==== Front Rev Bras Ginecol Obstet Rev Bras Ginecol Obstet 10.1055/s-00030576 RBGO Gynecology & Obstetrics 0100-7203 1806-9339 Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil 30352464 10.1055/s-0038-1670642 0162 Case Report Vulvar Lipoma: A Case Report Reda Ahmed 1 Gomaa Ihab 1 1 Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt Address for correspondence Ahmed Reda Department of Obstetrics and Gynecology, Ain Shams UniversityMaternity Hospital, Abasseya Square, CairoEgyptreda.ahmed@yandex.com 10 2018 1 10 2018 40 10 647649 21 5 2018 12 6 2018 https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The present study is a case report of vulvar lipoma. The vulva is a rare site for the development of lipomas, and the aim of the study is to determine if the current imaging modalities can diagnose lipomas correctly. A 43-year-old patient presented with a painless, slowly progressive, oval, mobile and non-tender right vulvar mass compressing the vagina and totally covering the introitus. Both the ultrasonography and magnetic resonance imaging (MRI) exams suggested the diagnosis of lipoma. Surgical excision was performed, and the histopathological examination of the mass confirmed a lipoma. Keywords benign tumor lipoma mesenchymal tissue soft tissue vulva vulvar lipoma ==== Body pmcIntroduction Lipoma is a common benign tumor of soft tissue, and its diagnosis is confirmed by the histopathological description of a well-circumscribed collection of mature adipose tissue.1 The etiology of lipoma is still to be elucidated, but it has been reported that trauma2 and gene rearrangement3 may play a role in its development. Typically found in subcutaneous fat, lipoma is frequently observed in the upper back, the neck, and the proximal upper and lower extremities.3 The vulva is a rare site for the development of lipomas, with few cases reported in the literature.4 5 6 7 8 9 The differential diagnosis of vulvar lipoma includes Bartholin gland cyst and abscess, inguinal hernia, as well as several benign and malignant neoplastic conditions.10 Case Description A 43–year-old woman presented to our clinic complaining of a vulvar mass that lately had been causing her discomfort during walking and sitting. The mass was painless, with an insidious onset and slowly progressive course over 4 years. The woman is a house wife, p5, with no past history of clinical importance. There was no past personal or family history of a similar condition. Upon examination, there was a single oval mass involving the whole right labia majora and covering the introitus (Fig. 1). The mass measured ∼ 15 cm in diameter, and was soft, mobile, non-tender, non-reducible, and gave no impulse on cough. The overlying skin was mobile, but stretched over this large mass. The mass was compressing the vagina, shifting it to the opposite side, but it was not fixed to the vagina. There was no palpable inguinal lymph node. Fig. 1 Vulvar swelling occupying the whole right labia majora and covering the introitus. An ultrasonographic examination showed a homogenous echo texture with no cystic changes or vascularity surrounded by an echogenic capsule with minimal vascularity. A magnetic resonance imaging (MRI) scan revealed an oval soft tissue mass with a well-defined capsule showing a homogenous high signal with suppression of a signal similar to subcutaneous fat, and showing no diffusion restriction or postcontrast enhancement (Fig. 2). Fig. 2 Magnetic resonance imaging scan showing oval soft tissue mass with well-defined capsule. The patient underwent surgical excision; an elliptical incision on the skin was performed to aid dissection and to remove redundant tissue for better cosmetic closure. The mass was easily separated from the surrounding tissue, and was removed completely from its capsule (Fig. 3). The histopathological examination revealed a collection of mature adipose tissue, confirming the diagnosis of lipoma. Fig. 3 Vulvar lipoma after surgical excision. Discussion Mesenchymal tissue, also referred to as soft tissue or connective tissue, is a derivative of the mesoderm. It comprises a variety of cell types, including fibroblasts and adipocytes. The most frequent benign mesenchymal tumor is lipoma, which is typically observed in subcutaneous fat, but may develop in almost all body organs, including the vulva, which is a rare site for lipoma development. The etiology and pathogenesis of lipomas remain undetermined. Trauma, obesity and gene rearrangement are risk factors for the development of lipomas.2 3 In the current report, we could not link lipoma to any risk factor. Similarly, previous case reports of vulvar lipoma did not find associated risk