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Incidental Finding of Vulvar Syringoma During the Treatment of Vulvar Intraepithelial Neoplasia - a Case Report

出版	2017
URL	http://books.google.com.hk/books?id=KQK3zQEACAAJ&hl=&source=gbs_api

註釋INTRODUCTIONSyringomas are benign adnexal tumors derived from intraepidermal eccrine sweat gland ducts. They mostly appear on the periorbital area, especially at the lower eyelids and malar areas. Syringoma on the genital area is rare condition in both females and males. Vulvar syringoma has relatively rare occurrence with only few cases reported in the literature to date. We presented the case of a 57-year-old, postmenopausal woman who was diagnosed with vulvar syringoma after vulvar biopsy due to vulvar intraepithelial neoplasia.CASE REPORTA 57-year-old woman was admitted to our department due to abnormal findings of vulvar smear. Patient had been postmenopausal for 6 years. According to the patient, vulvar pruritus had appeared about a year ago, but intensified in the last 4 months. Vulvar smear was taken from indurated 2 x 3,5 cm area on left labia majora. On left labia majora therewere also barely visible confluent nodules of 5-10 mm in diameter on discrete erythematous background. Vulvar smear cytology revealed intermediate vulvar intraepithelial neoplasia and patient underwent wide excision biopsy. Histological examination showed findings consistent with vulvar intraepithelial neoplasia grade II but also revealed well-circumscribed structure consisting of small solid and ductal structures with comma-like geometric shapes lined by double layer of epithelial cells and embedded in a fibrotic stroma in the dermis. The pathological findings confirmed the diagnosis of syringoma. The patient is under regular follow-up due to vulvar intraepithelial neoplasia.DISCUSSIONGenital syringomas have been rarely reported as sporadical cases in the literature. However, due to the fact that many syringomas are asymptomatic and are unrecognized by both patient and clinician the occurence of this tumor may be greater than previously reported. Hormonal factors are considered to play role in the development of syringomas, however further researches are needed to understand the role of hormones in the development of syringomas.Vulvar syringomas are skin-colored, asymmetrically distributed, smooth-surfaced papules of 2 to 20 mm in diameter that can be single or multiple. They are mainly located on the labia majora. Clinically, patients may complain of increasing discomfort and itching of vulva, especially during warmer months or during menstruation. In the case of chronic pruritic vulvar lesions in postmenopausal women it is of utmost importance to exclude malignancy. Biopsy with microscopic examination is essential in establishing the diagnosis. The differential diagnosis for vulvar syringoma is broad. Patient surveillance may be suggested for asymptomatic cases of syringoma, while symptomatic cases can be treated with various methods. The best treatment method for syringoma is complete destruction of the tumor by surgical excision, electrodesiccation, chemical peeling, topical atropine or tretinoin therapy, cryosurgery or carbon dioxide laser surgery. Symptoms like pruritis may resolve, however tumor recurrence and scar formation following treatment are frequent.CONCLUSIONIn the case of chronic pruritic vulvar lesions in postmenopausal women it is of utmost importance to exclude malignancy. Although rare diagnosis gynecologists should be aware of vulvar syringoma and should be kept in differential diagnosis of pruritic lesions of the vulva.