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Case Reports and Images in Obstetrics and Gynecology

 
     
Clinical Image
 
The surgical management of an exceptional vulvar tumor
Abdi Ahmed Bonahy1, Boullale Mohamed Mahmoud2, Zeinebou Habib2, Sidahmed Baba2, Sidi Mounir2, Mohamed Sidahmed3, Aissata BA Yaya4
1Head of the Obstetric Gynecology, Department of the Mother and Child Hospital center in Nouakchott, Assistant Professor at the Faculty of Medicine of Nouakchott
2Gynecologist at the Mother and Child Hospital Center in Nouakchott
3Head of Anesthesia Resuscitation, Department at the Mother and Child Hospital Center, Professor at the Faculty of Medicine of Nouakchott
4Gynecologist, Director of the Mother and Child Hospital Center in Nouakchott

Article ID: 100030Z08AB2017
doi:10.5348/Z08-2017-30-CR-10

Address correspondence to:
Dr. Abdi Ahmed Bonahy
Head of Obstetric Gynecology at the mother and child hospital center of Nouakchott-Mauritania
AHU Faculty of Medicine of Nouakchott

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How to cite this article
Bonahy AA, Mahmoud BM, Habib Z, Baba S, Mounir S, Sidahmed M, Yaya AB. The surgical management of an exceptional vulvar tumor. J Case Rep Images Obstet Gynecol 2017;3:43–46.


CASE REPORT

A 29-year-old female patient is referred for a vulvar mass, evaluating since one year which has appeared during pregnancy and is associated with depression. We find in her gynecological antecedents: a 4th gesture 4th pare, gave birth seven months ago. The examination finds a patient with good general condition. The gynecological examination showed an enormous mass of the large left lip, this mass is polylobed with umbilical areas of 37.5×20.5 cm and a broad base collar (Figure 1). The examination of the cervix and vagina is normal.

The vaginal examination showed no abnormalities. The results: AgHBS, HIV serology, syphilis, gonococcus and chlamydiae are negative. We suspected a giant condylomatous tumor that had a physical and psychological repercussion on the patient and we decided a surgical excision.

A losangic incision on the large left lip carrying all the tumor which weighed 2400 grams (Figure 2). The histological analysis of the surgical specimen confirms the benignity of a condylomatous tumor type Buschke—Löwenstein (Figure 3). Follow-up after one-month post-surgery showed good healing (Figure 4).



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Figure 1: Clinical aspect.



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Figure 2: In preoperative.



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Figure 3: Histological aspect.



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Figure 4: Check after one month.



DISCUSSION

The giant acuminate condyloma (GAG) is a rare tumor, reported clinically malignant disease, while being histologically benign [1]. The localization in women is vulgar in 90% of cases. In general, it starts on a large lip to extend to the whole of the lips, the vagina, the urethral meatus. In this case, it is a single tumor of the large lip different from the cases published by its healthy base and its weight 2.4 kg. This infection most often affects young people between the ages of 16 and 25 years [2]. The patient, in this case, is a 29-year-old. Clinically, the CAG is a more or less variable tumor of vegetating appearance, verrucous posing a diagnostic problem with CA degenerates of which only complete excision followed by an anatomo-pathological examination will confirm the certain diagnosis [4]. According to Paulstrock and Rabiil, GCA is characterized by papillomatosis. Of a well-differentiated keratinized epithelium associated with a lymphocytic infiltrate [1][2][3][4]. The diagnosis of tuberculous lymphadenitis is based on the histological examination of a large, surgical biopsy rather than a circular knife, in order not to wrongly conclude a condyloma [5]. It should be noted that pregnancy is a factor sometimes promoting and even developing AGC [6].

The patient developed this pathology during pregnancy. The evolution can be towards an extension ranging from the surface to the depth. It can be complicated by dermatitis, superinfection, or fistulization to the organs of neighborhood or squarely necrosis [6]. Without forgetting that the transmission of CAG is done mainly by sexual means and also via the water, linen, and other contaminated material [7].

