(POSTER) ANGIOFIBROMA OF VULVA - THE FIRST REPORTED CASE DURING PREGNANCY

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.