BENIGN TUMORS
Benign tumors of the vulva include the fibroma, fibromyoma, lipoma, papilloma, condyloma acuminatum, urethral caruncle, hidradenoma, angioma, myxoma, neuroma, and rarely endometrioid growths.
Condylomata acuminata are a form of papilloma commonly known as venereal
warts. These are caused by several serotypes (most frequently serotypes 6 and
11; 90%) of the human papilloma virus. This DNA virus is found in 2% to 4% of
all women, and up to 60% of patients have evidence of the virus when polymerase
chain reaction techniques are used. The virus is hardy and may resist even
drying, making transmission and autoinoculation common. There is some evidence
that fomite transmission could rarely occur. The virus is most commonly spread
by skin-to-skin (generally sexual) contact and has an incubation period of 3
weeks to 8 months, with an average of 3 months. Roughly 65% of patients acquire
the infection after intercourse with an infected partner. The papillomas
usually appear as multiple, soft, pointed, warty excrescences about the labia
and perineum. When numerous, they may give rise to a confluent, cauliflower-like
growth. Histologically, they present a central stroma of congested and
infiltrated connective tissue covered by hypertrophied, stratified squamous
epithelium with deep papillary projections and a thick, superficial, cornified
zone.
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| Plate 6-16 |
Fibromas arising from the connective tissue of the vulva are usually
small to moderate in size. They tend to become pedunculated as they increase in
size and weight. Their consistency depends in part on the degree of edema due
to degeneration or deficiency of the circulation. They may originate from the
region of the round ligament or the deeper pelvic structures and present
themselves at the vulva. Occasionally, microscopic section reveals an apparent
fibroma to be a fibromyoma. Sarcomatous changes may occur, though rarely.
Lipomas of the vulva are less common than fibromas. They are softer and
have a more homogeneous consistency. They may occasionally reach large proportions.
The hidradenoma is a benign, relatively rare tumor of sweat gland origin. It
appears usually as a small nodule on the labium majus or in the interlabial
sulcus. The skin over the surface of the tumor may ulcerate and bleed, giving
rise to a grayish or red fungating tumor, sometimes mistaken for carcinoma.
Histologically, the hidradenoma or sweat gland adenoma presents an edematous,
tubular structure lined by nonciliated columnar cells with clear cytoplasm and
dark-staining nuclei. In the smaller acini, cuboidal or rounded cells may be
evident. Cystic changes and intracystic papillary proliferations are not infrequent.
Urethral caruncles are pedunculated or sessile, small to pea-sized,
bright-red growths projecting from the posterior edge of the urethral meatus.
They may be granulomatous, angiomatous, or telangiectatic. They are extremely
sensitive and often give rise to urinary frequency and
dysuria. Because of the associated vascularity, edema, and inflammatory
reaction, bleeding occurs readily. Repeated or chronic infections of the
urethra or bladder may predispose toward the development of a caruncle. It is
important to discriminate a caruncle from patulous or simple eversion of the
external urethral meatus, prolapse of the urethral mucosa, and localized
carcinoma of the urethra. Urethral prolapse occurs most commonly in elderly
women. The entire circumference of the
urethral mucosa is seen to protrude through the external meatus, similar to
that seen in prolapse of the rectal mucosa through the anus. Congestion and
edema are marked. Localized thrombosis and necrosis may occur, accompanied by
severe bleeding. A small carcinoma of the urethra may simulate or be
superimposed upon a urethral caruncle. Errors in diagnosis may be avoided by
biopsy or excision instead of
destruction by cauterization.
