Fibroma of the vulva and uterine leiomyoma

International Journal of Gynecology & Obstetrics 59 (1997) 55-56

Brief communication

Fibroma of the vulva and uterine leiomyoma M. BaSbug”, M. Tayyar”l*, N. Erdoganb aDepamnent

of Obstetrics and Gynecology, School of Medicine, Erciyes bDepartment of Pathology, Kartal Hospital, Istanbul,

University, Turkey

Kayseri,

Turkey

Received 21 January 1997; revised 3 March 1997; accepted 14 March 1997

Keywords:

Vulva; Fibroma;

LAomyoma

Fibroma is a rare benign solid tumor of the vulva. Originating from the mesoderm, fibromas arise from the fibrous tissue of the vulva and are usually of small or moderate size. They tend to become pedunculated, especially if large and lymphadenematous, and the pedicle may become so long that the growth dangles between the limbs [l]. In the literature, only a few similar cases have been reported [2,3]. The largest fibroma of the vulva in the literature was reported by Buckner in 1851, which was 268 lb [l]. To our knowledge, there is no report about large fibroma of the vulva accompanying a large uterine leiomyoma in the literature. For this reason, we consider that this case is of interest and worthy of reporting. A 42-year-old woman gravida 3, para 3 was referred to our hospital because of a vulvar mass. Medical history revealed that she had 1-2 cm wide solid mass on her external genitalia for 2 years and this mass began to grow bigger during

* Corresponding author. Tel.: + 90 0352 2234489; fax: + 90 0352 2220473 0020-7292/97/$17.00 0 1997 International PIZ SOO20-7292(97)00081-7

the last 2 months. Also, during the last 2 months she has experienced excessive abdominal distention. During the examination, a non-tender solid mass, 20 cm long and 9 cm wide, originating from the right labium majus was palpated (Fig. 1). On pelvic examination, the uterus was found to be enlarged to the size of 16 weeks of gestation. Diagnosis of uterine leiomyoma was confirmed by ultrasonography and computed tomography. The remainder of the gynecological, physical and laboratory analyses including tumor markers were normal. Under general anesthesia, a circular incision around the base of the vulvar pendulous mass was undertaken, and a mass of 550 g was removed. Laparotomy revealed an enlarged uterus with dimensions of 18 x 10 cm. An abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The patient did well postoperatively and was discharged on the 6th day post-operative. Histologic examination of the vulvar mass showed bundles of fibroblastic cells with variable

Federation of Gynecology and Obstetrics

56

M. Bazbug

et al. /International

Federation

of Gynecology

& Obstetrics

59 (1997)

55-56

estrogen receptor, Dako, Carpinteria, USA] by phosphatase technique. Imusing alkaline munohistochemical receptor analysis revealed that uterine leiomyoma had significant progesterone receptor staining but had focally positive estrogen receptor staining. Immunohistochemical receptor analysis of the fibroma of the vulva showed negative progesterone and estrogen receptor staining. The histogenesis of mesodermal tumors remains obscure. In the literature, it has been reported that estrogen has a significant role in the etiology of uterine leiomyoma [4], however, there has been no report on what might be significant in the etiology of fibroma. We think positive immunohistochemical staining of progesterone and estrogen receptors of the uterine leiomyoma, and negative staining of the same receptors of fibroma of the vulva in the same patient, shows that there is no link between estrogen or progesterone and etiology of the fibroma. References Fig. 1. Large pendulous fibroma of the vulva.

111 Jones HW. Benign diseases of the vulva. In: Jones HW,

collagenization showing fibroma. The final diagnosis therefore, was fibroma. Pathologic evaluation of the uterus showed leiomyoma. Estrogen and progesterone receptor staining of the uterine leiomyoma and fibroma of the vulva were carried out by using commercially available kits [Mouse anti-progesterone receptor (monoclonal) Biogenex, San Ramon, USA, and Mouse anti-human

Wentz AC, Burnett LS, editors. Novak’s textbook of gynecology. Baltimore: Williams and Wilkins, 1988:570-596. 121 Perini 0, Gasparini M, Lazzari G. Voluminous pedunculate fibroma of the vulva. Friuli Med, 1969:360-368. [31 Lombard0 F and Percolla R. Large pendulous fibroma of the vulva. A clinical case. Minerva Ginecol, 1994:699-700. 141 Wexler AS, Pemoll ML. Benign disorders of the uterine corpus. In: DeCherney API, Pemoll ML, editors. Current obstetric and gynecologic diagnosis and treatment. Lebanon: Appleton and Lange, 1994731-743.