In the last few years, interest in vulvar disease has greatly increased. Hemangiomas are benign tumors of the vascular endothelium that. Hemangioma is a benign neoplasm that may affect the vulva, and it can cause functional or emotional disability. This article reports the case of. Abstract. Hemangioma is a benign neoplasm that may affect the vulva, and it can cause functional or emotional disability. This article reports the case of a.
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Hemangioma is a benign neoplasm that may affect the vulva, and it can cause functional or emotional disability. This article reports the case of a year-old female patient with a history of a genital ulcer for the past 3 years and who had undergone various treatments with creams and ointments. The patient was biopsied and diagnosed with vulvar hemangioma and was subsequently submitted to surgical excision of the lesion.
We emphasize the importance of following the steps of the differential diagnosis and proceeding with a surgical approach only if necessary. Hemangiomas are proliferative soft-tumor lesions marked by increased cell turnover.
They are the product of a derangement in angiogenesis that allows for the unsuppressed proliferation of vascular elements. These tumors usually appear after birth, grow rapidly and involute over the years. However, vascular tumors are rarely found in the female genital tract.
Although rare, we must be aware of the diagnosis of hemangiomas in the inferior female genital tract, as they might be a reason for a gynecologic consultation 3 and can cause functional or emotional disability.
The patient is a year-old femalemarried, self-employed, non-smoker, with prediabetes, dyslipidemia and premenopausal, with no use of hormonal contraception.
Case Reports in Obstetrics and Gynecology
The patient reported a genital lesion for the past 3 years and the use of various treatments involving creams and ointments, even though there was no diagnosis associated with dyspareunia and intermittent bleeding. Physical examination revealed a solitary vulvar ulcer Fig. The cervix had no abnormalities according to the colposcopy.
No abnormalities were present in the routine blood tests and examinations of the patient. Initially, the investigation began by discarding all possible infectious causes of genital ulcers, such as syphilis, herpes and chancroid, which all proved to be negative. There was suspicion of a manifestation of Behcet disease; therefore, we initiated the treatment with systemic corticosteroids.
The first response was partial, the patient presented a decrease in the itching and burning sensations, but the bleeding did not cease. Furthermore, the pathergy test result was negative.
Vulvar Hemangioma: Case Report.
Due to the patient complaints of pain and sexual dysfunction, it was hemagnioma to conduct a surgical excision of the lesion. The biopsy examination showed a proliferation of tortuous vessels in the submucosa Fig. A Detail of a tortuous vessel and its endothelial lining formed by a single layer of some flattened cells.
Some more swollen, without nuclear atypia. B Some of them are larger and full of erythrocytes, while others are smaller and located in the periphery. C Field of observation demonstrating the superficiality of these tortuous vessels and their close vullvar to the mucosa hemamgioma squamous epithelium.
D Nude area without epithelial lining composed of acute inflammatory cells polymorphonucleatedchronic lymphocytes and plasma cells and erythrocytes, characterizing ulcerated lesion. All using hematoxylin-eosin staining. The patient presented a hemangioma, which was clinically manifested as a bleeding ulcer.
In fact, the hemangioma can manifest as an ulceration and bleed, both occurring most often in younger patients. For this reason, vulva is important to diagnose it correctly and to treat it adequately. In this case, the first manifestation was a red, painful and persistent lesion followed by an ulcer complicated by life-threatening hemorrhage that was not responsive to hemangiomz treatments and which showed no signs of involution for more than 3 years.
Despite the negative evidence, over this time, an appropriated gynecological exam had been realized as well as the syndromic management, which is recommended by the Brazilian Ministry of Health. However, no final diagnostic was obtained, and no satisfactory results were observed. The syndromic management of genital ulcers is recommended as an initial treatment, given the number of differential diagnoses and the practical difficulties in establishing a clear-cut etiologic diagnosis.
It is prudent for healthcare providers to initially consider every female genital ulcer as a sexually transmitted disease STDwhich are: Therefore, our approach was to initially screen the patient for STDs; these all proved to be negative, which excluded these diseases from our differential diagnoses.
Continuing the investigation of the hemangiooma of the ulcer, we considered that it could be hemangioa by a non-sexually transmitted disease, 6 such as Behcet disease. However, there was no complete regression of symptoms.
