aims to present a very rare and big lipoma. In this case, the patient was 70 years old and was admitted to our clinic with the complaint of soft vulvar mass, 17 cm × 14 cm × 10 cm in size. The mass appeared about 7 years ago and was growing for the past 2 years and extended to the labium majus from the left inguinal region. The author performed a vulvar reconstruction with total excision of the mass. Pathological examination revealed a lipoma. Vulvar lipoma should be considered in the differential diagnosis of vulvar masses, although lipomatous masses are rarely seen in vulva.

To determine fetal clitoral dimensions in antenatal period and to provide a contribution to external genital morphology determination in premature infants. Thirty-one formalin fixed female fetuses aged between 18 and 40 weeks (17 fetuses aged 21.53 ± 1.88 weeks in the second trimester and 14 fetuses aged 31.00 ± 4.90 weeks in the third trimester) were evaluated. 20 (64.5%) fetuses were between 3 and 97% percentile range and within normal limits. Clitoris appearance (completely covered by labium majus/partially showing/prominent), length and width of clitoris, labium minus length, length, and width of labium majus were assessed. Clitoris length during the second trimester was 4.84 ± 1.09 mm, whereas it was 5.43 ± 1.07 in the third trimester. Clitoris width was as 3.35 ± 0.88 mm in the second trimester and as 4.55 ± 0.96 mm in the third trimester. A statistically significant increase was seen in width of clitoris, length, and width of labium majus and length of labium minus with gestational age in the second and third trimesters (p

CALME is the abbreviation of "childhood asymmetry labium majus enlargement" and denotes a physiological, non-neoplastic swelling of labium majus soft tissues. It is caused by the expansion of one or more normal vulvar tissue components and is devoid of a peripheral capsule. A few reports in the literature have raised awareness of this benign condition and stressed the need to avoid invasive procedures with possible permanent sequelae. The etiopathogenesis of CALME is still debated, although the hypothesis of a hormone-driven major labia stromal hyperplasia is favored over the assumption of a benign neoplastic process. This article aims to provide a detailed review of the clinical, histological, and instrumental findings of CALME and provide a step-based algorithm to approach and manage genito-inguinal masses in pediatric patients.

Schwannoma is a generally benign tumor of the peripheral nerve sheath arising from Schwann cells. Most schwannomas are found on the head and neck. Here, we describe a rare case of benign vulvar schwannoma located at the labium majus which was similar to an epidermoid cyst in clinical appearance.

Granular cell tumors are uncommon, usually benign, soft tissue neoplasms of neural origin. They occur throughout the body; vulval involvement is uncommon and labium majus is the commonest site in vulva. Complete surgical excision is the preferred treatment of choice to prevent recurrence. Here, we present a benign granular cell tumor over the mons pubis of vulva in a 27-year-old woman.

Aggressive angiomyxoma is an interstitial tumour that is often misdiagnosed and is likely to recur. There have been few reported cases of angiomyxoma in pregnant women. We report a case of a woman who was previously diagnosed with a tumour in her vulva that increased in size during both of her pregnancies and spontaneously decreased postpartum. Local excision was performed and a gonadotropin-releasing hormone agonist was administered. According to a literature review, aggressive angiomyxoma is associated with good maternal and child outcomes. Caesarean section is not the delivery method of choice, but it is indicated if the tumour is preventing vaginal birth. Treatment for angiomyxoma is mainly postpartum local resection supplemented by hormone therapy. This tumour frequently recurs and patients should undergo long-term follow-up.

