Leiomyoma in Vulva: A Diagnostic Dilemma

With the help of this case we summarize some crucial features to be picked up from history and examination before labeling a case as Bartholin’s abscess or cyst. A 20-year old unmarried girl, deaf and mute since birth, was initially diagnosed to have Bartholin’s abscess. On careful reexamination after inflammation subsided, a decision of excision of this tumor was taken. Intraoperatively it was found to be well encapsulated. Histopathology ascertained the diagnosis of vulval leiomyoma. 1. Introduction Unilateral inflamed vulval swelling in a woman of reproductive age is commonly Bartholin’s abscess. We report here an interesting case of vulval leiomyoma which was initially misdiagnosed as Bartholin’s abscess. We summarize some crucial features to be picked up from history and examination before labeling a case as Bartholin’s abscess or cyst. 2. Case Report A 20-year old unmarried girl, deaf and mute since birth, presented with swelling in vulva for 6 months. The swelling which was slowly increasing in size had become extremely painful for the last one week. There was no history of fever and vaginal discharge. On examination her general condition was fair and vital signs were stable. She was afebrile and there was no inguinal lymphadenopathy. Local examination revealed a labial swelling on the left side with signs of inflammation. Diagnosis of Bartholin’s abscess was made and she was started on parenteral antibiotics. Within 24 hours her pain decreased and inflammation subsided. As the girl and her parents insisted that she was sexually na？ve, she was reexamined. On reexamination 5 × 5？cm swelling on the left labia majora was noted. There were no signs of inflammation now. The swelling felt firm in consistency (not cystic). Labia minora was not everted and hymen was intact (Figure 1(a)). Keeping all these facts in mind a decision of surgical excision of the swelling was taken. Under spinal anesthesia a 3？cm incision was made at the mucocutaneous junction and a firm encapsulated mass was enucleated after dissection along its capsular plane (Figure 1(b)). Base was obliterated with interrupted sutures and overlying skin incision was closed. Figure 1: (a) Vulval swelling after the inflammation subsided. (b) Intraoperative: enucleation. (c) Gross specimen consisted of single, nodular, grey-white tissue mass weighing 56？gm; measures 6 × 4 × 3？cm. (d) Microscopy showing a benign tumor composed of sheets and fascicles of oval to spindle shaped cells with abundant dense cytoplasm, microcystic areas, areas of hyalinization, and focal lymphocytic infiltrate. On