The surgery remains the treatment of first intensity especially in our case where the tumor was accessible [4]. However, the excision of the tumor must be complete leaving a large margin of excision which can sometimes lead to a loss of substance that will later be repaired by a cutaneous graft is possible either in one time or in two stages to avoid the recurrences of primary tumor [4][5]. The case that we reported the surgical excision was wide and take a distance from the base of the tumor, so it was the radical treatment. The evolution was marked by a good healing without recurrence. Thus, the treatment must therefore remain surgical for the operable cases, in front of the frequency of recurrences and the possible malignant transformation [8]. Regular and prolonged monitoring is required after surgery to detect early recurrence [8]. Chemotherapies and immuno-modulatory treatments deserve better evaluation [4][5][6] [7][8].

The laser is sometimes used but has not given a great result [6]. The result of radiotherapy is controversial because it has a harmful effect on healthy tissues by making them anaplastic [4].


CONCLUSION

This study is an exceptional case of condyloma acuminate vulvar giant, The diagnosis was based on clinical and histological data. The surgical management is based on the wide excision which allows a cure.

Keywords: Buschke–Löwenstein tumor, Condylomatous tumor, Surgical management, Vaginal examination, Vulvar tumor


REFERENCES
  1. Strock P, Barrioz T, Lauroy J, et al. Aspect échoendoscopique d’un condylome acuminé géant rectal malin (tumeur de Buschke–Löwenstein). [Article in French]. Gastroenterol Clin Biol 2004;28:801–3.    Back to citation no. 1
  2. Trombetta LJ, Place RJ. Giant condyloma acuminatum of the anorectum: Trends in epidemiology and management— Report of a case and review of the literature. Dis Colon Rectum 2001 Dec;44(12):1878–86.   [CrossRef]   [Pubmed]    Back to citation no. 2
  3. Chu QD, Vezeridis MP, Libbey NP, Wanebo HJ. Giant condyloma acuminatum (Buschke–Löwenstein tumor) of the anorectal and perianal regions: Analysis of 42 cases. Dis Colon Rectum 1994 Sep;37(9):950–7.   [CrossRef]   [Pubmed]    Back to citation no. 3
  4. Rabii R, Joual A, Bellabidia B, et al. Giant scrotal condyloma acuminata: A case report. [Article in French]. Ann Urol (Paris) 2001 Jan;35(1):67–70.   [Pubmed]    Back to citation no. 4
  5. Dauendorffer JN, Cavelier-Balloy B, Bagot M, Renaud-Vilmer C. Male genital Buschke–Löwenstein tumour. [Article in French]. Ann Dermatol Venereol 2016 Nov;143(11):796–8.   [CrossRef]   [Pubmed]    Back to citation no. 5
  6. Qarro A, Ait Ali A, Choho A, Alkandry S, Borki K. Anorectal Buschke–Löwenstein tumor: Three cases report. [Article in French]. Ann Chir 2005 Feb;130(2):96–100.   [CrossRef]   [Pubmed]    Back to citation no. 6
  7. Rimtebaye K, Danki Sillong F, Zarif Agah Tashkand A, Kaboro M, Niang L, Gueye SM. Tumeur de Buschke–Löwenstein: à propos de 8 cas et revue de la littérature. [Article in French]. Afr J Urol 2016 22(4)319–24.   [CrossRef]    Back to citation no. 7
  8. Lévy A, Lebbe C. Buschke–Löwenstein tumour: Diagnosis and treatment. [Article in French]. Ann Urol (Paris) 2006 Jun;40(3):175–8.   [Pubmed]    Back to citation no. 8

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Author Contributions
Abdi Ahmed Bonahy – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Boullale Mohamed Mahmoud – Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Zeinebou Habib – Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Sidahmed Baba – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sidi Mounir – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Mohamed Sidahmed – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Aissata BA Yaya – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Abdi Ahmed Bonahy et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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