Currently, removal of excessive cutis with subdermal adipose tissues is done for labium majus rejuvenation. The objectives of this study were to determine the accurate labium majus anatomy, to develop new labiopexy and labioplasty techniques, to attest to the applicability of these two new operations, and to determine the impact of the operations on self-perceived body image and sensation of nerve endings. A prospective case series study was conducted. Eleven fresh human female cadavers and three living subjects were studied. Living subjects were healthy women and presented with labium majus deformities. The study was conducted in three phases: phase I, the labium majus anatomy of the cadavers was studied; phase II, anatomic findings from phase I were used to develop and standardize new stepwise surgical interventions; and phase III, newly developed operations were implemented on living subjects. Labial sensation tests of nerve endings were performed preoperatively and at 6 months postoperatively. The primary outcome measured the labial anatomy and applicability of the new operations. The secondary outcome measured the self-perceived body image and sensation of nerve endings before and after surgery. A new anatomic feature, the labium majus adipose sac, was discovered and was present in each subject. Labium majus labiopexy and labioplasty were executed without technical difficulties or complications. Postoperatively, the self-perceived body image improved and sensation of nerve endings was intact. The labium majus adipose sac is present in each woman. Intraoperatively, newly developed labium majus labiopexy and/or labioplasty do not create technical problems. Self-perceived body image improves and sensation of the nerve endings is intact after labiopexy or labioplasty. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Neurofibromatosis is an autosomal dominant progressive disorder with an incidence of approximately 1 in 3000 live births. Its recognized features include hyperpigmented skin lesions ( C afe - au - lait spots), neurofibromas, iris hamartomas, macrocephaly, centra l nervous system tumors, defects of the skull and facial bones, and vascular lesions. Involvement of the external genitalia is extremely unusual .

A yolk sac tumor (YST) of the vulva is extremely rare and highly malignant with recurrence frequently occurring within a year. This report presents the 13th known case of vulvar YST, with recurrence occurring after the longest known follow-up period so far reported in the literature.

Mastocytosis is a primary, abnormal accumulation of mast cells associated with a broad range of local and systemic symptoms. We report two female adolescents with episodic, unilateral, swelling of the labia majora that was discovered to be an unusual presentation of mastocytosis. Mastocytosis is frequently misdiagnosed because of its rarity and variable clinical presentation, which often mimics other conditions. In the appropriate setting, mastocytosis should be included in the differential diagnosis of labium majus swelling.

The aim of the present study was to investigate if tight-fitting underwear (string panties) equipped with string panty liners affected the vulvar skin microenvironment differently to regular panties with standard panty liners. Thirty-two healthy women participated in a crossover study where temperature, humidity, surface pH and aerobic microflora were measured on vulvar skin. Vulvar skin temperature was 35.2 +/- 0.19 (mean +/- SEM) and 35.3 +/- 0.17 degrees C, respectively, for the two underwear systems. Mean humidity and mean skin surface pH at vulvar skin did not differ between the two systems. Barely noticeable differences were found for the aerobic microflora both at labium majus and at perineum. The mean total number of microorganisms in the two different panty liners was the same, 6.0 +/- 0.15 and 6.0 +/- 0.16, respectively (log CFU per panty liner). The differences in panty and panty liner design studied seem to have negligible impact on the vulvar skin microclimate, skin surface pH and aerobic microflora. No support was found for the assumption that a string panty system would result in higher contamination of vulvar skin by anorectal microflora.

Many women use panty liners between menstrual periods. The aim of this study was to investigate whether the use of such products might influence the vulva skin. Twelve healthy women were studied on four occasions with three different product constructions and on one occasion without products. Temperature, surface wetness and surface pH were measured on vulva skin. Mean skin temperature when the women were wearing a conventional panty liner (with a non-breathable back sheet) was 35.9 degrees C, compared to 34.4 degrees C when wearing no panty liner at all (p < 0.01) and 34.5 degrees C when using a panty liner with a breathable (i.e. vapour permeable) back sheet (p < 0.01). Skin humidity was significantly higher when the conventional panty liner was used compared to no panty liner or to the breathable panty liner (both cases p < 0.01). The mean pH value at the exterior aspect of the labium majus was 5.8 with the conventional panty liner, 5.2 with no panty liner and 5.3 with the breathable panty liner (p < 0.001 and p < 0.01, respectively). The results indicate that the conventional panty liner changes the vulva skin microclimate, but that the breathable panty liner to a substantial degree keeps the microclimate at an undisturbed level. The actual effect of these differences on microbiological flora will be addressed in a subsequent study.

The vulva is an extremely rare site for lymphangioma, a benign tumor of the lymphatic vessels. A small number of case reports have described cavernous lymphangioma involving the unilateral labium majus of young women. We report a case of cavernous lymphangiomas involving the bilateral labia minora.A 14-year-old girl presented with bilateral tumors of the labia minora, which were removed surgically and histologically diagnosed as cavernous lymphangioma. Positive nuclear staining for estrogen and progesterone receptors was demonstrated in the stromal fibroblasts immunohistochemically.It is suggested that an increase in estrogen and progesterone levels may have led to, or at least affected, the development of these tumors in this patient. Excision followed by cosmetic repair may be the optimal treatment.

