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      Differential Diagnosis between Bartholin Cyst and Vulvar Leiomyoma: Case Report Translated title: Diagnóstico diferencial entre cisto de Bartholin e leiomioma vulvar: relato de caso

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          Abstract

          Genital leiomyomas are rare tumors that can often be misdiagnosed as Bartholin cyst. We report a case of a 32-year-old patient who had a cystic nodulation in the left labium majus that was suggestive of Bartholin cyst. A resection surgery was performed, and the definitive histopathology diagnosis was vulvar leiomyoma. The macroscopic features of cystic lesions difficult the differential diagnosis between leiomyoma and Bartholin cyst; therefore, a histopathologic examination is often recommended.

          Translated abstract

          Resumo

          Os leiomiomas genitais são tumores raros, e frequentemente são diagnosticados como cisto de Bartholin. Relatamos o caso de uma paciente de 32 anos em que ocorreu nodulação cística no grande lábio esquerdo sugestiva de cisto de Bartholin. Uma cirurgia de ressecção foi realizada, e o diagnóstico histopatológico definitivo foi leiomioma vulvar. As características macroscópicas das lesões císticas dificultam o diagnóstico diferencial entre o leiomioma e o cisto de Bartholin, de modo que o exame histopatológico é frequentemente recomendado.

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          Leiomyomas beyond the uterus: unusual locations, rare manifestations.

          Najla Fasih, Alampady K Prasad Shanbhogue, David MacDonald … (2015)
          Uterine leiomyomas affect 20%-30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge: These histologically benign tumors, which originate from smooth muscle cells, usually arise in the genitourinary tract (in the vulva, ovaries, urethra, and urinary bladder) but may arise in nearly any anatomic site. In addition, unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. In the presence of such a pattern, a synchronous uterine leiomyoma or a previous hysterectomy for removal of a primary uterine tumor may be indicative of the diagnosis. However, some extrauterine leiomyomas may mimic malignancies, and serious diagnostic errors may result. The most useful modalities for detecting extrauterine leiomyomas are ultrasonography, computed tomography, and magnetic resonance (MR) imaging. The superb contrast resolution and multiplanar capabilities of MR imaging make it particularly valuable for characterizing these tumors, which usually show low signal intensity similar to that of smooth muscle on T2-weighted images. The radiologist's recognition of this and other characteristic features may help steer the clinician toward timely, appropriate management and away from unnecessary, potentially harmful treatment.
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            Smooth-muscle tumors of the vulva. A clinicopathological study of 25 cases and review of the literature.

            Paul R Young, F Koerner, Fiona G. G. Nielsen … (1996)
            The clinical and pathological features of 25 smooth-muscle tumors of the vulva were analyzed. The patients ranged in age from 17 to 67 (mean, 37.6) years; two were pregnant. Twenty-three tumors were 1.5 to 16 (mean, 5.2) cm in greatest dimension; the size of two tumors was unknown. Microscopic examination showed that 16 tumors were circumscribed, six had focally infiltrative margins, and the margins could not be evaluated in three tumors. Fourteen tumors were composed mainly of spindle cells; two of these tumors had prominent myxoid stroma. Seven tumors were predominantly epithelioid and had a prominent hyalinized or myxoid stroma; often the cells had a plexiform pattern. Four tumors contained an approximately equal number of epithelioid and spindle cells. Ten tumors had mild, nine moderate, and six severe cytologic atypia. Mitotic figures ranged from 0 to 10 (average, 1.8) per 10 high-power fields (hpf). Immunohistochemically, all the tumors stained for one or more muscle markers. Thirteen of 17 tumors were positive for estrogen receptors, and 16 of 18 were positive for progesterone receptors. Follow-up information ranging from 1 month to 19 years (average, 5 years) was available in 19 cases. Four tumors recurred locally, and one patient with recurrent tumor died of metastases 7 months after the initial operation. We propose an expanded criteria to distinguish between leiomyomas and leiomyosarcomas of the vulva. Tumors that manifest three or all of the four following features should be considered sarcomas: > or = 5 cm in greatest dimension, infiltrative margins, > or = 5 mitotic figures per 10 hpf, and moderate to severe cytologic atypia. Those that have only one of these characteristics should be diagnosed as leiomyoma, and those that exhibit only two of these features should be considered benign but atypical leiomyomas. The sarcomas should be excised with widely negative margins; the leiomyomas and the atypical leiomyomas should be excised conservatively, with long-term, careful follow-up.
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              Outcomes from leiomyoma therapies: comparison with normal controls.

              James Spies, Linda D Bradley, Richard Guido … (2010)
              To assess the severity of symptoms caused by uterine leiomyomas, their effect on health-related quality of life, and the change after treatment compared with a normal control group.
              Article 0 comments Cited 14 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Rev Bras Ginecol Obstet
                Journal ID (iso-abbrev): Rev Bras Ginecol Obstet
                Journal ID (doi): 10.1055/s-00030576
                Title: RBGO Gynecology & Obstetrics
                Publisher: Thieme Revinter Publicações Ltda (Rio de Janeiro, Brazil )
                ISSN (Print): 0100-7203
                ISSN (Electronic): 1806-9339
                Publication date (Print): August 2017
                Publication date PMC-release: 1 August 2017
                Volume: 39
                Issue: 8
                Pages: 433-435
                Affiliations
                [1 ]Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
                Author notes
                Address for correspondence Kelly Alessandra da Silva Tavares, MD Rua dos Democratas, 277, apartamento 4104305-000, São PauloBrazil kellyalessandradasilva@ 123456yahoo.com.br
                Article
                Publisher ID: 5919
                DOI: 10.1055/s-0037-1604178
                PMC ID: 10316947
                PubMed ID: 28783860
                SO-VID: 3bc8b5b0-395b-4d35-90a5-aad28a65bdfb
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                Date received : 29 October 2016
                Date accepted : 05 May 2017
                Categories
                Subject: Case Report

                Keywords: vulvar neoplasms,bartholin gland,leiomyoma,histology,case report,neoplasias vulvares,glândula de bartholin,leiomioma,histologia,relato de caso
                Data availability:
                Keywords: vulvar neoplasms, bartholin gland, leiomyoma, histology, case report, neoplasias vulvares, glândula de bartholin, leiomioma, histologia, relato de caso

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