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This case report describes a 40-year-old woman presenting with a painful, hemorrhagic vulvar lesion that initially mimicked a boil and was unresponsive to antibiotic therapy. Although the patient had a prior episiotomy scar, the lesion appeared distinctly away from it, yet symptoms demonstrated a clear cyclical relationship with menstruation through enlargement and bleeding during the premenstrual period. Complete surgical excision confirmed the diagnosis of vulvar endometriosis via histopathology, with no recurrence observed during one year of follow-up. This paper is centrally about endometriosis — specifically primary vulvar endometriosis occurring away from previous perineal trauma sites.
Abstract
Vulvar endometriosis is an uncommon form of extra pelvic endometriosis. It is frequently associated with previous perineal trauma or episiotomy, although lesions may occasionally occur away from sites of previous trauma. The condition may mimic other common vulvar lesions and therefore requires a high index of suspicion. A 40-year-old woman, para 1, presented with a painful vulvar swelling that was initially treated as a vulvar boil. She had undergone a full-term vaginal delivery with right mediolateral episiotomy 8 years earlier. Examination revealed a small, approximately 1–2 cm haemorrhagic cystic lesion on the right labia majora, distinctly away from the episiotomy scar. The lesion was tender and mobile, with no attachment to the underlying perineal muscles or abnormality of the overlying skin. Initial treatment with antibiotics and topical antifungal therapy did not result in improvement. On subsequent presentation around the premenstrual period, the lesion had enlarged and developed bleeding, with symptoms showing a clear cyclical relationship with menstruation. Complete surgical excision was performed under sedation and local anaesthesia. Histopathological examination confirmed vulvar endometriosis. There was no recurrence during 1 year of follow-up. Vulvar endometriosis should be considered in the differential diagnosis of a painful or recurrent vulvar lesion, particularly when symptoms show a cyclical relationship with menstruation, even when the lesion is located away from a previous episiotomy or other site of perineal trauma. Complete excision with histopathological confirmation is an effective diagnostic and therapeutic approach.
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Vulvar endometriosis away from a previous episiotomy scar mimicking a vulvar boil: a case report
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20264035Keywords:
Vulvar endometriosis, Extra pelvic endometriosis, Perineal endometriosis, Vulvar lesion, Episiotomy, Case reportAbstract
Vulvar endometriosis is an uncommon form of extra pelvic endometriosis. It is frequently associated with previous perineal trauma or episiotomy, although lesions may occasionally occur away from sites of previous trauma. The condition may mimic other common vulvar lesions and therefore requires a high index of suspicion. A 40-year-old woman, para 1, presented with a painful vulvar swelling that was initially treated as a vulvar boil. She had undergone a full-term vaginal delivery with right mediolateral episiotomy 8 years earlier. Examination revealed a small, approximately 1–2 cm haemorrhagic cystic lesion on the right labia majora, distinctly away from the episiotomy scar. The lesion was tender and mobile, with no attachment to the underlying perineal muscles or abnormality of the overlying skin. Initial treatment with antibiotics and topical antifungal therapy did not result in improvement. On subsequent presentation around the premenstrual period, the lesion had enlarged and developed bleeding, with symptoms showing a clear cyclical relationship with menstruation. Complete surgical excision was performed under sedation and local anaesthesia. Histopathological examination confirmed vulvar endometriosis. There was no recurrence during 1 year of follow-up. Vulvar endometriosis should be considered in the differential diagnosis of a painful or recurrent vulvar lesion, particularly when symptoms show a cyclical relationship with menstruation, even when the lesion is located away from a previous episiotomy or other site of perineal trauma. Complete excision with histopathological confirmation is an effective diagnostic and therapeutic approach.
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References
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Singh S, Naik M. Spontaneous vulvar endometriosis of labium minus: a case report and review of literature. J Gynecol Surg. 2020;36(6):365-7. DOI: https://doi.org/10.1089/gyn.2020.0062
Adedipe TO, Chukwujama U. Vulvar endometriosis mimicking as primary vulvodynia in a young nulliparous woman: algorithm of care following a rapid literature review. J Clin Gynecol Obstet. 2021;10(2):35-9. DOI: https://doi.org/10.14740/jcgo735
Sarpietro G, Matarazzo MG, Vecchio GM, Palermo G, Cianci A. Primary vulvar endometriosis in postmenopausal woman: a case report and review of the literature. Minerva Obstet Gynecol. 2023;75(4):387-9. DOI: https://doi.org/10.23736/S2724-606X.22.05089-8
Bennaceur S, Ouguerzi N, Laaboudi R, Kouach J. Vulvar endometriosis: a case report. Clin Obstet Gynecol Res. 2024;3(2):1-4.
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