WOS:000264352700011 PubMed: 19293505 We herein report an 11-year-old girl who came to our clinic with a swelling on the genital area of 2 months duration. Dermatological examination of the patient was performed and a pigmented lesion was found on the inner surface of the labium majus of the mucosa. The lesion was well circumscribed and approximately 1 cm in diameter, with homogenous color distribution. The patient was diagnosed as Spitz nevus on the basis of clinical and histopathological findings. Our case is probably the first reported case of Spitz nevus localized to the genital mucosa in the English literature.

is successfulwhen the tissue looks normal and is pliable, but this israrely the case. Sometimes, a flap should be transposed be-tween the vagina and the rectum, by using a muscle likethe gracilis or the labium majus (associated or not to theoverlying skin and/or to the underlying bulbo-cavernousmuscledso-called Martius flap).

Angiomyofibroblastoma represents a rare, benign mesenchymal tumor with a predilection for the vulvovaginal region. Lipomatous change may occur but rarely comprises a substantial component of the lesion. There are only eight reports in the English language literature describing the lipomatous variant of this tumor. We describe a further lipomatous angiomyofibroblastoma that occurred on the labium majus of a 49-year-old woman. The histopathologic and immunohistochemical features are described, and the collective experience in the literature is reviewed.

Asymmetric vulva swelling during prepubertal period is related to a variety of inflammatory and neoplastic lesions. An 11-year-old girl with childhood asymmetric labium majus enlargement is presented.

A 78-year-old woman presented with a large bulge in the right labium majus. She had a previous history of two anterior and posterior vaginal wall prolapse repairs, a vaginal hysterectomy for uterovaginal prolapse, a sacrospinous ligament fixation for vaginal vault prolapse, and a LeFort partial colpocleisis for recurrent vault prolapse. Magnetic resonance imaging (MRI) revealed an anterior perineal hernia containing small bowel. Surgery was performed to close the pelvic floor defect through a perineal approach, and polypropylene mesh was used as a bolster. The hernial sac contained small bowel with very thin adhesions. Over 6 months of follow-up, there was no recurrence of the hernia or mesh complications. Perineal hernias after gynecological surgeries for benign diseases are rare. The indications for repair and the optimal surgical approach are not well described.

We report the case of woman who presented a vulvar basal cell carcinoma (BCC) on the inner part of the labium majus, treated with local resection. Vulvar BCC is a rare cancer but can be long misdiagnosed due to a non-specific presentation. Though even rarer, BCC involving the mucosal side of the labium majus has to be considered in the differential diagnosis of the vulvar tumors. A complete excision with free margins is the treatment most recommended. Other recommendations include the early identification of aggressive subtypes, which carry a greater risk of recurrence and spreading potential as well as a long-term follow-up with exhaustive muco-cutaneous examination.

Extraskeletal myxoid chondrosarcoma (ESMC) is a rare tumor seen more often in men. It is seen to arise from soft tissue of lower extremity or buttocks. We report a case of soft tissue swelling of left labium majus in a 66-year-old female. Patient underwent wide excision with uneventful postoperative course. Histopathology of specimen confirmed it to be ESMC. Patient refused adjuvant therapy. Followup of 1 year has shown her to be disease- and symptom- free. Only two cases arising from vulva have been reported in literature . This is the third case and first from Indian subcontinent. A brief review of clinical features, diagnosis, treatment, and outcome of patients with extraskeletal chondrosarcoma is presented.

Fibroepithelial polyps are among common benign skin lesions. They are usually small and skin-colored lesions and are located frequently in the axilla and neck. They are rarely seen in the vulva. There is a small number of cases that reach the giant sizes in this area in the literature. A 20-year-old female patient presented with a pedunculated mass measuring 25 cm in diameter, localized to the right labium majus. The lesion was excised and the histopathological diagnosis was fibroepithelial polyp. We present this case because of it is the largest reported fibroepithelial polyp of the vulva in the literature.

Neurofibroma is a benign tumour that rarely affects the vulva. This report describes the case of a vulval neurofibroma in a 21-year old nulliparous woman with no history of trauma and no features of Von Recklinghausen’s disease. Treatment involved excision of the tumour with satisfactory results.

