Abstract:
A 33 year old pregnant mother with one living child
presented to University Gynaecology clinic of De
Soysa Hospital for Women, Colombo at 20 weeks of
period of amennorhoea complaining of a recent onset
vulval lump. On examination there was a 6x5x4 cm
lump in the upper end of the right labium majus beside
the clitoris. There was no evidence of androgenization
and the rest of the vulva appeared normal. Ultra sound
scan revealed normal pelvic structures with moderately
echogenic mass lesion with lobulated contour and
elongated hyporechoic as well as hyperechoic areas.
There was no evidence of arterio-venous fistula when
viewed with colour Doppler.
She was followed up regularly and the lump increased
in size during the course of pregnancy. She was free
of pain and it did not affect her family life. In view
of possible increase in vascularity during pregnancy,
excision biopsy of it was postponed until delivery.
She was seen 3 months post-partum and was found
to have the lump with same size and shape. Then she
underwent excision biopsy of it without damaging
the clitoris. The post operative period was uneventful
and she was happy and contended with the surgery.
Histopathology report revealed a circumscribed
tumour composed of haphazardly arranged bland,
spindle shaped cells. Immunohistochemical assays with
Desmin and smooth muscle Actin were negative and
it excluded the possibility of liomyoma and mammary
type myofibroblastoma. It stained strongly with C D 34
giving a conclusion of angiofibroma of vulva.
This is a very rare benign tumour of vulva and only
16 reported cases were found in indexed literature
(Medline, 1966-2007 search terms; Angiofibroma
vulva). This is the first reported case of angiofibroma
of vulva to appear during the course of pregnancy.
Interestingly the size of the lump increased during the
latter part of pregnancy and remained in the same size
after delivery. The possible explanation may simply be
the increased vascularity of vulva during pregnancy.
Expression of oestrogen receptors had been studied
in nasopharyngeal angiofibromas. However there
is paucity of clinical materials regarding oestrogen
receptor status in vulval angiofibromas.