Subsequently, the biopsy of an ulcer, which did not respond to initial therapy, was the recommended course of action. As most hemangiomas present spontaneous involution, treatment may be reserved for lesions that present complications, such as functional impairment, uvlvar, ulceration, and bleeding, as the ones presented by our patient; however, there are others, like unusually rapid growth, infection, and cosmetic concerns.
The vulvag approach in our case was a conservative treatment with systemic corticosteroids to minimize the inflammatory process, as we assumed we were dealing with a manifestation of Behcet disease.
Fortunately, these medications are effective in inducing rapid involution in massive hemangiomas.
Vulvar Hemangioma: Case Report.
The patient responded partially with a significant improvement in the itching and burning symptoms. However, the ulcer did not involute as expected, and she was still suffering from bleeding and dyspareunia. It is important to highlight that during this period, the biopsy was suggested and refused by the patient, who accepted it only upon knowledge that it could be a malignant neoplasm.
The surgical excision of hemangiomas of the female genitalia is reserved for symptomatic lesions refractory to medical management. A circular excision and purse-string closure are considered the best surgical approach for hemangiomas. A definite diagnosis of hemangioma was reached after pathological examination of the lesion. The proliferation of large vessels full of erythrocytes in the submucosa, involving the dermis are pathognomonic of hemangioma and excluded the possibility of being an ordinary inflammatory process Fig.
A second surgical approach was necessary in this case because of a residual vulvar lesion. The biopsy and histological examination of this tissue were compatible with a Bartholin cyst. Vulvar hemangioma is an extremely rare pathology in adults; however, infantile hemangioma is one of the most common benign soft-tissue tumors in infants.
The treatment of infantile hemangiomas has been changing from surgical incision to the use of oral corticosteroids, cryosurgery, laser, radiation, propranolol, and anticancer drugs vincristine and bleomycin. More recent reports also suggest alternative modalities for the treatment of this disease, such as the use of curcumin, indicating that the effectiveness of curcumin in hemangioma may be associated with its potent antiproliferative and apoptotic activities in hemangioma endothelial cells.
To conclude, this case represents a rare situation of a vulvar hemangioma that presented as a genital ulcer, associated with psychological and physical dysfunction for the patient. The symptoms of itching, pain and sexual impairment were significant, and the delay in the diagnosis and resolution of the problem were a source of distress for the patient and her husband. An Bras Dermatol ; Plast Reconstr Surg ; Hemangioma of the ovary-a case report and review of literature.
Indian J Pathol Microbiol ;34 Life-threatening hemorrhage from a vulvar hemangioma. J Pediatr Surg ;37 A rare mass formation of the vulva: J Low Hemaangioma Tract Dis ;12 Sexually transmitted diseases treatment guidelines, Global control of sexually transmitted infections.
Lancet ; Arch Dermatol ; Centers for Disease Vulvzr and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis ;61 Suppl 8: Vascular anomalies of the female external genitalia.
J Pediatr Surg ;41 Circular excision of hemangioma and purse-string closure: Arch Facial Plast Surg ; 5 Complications of infantile hemangiomas.
Clin Dermatol ;32 Current management of infantile hemangiomas and hemangiona common associated conditions. Otolaryngol Clin North Am ;45 Propranolol therapy of infantile hemangiomas: Pediatr Surg Int ;29 Curcumin induces apoptosis and inhibits proliferation in infantile hemangioma endothelial cells via downregulation of MCL-1 and HIF-1a. Medicine Baltimore ;97 This is an open-access article distributed under the terms of the Creative Commons Attribution License. Services on Demand Journal.
Case Report Vulvar Hemangioma: Abstract Hemangioma is a benign neoplasm that may affect the vulva, and it can cause functional or emotional disability. Introduction Hemangiomas are proliferative soft-tumor lesions marked by increased cell turnover. Case Report The patient is a year-old femalemarried, self-employed, non-smoker, with prediabetes, dyslipidemia and premenopausal, with no use of hormonal contraception.
Discussion The patient presented a hemangioma, which was clinically manifested as a bleeding ulcer. The biopsy and histological examination of this tissue were compatible with a Bartholin cyst Vulvar hemangioma is an extremely rare pathology in adults; however, infantile hemangioma is one of the most common benign soft-tissue tumors in infants.
Conclusion To conclude, this case represents a rare situation of a vulvar hemangioma that presented as a genital ulcer, associated with psychological and physical dysfunction for the patient. February 24, ; Accepted: Conflicts of Interest The authors have no conflicts of interest to declare. How to cite this article.