PubMed: 19345909 Unilateral vulva swelling during prepubertal period consists of a wide variety of inflammatory and neoplastic lesions. A group of labial lesions that showed normal radiologic, histopathologic and surgical findings are reported as childhood asymmetric labium majus enlargement. An 11-year-old girl with childhood asymmetric labium majus enlargement is presented to discuss the clinicopathologic features, differential diagnosis, and indications of conservative approach in the treatment of this rare entity. © 2009 North American Society for Pediatric and Adolescent Gynecology.

To report and propose a consensus term for eight cases of a newly recognized, asymptomatic, rapidly growing unilateral labium majus mass without palpable borders in prepubertal girls, appearing to be temporally associated with the physiologic increase of adrenal hormones. Histologic examination, special stains, and immunohistochemistry were performed on all cases. In our personal cases, electron microscopy and chromosomal analysis were also performed, together with pelvic magnetic resonance imaging (MRI), inguinal exploration, vaginoscopy with biopsies, and adrenal hormone levels. Of the eight cases, seven were Ashkenazi Jewish girls from the same area in New York City. The unilateral masses were asymptomatic, soft, without palpable borders. The overlying skin had a slightly tan peau d’orange surface. The masses could not be completely excised because they extended into the contiguous pelvic floor. Histologically, the masses were composed of bland hypocellular fibrous tissue extending into the deep subcutaneous tissue. The masses blended into the surrounding tissue and adjacent pelvic floor as shown by MRI preoperatively and postoperatively. Residual tissue did not progress after incomplete resection. These fibrous lesions develop in months at the time of physiologic increase in adrenal hormone secretion just before puberty and subsequently appear to stop growing. The surgeon should not attempt a complete removal but simply excise sufficient tissue for a reasonable cosmetic result and to confirm the diagnosis. The lesions reflect fibroblastic hyperplasia, which is possibly hormone-driven. The ethnic and geographic clustering of cases raises consideration of environmental exposures or genetic predisposition. III

Skin tags are skin-colored, pedunculated tumors with a smooth surface. Histologically are composed by loose collagen fibers and dilated capillaries. Giant skin tags are reported rarely in the literature. We present the case of two giant skin tags on labium majus. To our knowledge, these are the largest skin tags reported.

Extraskeletal mesenchymal chondrosarcoma is a rare tumor. It has been noted to occur most commonly in muscle and the central nervous system. It has never been reported to occur in the soft tissues of the anogenital region. We report the first such case, occurring in a 40-year-old woman who presented with a 1-year history of a mass originating in the left labium majus. After extensive local resection and lymph node dissection she remains disease free after 40 months follow-up.

Hydrocoele of the canal of Nuck is an uncommon presentation in the neonate and complications are rare. A 6-day-old girl presented with a right groin swelling from birth. The swelling remained static until age 3 days when it increased rapidly in size. There was no fever or gastrointestinal symptoms. Physical examination showed a large nontender mass extending from the right groin into the ipsilateral labium majus with distortion of the external genitalia. Needle aspiration yielded cloudy fluid, which gave a growth of Klebsiella on culture. A hydrocoele of the canal of Nuck was confirmed at surgery and was excised. Postoperative course was uneventful and there has been no recurrence at 2 years of follow-up.

A 29 year old Nigerian woman presented with a history of a swelling in the vulval area of two months' duration. She had no history of pain, tenderness, or vaginal discharge. Her menstrual cycles were regular. Previous cervical smears and gynaecological examination were normal. On examination, she had a large mass in the right labia. It was painless, non-tender, and fluctuant. It was distending the whole of the labium majus on the right (fig 1). Fig 1 She had excision biopsy under general anaesthetic, with good results (fig 2). Fig 2

Specific 5alpha-dihydrotestosterone (DHT) binding capacity (Bmax) has been determined for human skin fibroblast strains from non-genital areas of males and females (N = 8), as well as prepuce and labium majus (N = 9). Genital strains had a mean three times that of non-genital ones (32 vs. 11 fmol/mg cell protein). There were no sex differences. Variation among strains was not simply correlated with donor age; that within strains was unrelated to in vitro age. The lowest values for genital strains overlapped the nongenital ones; those of the nongenital strains approached the limit of detectability. These results parallel those for delta4-3-ketosteroid 5alpha-reductase activity. Thus, serially cultured genital and nongenital skin fibroblasts express their relative differentiative ancestry as androgen target cells. This expression may affect the diagnosis of androgen insensitivity and certain inborn errors of metabolism; its variability is discussed in terms of clonal heterogeneity.