A case of primary vulva epidermoid cyst
Chu
Liua, Xiaohui Guoa, Hua
Lana, Da Zenga, Jing
Yuana, JiaHui Yonga, Songshu
Xiaoa*
aDepartment of Gynecology and Obstetrics, The Third
Xiangya Hospital, Central South University, Changsha, Hunan, China
Corresponding Author:
Songshu Xiao
Department of Gynecology and Obstetrics, the third Xiangya Hospital,
Central South University
Changsha, Hunan, 410013, People’s Republic of China.
Tel: 13787412954
Email: xiaosongshu@csu.edu.cn
Number of Figures: 3
Word count: 834
Keywords: vulva, perineum, Epidermoid cyst
Established Facts
Already known fact that primary or secondary epidermoid cysts occurring
in female external genitals are more common in the clitoris.
Novel Insights
New information shows in this case report, Epidermoid cysts occurring in
the vulva. And the First diagnosis is vestibular gland cyst. Through
this case report, the clinician can raise awareness of differential
diagnosis between primary vulva Epidermoid cysts and vestibular gland
cyst.
Abstract
Introduction: Epidermoid cyst is a benign tumor, which is one
of the most common skin tumors. It usually occurs in the
maxillofacial,occasionally in the sublingual, intracranial and spleen,
etc. But rare epidermoid cyst originating from the female vulva.Case presentation: In this report, We discuss a case of
epidermoid cyst originating from the female vulva, which was completely
excised by surgery. Pathologically confirmed as a vulva epidermoid cyst.Conclusions: It has been reported that primary or secondary
epidermoid cysts occurring in female external genitals are more common
in the clitoris, and the clinical manifestation is clitoris hypertrophy.
The site of epidermoid cysts in this case is rare and it is easy to be
misdiagnosed as vestibular gland cyst. Therefore, the clinician should
strengthen the differential diagnosis.
Introduction: Epidermoid cyst is a benign tumor, which is one
of the most common skin tumors, occasionally occurring under the tongue,
intracranial and spleen. Primary epidermoid cysts may be derived from
ectodermal vestigial tissue1. The clinical
manifestation of primary vulva epidermoid cysts is painless vulva mass.
If the cyst increases further, it may affect walking. Local color
doppler ultrasound and nuclear magnetic resonance can assist diagnosis,
and pathological results are the gold standard for diagnosis. The main
treatment is surgical excision of cyst.
Case presentation: A 29-year-old women consulted for a vulva
mass discovered at the age of 27. The patient first noticed this mass
when it was very tiny while two years ago, about the size of a mung
bean, and then it started growing over the last 2 years. Without pain or
discomfort of walking. Perineal examination revealed a 3cm×3cm, smooth
surface, normal skin temperature, clear boundary and no tenderness
cystic swelling between below the right labia majora and outboard the
perineal body (Figure 1). Vaginal patency, a small amount of white
odor-free secretions. Smooth cervix, normal size, medium texture. No
obvious abnormalities were observed in bilateral attachments. No
palpable enlarged lymph nodes in the groin. Local color doppler
ultrasound of vulva: A 27mm× 16mm unechoic region with clear boundary
can be consideration it may be a vestibular gland cyst. Blood routine
and coagulation function were normal. Preliminary diagnosis of
vestibular gland cyst. Immediately, the patient was scheduled for
surgery, the mass of vulva was removed under the venous general
anesthesia, The pedicle of this cyst was found to be tightly adhering to
the skin, and the mass was stripped completely(Figure 2), after that, we
performed an effective hemostasis and the incision was primarily closed
with no-tension simple stitches. The gross specimen shows that there are
yellow-white bean dregs and sebum inside in the cyst, and no nipples or
hair in it. The cyst wall is smooth. Postoperative pathologic
examination (Figure 3)show that benign cyst with layered squamous
epithelium lining the cyst wall, containing multiple keratinites.
Pathology confirmed that it is a vulva epidermoid cyst.
Discussion: Epidermoid cysts tend to occur on the face, head
and neck, the wall of the cyst is thin. Histopathological appearance of
the epidermoid cyst lined by stratified squamous epithelium and filled
with keratinous material, The latter is also the most important point to
differentiate from dermatoid cysts2. In the case of
epidermoid cysts occurring in female genitalia, more located in the
clitoris were reported, including primary epidermoid cysts in the
clitoris and Secondary clitoris epidermoid cysts. Primary clitoris
epidermoid cysts may be accompanied by sex deformity3,
clinical manifestations are non-hormonal clitoris hypertrophy; The
formation of a secondary epidermoid cyst can be caused by trauma or
surgery leading to the implantation of the epidermis into the dermis,
such as clitoris epidermoid cysts formed after female genital
mutilation4-6, common in sub-Saharan Africa. In
addition, Huang Jing et al reported a case of vaginal epidermoid
cyst1. There are few epidermoid cysts located between
the lower labia majora and the perineal body. The vulvar epidermoid
cysts are often misdiagnosed as vestibular gland cysts. Because
epidermoid cysts may be malignant, the first choice for treatment is
surgery. It is difficult to distinguish vulva epidermoid cyst from
vestibular gland cyst before operation, so in the case of undiagnosed,
we should pay more attention to the separation of cyst wall, avoid the
rupture of cyst during the operation, form an iatrogenic epidermoid
cyst. On the other hand, the cyst should be stripped as clean as
possible, if the cyst wall remains, it may lead to recurrence or even
malignant change in the future7. Due to the abundant
blood supply in the vulva, attention should be paid to hemostasis during
operation to avoid the formation of subcutaneous hematoma.
Conclusions: It has been reported that primary or secondary
epidermoid cysts occurring in female external genitals are more common
in the clitoris. Epidermoid cysts occurring in the vulva is easy to be
misdiagnosed as vestibular gland cyst. But epidermoid cysts may be
malignant. So, it is our hope that through this case report, the
clinician can raise awareness of differential diagnosis between primary
vulva Epidermoid cysts and vestibular gland cyst.