Clitoral leiomyoma in a premenopausal woman: a case report

Abstract

Background Extrauterine leiomyomata is an uncommon lesion that can lead to several problems of differential diagnosis, especially when localized in the external genitalia. There are few reports in the English literature and a novel association with Alport’s syndrome has been investigated since the 1980s. Case presentation Here, we describe the case of a premenopausal woman who presented with an indolent swelling of the right interlabial fossa that resulted in a Bartholin cyst. In addition to this cyst, a benign leiomyoma of the right side of the clitoris was also found and removed. Our patient refused any further examination, although she was informed that genetic counselling could be organized to rule out an association with Alport’s syndrome. Conclusions Extrauterine leiomyomata localized in the external genitalia is an uncommon lesion arising from smooth muscle cells around vascular epithelium or erectile tissue. Since an association between extrauterine leiomyomata and Alport’s syndrome has been described, genetic testing can be proposed to these patients. Upper intestinal tract symptoms such as dysphagia should prompt a gastroenterological evaluation as an association with an esophageal leiomyomatosis has been described.

A rare case of benign vulvovaginal leiomyoma: Case report and literature review

“…An everted labia minora and soft consistency of the cyst suggest Bartholin's cyst, whereas an inverted labia minora and a hard consistency of the cyst suggest vulvar leiomyoma [ 8 ]. Vulval leiomyoma can also be found hidden by another pathology or present in the clitoris [ 9 , 10 ].…”

“…One case even died of a leiomyosarcoma of the vulva [ 17 ]. Therefore, it is recommended to surgically remove any vulval mass for proper histological and immunological examination [ [8] , [9] , [10] , [17] , [18] , [19] , [20] ]. This should be performed after proper ultrasonographic examination or even magnetic resonance imaging to determine preoperative soft tissue invasion [ 18 ] and to differentiate between a Bartholin gland cyst and a leiomyoma [ 7 ].…”

Alport syndrome with pelvic leiomyomatosis: The role of hormonal suppression

“…Unfortunately, this article does not describe the results of this treatment nor follow-up data. The report of Taraschi et al describes the case of a premenopausal woman presenting with a benign leiomyoma on the right side of the clitoris [14]. Unfortunately, the patient refused genetic testing to rule out Alport syndrome and GnRH analogues were not tried in this case.…”

“…Only a few trials tried to use GnRH analogues in the treatment of patients with Alport syndrome and diffuse leiomyomatosis [13,14]. The abstract of Burgos et al explains that they aimed at using GnRH analogues to shrink a tumor in the genito-pelvic region to be able to extirpate it with the highest likelihood of success [13].…”