Background: Vulval Leiomyoma is a rare type of benign tumour of the vulva. They
occur commonly in the fourth and fifth decades. The prevalence of leiomyoma
accounts for 0.03% of all gynaecological neoplasms and 0.07% of all vulva
tumours.
Aim: To present this rare clinical entity and management.
Case Report: Mrs I. G., a 35 year old para1+0 (1 alive) who presented with a 3
year history of vulva swelling and offensive vaginal discharge of 3 years
duration and vulva pain of 2 years duration. On Examination, she was pale,
with a huge whitish grey and tender mass on the left labium which was
friable. She was counseled and basic investigations carried out. She had
excision of the mass under local anaesthesia. Her post op period was
uneventful. Histology report revealed vulva leiomyoma. She has done well at
her follow up visit.
Conclusion: We presented a case of vulva leiomyoma,
which is an extremely rare gynaecological neoplasia. She had excision of the
mass and had an excellent post operative period.
Vulva
leiomyoma of the vulva are rare 1, masquerading and often
misdiagnosed as Bartholin’s cyst preoperatively.2 Researchers have
observed this tumour of smooth muscle origin. 1-2 They are usually
painless, solitary and well circumscribed. 1,2 They can affect
females of any age group but between 30 – 80 years. 2 These tumours
affect 30% of women older than 35 years. 1-4,5 Less than 160 cases
previously and approximately 300 cases have been reported in recent times. 1-3,6-9
Histologically, vulva leiomyomas originate from smooth muscle within erectile
tissue, blood vessel walls and round ligament. 4 Scholars have shown
the vulva leiomyomas demonstrate spindle shaped cells, but other histological
type such as epitheloid tumours are also reported. 4
CASE REPORT:
Here
we present a Mrs I.G 35 year old primipara with vulva leiomyomas initially
thought to be a malignant tumour of the vulva. Mass was medial due to the left
labia minora, She had had 1 spontaneous Vaginal delivery without induction of
labour. The family history was not contributory. She had elective excision
under spinal anaesthesia. Incision at mucocutaneous junction revealed soft
fleshy friable mass measuring 6cm by 4cm. The mass enucleated in fragments,
sent for histopathology. She recovered well post operatively and had no complication.
Histology examination revealed specimen measuring grayish white soft tissue.
Microscopic
description:
Specimen polypoid tissue displaying whirling bundles of smooth muscle fibers.
The individual cells are spindle shaped with central nuclei and bipolar
cytoplasm. There was no evidence of malignancy. A diagnosis of vulva tissue –
Leiomyomatous polyp
DISCUSSION:
We
present a 35yr old primipara with left vulva leiomyoma. Vulva leiomyoma is a
rare type of benign tumour arising from smooth muscle cells. 2 Researchers
have shown that 160 cases have been reported in English language. 2-4
Kurdi et al reported leiomyoma of the vulva in a 46 year old multipara which
was a diagnostic challenge cas. 4,5 They had initially made a
diagnosis of Bartholin’s cyst prior to the confirmation from the histopathology
report. 4 Vulva leiomyoma has a myriad of histological origin
ranging from smooth muscle cells, spindle cells and epitheliod cancer cells of
eosinophils cytoplasm. 4,5 Vulva leiomyomas stain positive for
estrogen receptors when immunochemical stains are done. 3-4 For this
reason, treatment with receptor modulators in adjuvant to surgery may be quite
beneficial. 2-4,6-8
A strong differential of vulva leiomyoma is
Bartholin’s cyst since they share some clinical features such as painless lump,
redness and swelling of the area. 4,9 However, in our case the
swelling was painful depicting bartolin’s abscess, with everted labia minora,
however in vulva leiomyoma, the labia in majority of cases are inverted. 4
CONCLUSION:
We
presented a case of vulva leiomyoma, which is an extremely rare gynaecological
neoplasia. Our patient presented with features suggestive of malignancy of
vulva. She had excision of the mass and histology report confirmation vulva
leiomyoma. She had an excellent post operative period and follow-up period.
REFERENCES:
1.Muhammed
PA et al. A rare case of benign vulvo vaginal Leiomyoma: Case report and
literature review. Annuals of medicine and surgery 2022; 77:13720
2.Jang
SH, Cho HD, Lee JH, Hong SA, Ahn H et al. Valvular Epitheloid leiomyoma with
myxoid change: A case report and literature review
3.Chang
CH, Li PC, Hsu TH, Ding DC. Vulva myoma: A case report and review of
literature. Taiwan J Obstetrics and Gynaecology2021;60(5):924 – 926
4.Tarrah
R et al. Vaginal leiomyoma misdiagnosed as a Bartholin abscess: A case report
from Damascus, Syria Https://journals.sagepub.com>doc (accessed
29/7/2023)
5.Kurdi
S et al. Leiomyoma of the vulva: A diagnostic challenge. Case report.
Http://www.hindawi.am> (Http://www.hindawi.com.criog) (accessed
29/7/2023).
6.Singh
A, Goel B, Takkar N, Jain E. Int J Rerod Contracept Obstet Gynecol
2017:6;306-8.
7.Sun
C, Zou J, Wang Q et al. Review of the pathophysiology, diagnosis, and therapy
off vulva leiomyoma, a rare gynaecological tumour. J Int Med Res. 2018,
46.663-74.10.11.77/0300060517721796
8.Ammouri
S, Elkarkri C, Zeraidi N, Lakhdar A, Baydada A. Vulvar leiomyoma: a case
report. Pan Afri Med J. 2019;32:208.
9.Mohammad
HM, Rashid RJ, Othman S et al. Vaginal leiomyoma: A casa report. Int. J of
Surg. Open 2023;58: 100663
10.Patil
RR, Vijay NR, Joshi S. An unusual presentation of vaginal leiomyoma. J Mid Life
Health 2019; 10(4): 204-205.
Cite this
Article: Adewale, O; Eli, S; Ocheche, U; Wakama, I; Okagua, KE; Martin, N;
Don-Baridom, G; Nwosu, CC (2023). Vulval Leiomyomatous polyps: An unusual
case report and management. Greener
Journal of Medical Sciences, 13(2): 144-145.
