Vulva neoplasms are a group of tumor diseases of the vulva that differ in morphology. Tumors may be asymptomatic; with large sizes or infiltrative growth, they are accompanied by discomfort and soreness in the perineum, bloody or purulent discharge, irritation and itching of the vulva. Diagnosis of neoplasms of the external genitalia is based on examination of the vulva, vulvoscopy, cytological examination of smears, biopsy. Treatment of benign tumors of the vulva is reduced to their excision or exfoliation; in case of malignant neoplasms, vulvectomy or combined treatment is performed.
Vulva neoplasms are formed as a result of pathological tissue overgrowth caused by abnormal cell division. They can come from almost all tissue structures located in this zone – connective, fatty, muscular, lymphoid, epithelial, etc. Neoplasms of the external genitalia combine benign (fibroids, fibrolipomas, hydroadenomas, myxomas, hemangiomas, lymphangiomas, papillomas) and malignant tumors – vulvar cancer. They can be localized in the pubic area, labia minora and labia majora, clitoris, external opening of the urethra, posterior adhesions.
Benign neoplasms of the external genitalia have a relatively slow proliferating growth within the surrounding tissues. Malignant tumors are characterized by infiltration (penetrating germination) of surrounding tissues, rapid growth, cellular atypia, the ability to metastasize to lymph nodes and distant organs.
The etiology of vulvar neoplasms is ambiguous. Potential factors of their development can be disorders of neuroendocrine regulation, long-term hormonal contraception, STIs (HPV, chlamydia, genital herpes, etc.), colpitis, vulvitis, traumatization of the external genitalia.
Gynecology encounters benign neoplasms of the external genitalia relatively rarely. Fibroids and fibroids, hydroadenomas, lipomas and fibrolipomas, myxomas, hemangiomas, lymphangiomas occur more often in the area of the labia majora; papillomas (viral formations emanating from the integumentary epithelium) occur in the area of the vestibule of the vagina.
Fibroma (fibroadenoma) of the vulva is a formation represented by mature fibrous connective tissue structures and bundles of collagen fibrils. Fibroids have a wide base or leg, are not soldered to the surrounding tissues. The consistency of the tumor is determined by the location of the collagen bundles and the degree of hyalinization of the neoplasm. More often, the fibroma is located in the thickness of the labia majora, less often in the area of the vestibule of the vagina; it increases in size slowly.
The structure of the vulvar fibroids is represented by muscle fibers. The types of fibroids include leiomyoma, formed by smooth muscle fibers, and rhabdomyoma, consisting of striated fibers. Fibroids are localized in the thickness of the muscles of the labia majora, characterized by a dense elastic consistency, mobility, and incoherent with surrounding tissues.
Fibromyoma of the vulva combines fibroid and muscle type fibers, originates from the muscle elements of the round ligament, is localized in the labia majora.
Vulvar lipoma is a tumor of a fatty structure, sometimes containing components of connective tissue (fibrolipoma). It is localized on the pubis or labia majora, has a pronounced capsule, round shape, soft consistency, relative mobility.
Myxoma of the vulva is a mesenchymal tumor located in the subcutaneous layer of the labia majora or pubis. Myxoma is more often detected in older women. Macroscopically it has rounded contours, gelatinous consistency, capsule, yellowish-white color.
Vulvar hemangioma originates from the vessels of the skin and mucosa of the external genitalia. According to its structure, it can be cavernous or capillary. Hemangiomas are located on the labia, have the appearance of a red or cyanotic node rising above the mucous membrane or skin. Vascular tumors can grow quite quickly and spread to the tissues of the vagina, cervix or uterine cavity.
The lymphangioma of the vulva is formed by lymphoid tissue, has a multi-cavity structure and contains a protein effusion. The lymphangioma cavity is lined with epithelium. Macroscopically, the lymphoid tumor is represented by fine-grained juicy nodules with a bluish tinge, having a soft consistency with separate dense inclusions.
Vulvar papilloma (condyloma) is a tumor associated with HPV, formed by the integumentary epithelium of the labia majora and the vestibule of the vagina. Microscopically, the fibroepithelial structure is determined in it, sometimes with signs of pronounced acanthosis. Papillomas can have a single or multiple character, a whitish or dark brown color, a thin leg or a wide base. Externally, the vulvar papilloma looks like papillary growth in the labia with exophytic growth. Vulvar papillomas can spread to the vaginal mucosa and become malignant.
Hydroadenoma of the vulva comes from the sweat glands of the pubis or labia majora. Hydroadenomas look like multiple symmetrical nodular eruptions of oval or rounded shape, yellowish, pinkish or brownish tint. Microscopically represented by cystic cavities lined with flattened epithelium containing colloidal mass.
Among the tumor-like formations of the vulva, bartholin cyst are also found.
Small vulva neoplasms are not accompanied by clinical symptoms. As they grow, fibroid, muscle, fat, vascular tumors stretch the tissues of the pubis or labia, protrude outward, rising in the form of swelling or polypoid overgrowth. In this case, there are sensations of a foreign body in the perineum, discomfort during movements, sexual intercourse.
With traumatization of vulvar hemangiomas, contact bleeding may occur. In some cases, there is inflammation, ulceration, suppuration of neoplasms of the external genitalia. When the urethra is squeezed by a tumor, urination disorders may develop. If there is a violation of blood circulation in the tumor formation (hemorrhage, necrosis), swelling and soreness appear in the vulva area.
Recognition vulva neoplasms is performed during a direct examination by a gynecologist. To detect the spread of tumor infiltration, vaginal examination, vulvoscopy, if necessary, colposcopy, transvaginal ultrasound are performed.
In order to exclude non-specific and sexual infections, bacteriological smear examination, PCR diagnostics are carried out. To clarify the goodness of the neoplasm, tumor punctates, smears and scrapings from the edges of ulcers are examined, a histological examination of the biopsy is performed. Hydroadenoma of the vulva is differentiated with manifestations of syphilis.
Non-progressive and non-uncomfortable vulvar tumors with a confirmed benign structure can be left under observation. Surgical removal of neoplasms of the external genitalia is performed with their growth, symptomatic course, danger of malignancy, physical and aesthetic discomfort.
Tumors on the leg are subject to excision at the base. Neoplasms located in the thickness of the tissues are exfoliated from the surrounding tissues with suturing of the bed. With extreme caution, tumors located close to the urethra should be exfoliated in order to avoid injury to the urethra. In this case, a urologist may be involved in the operation.
When removing vulvar papillomas, preference is given to cryodestruction, radio wave excision, laser removal, electrocoagulation, plasma coagulation, chemical moxibustion with solcoderm. Vulvar hemangiomas can be cured surgically, by electrocoagulation, cryotherapy, sclerotherapy.
In general, undetected benign vulva neoplasms are malignant in isolated cases. After removal of neoplasms, their re-formation may often occur. After removal of vulvar papillomas, antiviral treatment is required. The course of the operation and the postoperative period may be complicated by bleeding, injury to the urethra, and the formation of hematomas.