Gynecology & Obstetrics Case report Open Access

A Giant Pedunculated Vulvar Lesion: A Case Report

Pegah Arfae and Zahra Honarvar^* Department of Obstetrics and Gynecology, Kerman University of Medical Sciences, Iran
^*Correspondence: Zahra Honarvar, Department of Obstetrics and Gynecology, Kerman University of Medical Sciences, Iran, Email:

Received: 06-Feb-2022, Manuscript No. IPGOCR-22-12463; Editor assigned: 08-Feb-2022, Pre QC No. P-12463; Reviewed: 20-Feb-2022, QC No. Q-12463; Revised: 17-Mar-2022, Manuscript No. R-12463; Published: 24-Mar-2022, DOI: 10.21767/2471-8165.1000012

Introduction

Angiofibroma is a soft tissue tumor that occurs in vulvo vaginal region in females and inguino-scrotal region in males [1].

These tumors are well-circumscribed, superficial and include soft spindle cells and veins [2]. It is first described by Nucci MR, et al. [1] in 1997 in a series of 6 cases that occurred almost in the vulvar region of middle- aged women.

Since the first description by Nucci, few studies have been published about this kind of lesion in the literature. According to studies, there is no known risk factor for angiofibroma.

Case Presentation

We present an unusual case of pedunculated angiofibroma mass. A healthy virgin 44-year-old woman consulted for a painless vulvar mass. There was no previous infection or bleeding. The patient history revealed that the mass was first identified four years earlier and it had gradually enlarged. It caused discomfort when sitting or walking due to its size. Gross examination showed a firm freely mobile tumor measuring 25*20*17 cm in the left labia majora (Figure 1).

Figure 1: Microscopic evaluation showed a vulvar tissue with a well-defined neoplastic growth composed of fascicle of spindle cells with bland nuclei along with thick wall dilated blood vessels gross examination showed a firm freely mobile tumor measuring 25*20*17 cm in the left labia majora.

There was no family history of cancer. She didn’t report any use of Oral Contraceptive Pills (OCP) or hormone replacement therapy. The patient gynecological examination was normal and no palpable inguinal lymph nodes were distinguished.

The patient underwent surgery with a diagnosis of vulvar mass. The mass was composed of large vessels and after resection had 3 kgs weight. Microscopic evaluation showed a vulvar tissue with a well-defined neoplastic growth composed of fascicle of spindle cells with bland nuclei along with thick wall dilated blood vessels (Figure 2).

Figure 2: Microscopic evaluation showed a vulvar tissue with a well-defined neoplastic growth composed of fascicle of spindle cells with bland nuclei along with thick wall dilated blood vessels.

Discussion

Angiofibroma is considered benign. Surgical excision of the lesion seems to be the adequate management [3], not only to treat the patient but also to achieve a correct diagnosis. The potential recurrence risk of these lesions is low [4].

However, Mc Cluggage WG, et al. [5] reported one case of recurrence in a 49-year-old woman that occurred 6 months after excision.

Angiofibroma should be considered in the differential diagnosis of painless soft masses that may reach large dimensions in the vulva [6].

The present case is the largest angiofibroma defined in the literature.

There are many mesenchymal tumors which enter into the differential diagnosis with angiofibroma as spindle cell lipoma, solitary fibrous tumor, mammary myofibroblastoma, angiomyofibroblastoma, aggressive angiomyxoma and smooth muscle tumor. All these described tumors share similar morphologic features and are characterized by bland ovoid to spindle shaped cells with wispy collagen; vaiably sized thich- walled blood vessels [7].

Conclusion

In summary, Pathologists should be aware of morphological variation to avoid diagnostic errors and therefore an aggressive treatment. Angiofibroma in women represents a benign lesion, so a treatment of simple local excision of the lesion is adequate.

REFERENCES

1. Nucci MR, Granter SR, Fletcher CD (1997) Cellular angiofibroma: a benign neoplasm distinct from angiomyo fibroblastoma and spindle cell lipoma. Am J Surg Pathol 21(6): 636-644.

[Google Scholar], [Crossref], [Indexed at]

2. Chen E, Fletcher CDM (2010) Cellular angiofibroma with Atypia or sarcomatous transformation: clinicopathologic analysis of 13 cases. Am J Surg Pathol 34(5): 707-714.

[Google Scholar], [Crossref], [Indexed at]

3. Kumar P, Singh S, Kumar A, Janoria S (2018) A rare case of cellular angiofibroma affecting the periurethral region in a 38-year-old woman. BMJ Case Rep 2018: 225386.

[Google Scholar], [Crossref], [Indexed at]

4. Khmou M, Lamalmi N, Malihy A, Rouas L, Alhamany Z (2016) Cellular angiofibroma of the vulva: a poorly known entity, a case report and literature review. BMC Clin Pathol 16(1): 8.

[Google Scholar], [Crossref], [Indexed at]

5. Mc Cluggage WG, Perenyei M, Irwin ST (2002) Recurrent cellular angiofibroma of the vulva. J Clin Pathol 55(6): 477-479.

[Google Scholar], [Crossref], [Indexed at]

6. Umit A, Hasan T, Unal T, Ahmet TE, Ahmet KA (2016) Giant Vulvar Mass: A Case Study of Cellular Angiofibroma. Hindawi Case Rep Obstet Gynecol 2016: 2094818.

[Google Scholar], [Crossref], [Indexed at]

7. Micheletti AM, Silva AC, Nascimento AG, Da Silva CS, Murta EF, et al. (2005) Cellular angiofibroma of the vulva: case report with clinic pathological and immunohistochemistry study. Sao Paulo Med J 123(5): 250-252.

[Google Scholar], [Crossref]