Benign vulvar tumor

General information

Vulvar neoplasms are a pathologic condition of uncontrolled cell division in which various types of tissue overgrow on the external genitalia. 

In modern medicine, benign tumors or tumor-like neoplasms are understood as growths, cysts, and structural malformations that:

• retain a particular histologic affinity with the underlying tissue and, at least partially, functional differentiation of cells;
• do not show a tendency to metastasize, i.e., to spread their cells by lymphogenous or hematogenous pathways, which would lead to the emergence of new foci in other areas of the body; 
• do not show invasiveness, i.e., they do not grow through adjacent tissues and organs, even by exerting mechanical pressure on them or pushing them apart as they grow (expansive growth); 
• increase in size relatively slowly, may stop growing and/or spontaneously reduce in size, although in some cases they reach gigantic size; 
• are not prone to fouling by abnormal intrinsic blood supply networks (neovascularization);
• in most cases, do not pose a direct threat to life.

It should be noted that the differential diagnostic criteria are revised periodically. Their list is refined and expanded, taking into account new scientific facts, concepts, and theories. Thus, today, experts distinguish intermediate, borderline forms of neoplasia, in which there are signs of both benignity and malignancy.

Some classic, most typical, and common benign neoplasms localized in the area of the vulva, i.e., female external genitalia (genitalia, vaginal vestibule), are discussed below. This is a rather large and heterogeneous group of diseases.

Classification

Benign vulvar tumors are divided into the following types:

• Myoma – is a formation, the structure of which is formed by muscle fibers. It is characterized by mobility and dense elastic consistency. It is localized most often in the depth of the muscles of the labia majora.
• A fibroma has matured fibers of connective tissue in its structure. It often has a pedicle or a base. It is characterized by slow growth and heterogeneous consistency.
• Vulvar papilloma (condyloma) is a consequence of the presence of the human papillomavirus in the body. It is formed from cells of connective and epithelial tissues. It often has a dark brown or whitish color, broad base or stab, and is characterized by papillary overgrowth. It is usually localized on the threshold of the vagina or the labia majora. It has a high risk of malignization.
• Lipoma is formed from fat tissue cells. It is usually round and has a pronounced capsule. It is characterized by a soft consistency and little mobility. It is usually located on the labia majora or on the pubis.
• A lymphangioma is formed by lymphoid tissue cells and is a small bumpy nodule. It has a bluish color and soft consistency.
• Vulvar hemangioma is a vascular neoplasm of reddish or bluish color. Its danger lies in the high risk of sprouting into the tissues of internal organs – vagina and uterus.

Causes

The pathogenesis of genital benign tumors of different types can differ significantly. The most likely causes include chronic infections (primarily papillomavirus, herpesvirus, and chlamydia), inflammatory processes, trauma, abrasions, and irritations, and neuroendocrine factors, including iatrogenic (long-term use of hormone-containing oral contraceptives). 

Not all aspects of the formation of benign tumors and tumor-like formations have been clarified; research in this area is ongoing, and as new reliable information is accumulated, prevention and treatment methods will be improved.

Symptoms of benign vulvar tumor

The presence or absence, severity, and nature of clinical manifestations depend mainly on the size and location of the tumor. In most cases, such neoplasia does not bring any perceptible discomfort except for psychological discomfort (although, in many cases, a woman is not even aware of the existence of an asymptomatic tumor). However, an increase in size can significantly violate the symmetry of the vulva, causing sensations of bloating, foreign body, and soreness during sexual intercourse and/or walking. Constant traumatization is fraught with bleeding, risk of secondary infection, suppuration, and formation of the abscesses; mechanical pressure of the tumor on the urethra leads to difficulties in urination.

The first stages of benign tumor growth are usually asymptomatic. At later stages, a woman may feel discomfort when moving, pain during sexual intercourse, and the sensation of a foreign body on the internal organs. In addition, any mechanical damage to the neoplasm can cause inflammation, suppuration, ulcers, and bleeding.

The most severe complications include recurrence after removal and malignization (transformation of a benign tumor into a malignant, cancerous tumor). The latter, however, is considered quite rare; still, it is better not to take risks.

Diagnosis

If a benign (presumed) vulvar tumor is identified, potential causes are investigated, and a large set of diagnostic tests are performed to establish an accurate diagnosis. Only a gynecologist can determine the presence of benign vulvar tumors. Diagnosis begins with the collection of anamnesis, followed by a standard gynecological examination. If necessary,following methods are used:

• Vulvoscopy (visual examination of the external genitalia with the help of a special device – colposcope).
• Transvaginal ultrasound.
• Vaginal examination.
• A tumor biopsy – is necessary to determine the histological structure of the tumor and differential diagnosis with malignant neoplasms.
• Swabs for culture, serologic, and genetic studies.

Treatment

Indications for removing benign vulvar tumors may include tumor growth and the risk of tissue structure changes. In other cases, systematic follow-up visits to the attending physician are prescribed. 

At the current stage of medical development, any neoplasm, even asymptomatic, is recommended to be removed. Both classical surgical (excision, excision) and high-tech minimally invasive methods are practiced, the range and capabilities of which are constantly expanding: radio wave ablation, electro- or plasma coagulation, laser surgery, and many others. Approaches such as cryodestruction, chemical cauterization, or sclerotherapy (removal of vascular angiomas) have not lost their importance.

All these treatment options are available in more than 720 hospitals worldwide (https://doctor.global/results/diseases/benign-vulvar-tumor). For example, Partial vulvectomy can be performed in 25 clinics across Turkey for an approximate price of $2.5 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/partial-vulvectomy). 

Rehabilitation

In order to quickly return to the usual life, women after surgery on the external genitalia need to follow all the recommendations of the attending physician:

• take prescribed medications by the dosage;
• practicing good perineal hygiene;
• do not wear synthetic or tight underwear;
• eliminate physical activity;
• no heavy lifting.

If a wound opens, there are signs of inflammation, or you experience pronounced discomfort during the rehabilitation period, you should definitely see a gynecologist. The schedule of routine examinations depends on the initial diagnosis.