Vulvar endometriosis

A 30-year-old woman presented with cyclical vulvar pain and swelling that had persisted for nine months. \nFour years previously she had undergone laparotomy with excision of a left ovarian endometrioma and exploration of the right groin for suspected inguinal hernia. Postoperatively, she had a six-month course of gonadotrophin-releasing hormone agonist (GnRHa) therapy and had been taking combined oral contraceptives since then. She was found to have a 4 X 3 X 1 cm tender mass with bluish discoloration over the right mons pubis (Figure). Biopsy of the mass showed evidence of old hemorrhage. After three months of GnRHa administration, the mass had reduced to 2 X 1 X 1 cm. The mass was excised and \nhistological examination confirmed endometriosis. Vulvar endometriosis has been reported at or near the site of surgical scars,1,2 likely due to the implantation of endometrial tissue during previous surgery, as illustrated in this case. Consent to publish this image was obtained from the patient.