1. Leiomyosarcoma of the Vulva Bapir M, Hoh J & Al-Inizi S
Department of Women Health, South Tyneside District Hospital
Harton Lane, South Shields, United Kingdom
Background
Leiomyosarcoma of the Vulva is a rare mesenchymal tumour and accounts for 1% of vulval cancer.¹ When localised in the Bartholin’s gland area, these tumours can be easily mistaken for benign lesion causing a delay in diagnosis.²
Discussion
Leiomyosarcoma is the most common histologic variant of vulvar sarcoma.
According to Nielsen et al, tumours that manifest three or all of the four following features should be considered sarcomas: ≥ 5 cm in greatest dimension, infiltrative margins, ≥5 mitotic figures per 10 hpf, and moderate to severe cytologic atypia.³
Surgery is the primary treatment but adjuvant radiation therapy is indicated for high-grade tumours and locally recurrent low-grade sarcomas. 4
Case detail
42 years old, Para 3 with previous history of grade 2 ductal carcinoma of the left breast and was on tamoxifen. She was referred by her GP with two years history of slow growing right labial swelling which was thought to be a possible Bartholin’s cyst causing discomfort during sexual intercourse in the last few months.
On examination in clinic, it was felt to be a 6x5cm right Bartholin’s cyst. She was booked for surgery. Under general anaesthetic, it was found to be a 6x5 cm hard mass on the right labia majora which looked like a fibroid. It was completely excised.
Histology confirmed leiomyosarcoma presumably cutaneous in origin. She then had wide local excision of the right vulval scar. Histology showed completely excised, 2mm residual tumour.
Further imaging were performed which excluded any metastatic disease. She had re-excision of scar 6 weeks following the WLE. Histology showed no residual disease and no further treatment needed following discussion at MDT. However, she will have regular follow up in clinic.
Leiomyosarcoma of the Vulva
Conclusion
Most vulval lesions at the Bartholin’s area are either benign Bartholin’s cyst or abscess. However, the possibility of Bartholin’s gland carcinoma or leiomyosarcoma should always be considered if a rapidly growing large hard vulval mass is found in this area to avoid delay in diagnosis.
Fibroids in this area are very rare but any lesions with rapid growth to a certain size are red flag symptoms and leiomyosarcoma should always be part of the differential diagnosis.
6x5 cm Leiomyosarcoma
References
1. Be sli M, Sahin K, Gungor T, Turgut Sahin K, Bayramolu H, Zayifolu Karaca M et al. Vulvar leiomyosarcoma mimicking bartholin gland CYST: A case report, International Journal of Gynecological Cancer. 2011;21/12(3): X
2. Gonzalez-Bugatto F, Anon-Requena MJ, Lopez-Guerrero MA, Baez-Perea JM, Bartha JL, Hervias-Vivancos B. Vulvar leiomyosarcoma in Bartholin's gland area: a case report and literature review. Archives of Gynecology & Obstetrics. 2009;279(2):
3. Nielsen GP, Rosenberg AE, Koerner FC, Young RH, Scully RE. Smooth muscle tumors of the vulva. A clinicopathological study of 25 cases and review of the literature. AM J Surg Pathol 1996;20(7):779-93
4. Curtin JP, Saigo P, Slucher B, Venkatraman ES, Mychalczak B, Hoskins WJ. Obstetrics and Gynecology. 1995;86(2):