factors. Only one study7 suggested trauma might be linked to their patient, a 17-year-old Tae Kwon Do practitioner. Lipoma commonly develops between the fourth and sixth decades of life, but it can be found in all age groups. Like other lipomas, vulvar lipoma has a similar pattern, being reported in all age groups,4 5 6 7 8 9 including adolescents7 8 and infants.9 The diagnosis of lipoma is usually made through a clinical examination. It may present as a painless mass that has a slowly progressive course and is soft, mobile and not adherent to the overlying skin. In the current case, the clinical examination was suggestive of lipoma, but due to the rarity of the condition, we preferred not to rely on clinical findings alone, and decided to subject the patient to further imaging investigations. The ultrasound examination of a case report of vulvar lipoma showed that the appearance of an encapsulated homogenous echogenic mass is a diagnostic criterion for lipoma.11 An earlier study on ultrasonography of superficial lipomas revealed that the majority of the cases had homogenous echotexture and were well-defined masses.12 The MRI examination of lipomas usually shows high signal in weighted images, and serves as the best imaging modality for the assessment of soft tissue.13 In the present study, both imaging modalities were excellent in diagnosing vulvar lipoma. Lipomas can be managed conservatively, especially if they are small in size and asymptomatic, for, if they grow large, they may cause discomfort and disfigurement, and may result in psychological and social problems. Surgical excision, liposuction, laser, ultrasound and injection of pharmaceutical agents are management options for the treatment of lipomas.14 Surgical excision is the treatment of choice for lipomas, with complete removal of the capsule to prevent recurrence. In the present case, we chose surgical excision because the mass was symptomatic, and to confirm the diagnosis of lipoma, since the vulva is a rare site for the development of this tumor. Conclusion The vulva is a rare site for the development of lipomas. Ultrasonography and MRI are the preferred diagnostic modalities for lipoma. In symptomatic cases, surgical excision is the treatment of choice. Conflict of Interests The authors have none to declare. ==== Refs References 1 Morgan M B Benign mesenchymal tumors New York, NY Springer 2010 153 161 2 Coban Y K Uzel M Gumus N Lipoma due to chronic intermittent compression as an occupational disease Ann Plast Surg 2006 57 03 275 278. Doi: 10.1097/01.01.sap.0000223205.88824.3916929194 3 Bianchini L Birtwisle L Saâda E Identification of PPAP2B as a novel recurrent translocation partner gene of HMGA2 in lipomas Genes Chromosomes Cancer 2013 52 06 580 590. Doi: 10.1002/gcc.2205523508853 4 El-Agwany A S Huge vulvar lipoma and uterine fibroid: concomitant female genital mesenchymal lesions at different sites Indian J Gynecol Oncol 2017 15 19. Doi: 10.1007/s40944-017-0112-6 5 Jayi S Laadioui M El Fatemi H Vulvar lipoma: a case report J Med Case Reports 2014 8 203. Doi: 10.1186/1752-1947-8-203 6 Odoi A T Owusu-Bempah A Dassah E T Darkey D E Quayson S E Vulvar lipoma: is it so rare? Ghana Med J 2011 45 03 125 127 22282580 7 Lee J H Chung S M Large vulvar lipoma in an adolescent: a case report J Korean Med Sci 2008 23 04 744 746. Doi: 10.3346/jkms.2008.23.4.74418756071 8 Jóźwik M Kołodziejczak M Klonowska-Dziatkiewicz E Jóźwik M Giant vulvar lipoma in an adolescent girl: a case study and literature review J Pediatr Adolesc Gynecol 2014 27 05 e117 e119. Doi: 10.1016/j.jpag.2013.09.00124629715 9 Childress K J Hicks J Wu H Brandt M L Adeyemi-Fowode O A Lipoblastoma of the labia: a case report J Pediatr Adolesc Gynecol 2016 29 06 e97 e99. Doi: 10.1016/j.jpag.2016.06.00627343432 10 Heller D S Benign tumors and tumor-like lesions of the vulva Clin Obstet Gynecol 2015 58 03 526 535. Doi: 10.1097/GRF.000000000000013326125957 11 Sherer D M Gorelick C Wagreich A Sonographic findings of a large vulvar lipoma Ultrasound Obstet Gynecol 2007 30 05 786 787. Doi: 10.1002/uog.513017763338 12 Fornage B D Tassin G B Sonographic appearances of superficial soft tissue lipomas J Clin Ultrasound 1991 19 04 215 220. Doi: 10.1002/jcu.18701904051646225 13 Nagano S Yokouchi M Setoguchi T Differentiation of lipoma and atypical lipomatous tumor by a scoring system: implication of increased vascularity on pathogenesis of liposarcoma BMC Musculoskelet Disord 2015 16 36. Doi: 10.1186/s12891-015-0491-825879189 14 Boyer M Monette S Nguyen A Zipp T Aughenbaugh W D Nimunkar A J A review of techniques and procedures for lipoma treatment Clin Dermatol 2015 3 105 112. Doi: 10.11138/cderm/2015.3.4.105