Giant Acrochordon of Labia Majora: An Uncommon Manifestation of a Common Disease
Identifieur interne : 000224 ( Pmc/Corpus ); précédent : 000223; suivant : 000225Giant Acrochordon of Labia Majora: An Uncommon Manifestation of a Common Disease
Auteurs : Shilpa Garg ; Sukriti BavejaSource :
- Journal of Cutaneous and Aesthetic Surgery [ 0974-2077 ] ; 2015.
Url:
DOI: 10.4103/0974-2077.158454
PubMed: 26157316
PubMed Central: 4477464
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Giant Acrochordon of Labia Majora: An Uncommon Manifestation of a Common Disease</title><author><name sortKey="Garg, Shilpa" sort="Garg, Shilpa" uniqKey="Garg S" first="Shilpa" last="Garg">Shilpa Garg</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Baveja, Sukriti" sort="Baveja, Sukriti" uniqKey="Baveja S" first="Sukriti" last="Baveja">Sukriti Baveja</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26157316</idno><idno type="pmc">4477464</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477464</idno><idno type="RBID">PMC:4477464</idno><idno type="doi">10.4103/0974-2077.158454</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000224</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000224</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Giant Acrochordon of Labia Majora: An Uncommon Manifestation of a Common Disease</title><author><name sortKey="Garg, Shilpa" sort="Garg, Shilpa" uniqKey="Garg S" first="Shilpa" last="Garg">Shilpa Garg</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Baveja, Sukriti" sort="Baveja, Sukriti" uniqKey="Baveja S" first="Sukriti" last="Baveja">Sukriti Baveja</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Cutaneous and Aesthetic Surgery</title><idno type="ISSN">0974-2077</idno><idno type="eISSN">0974-5157</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ahmed, S" uniqKey="Ahmed S">S Ahmed</name></author><author><name sortKey="Khan, Ak" uniqKey="Khan A">AK Khan</name></author><author><name sortKey="Hasan, M" uniqKey="Hasan M">M Hasan</name></author><author><name sortKey="Jamal, Ab" uniqKey="Jamal A">AB Jamal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dey, M" uniqKey="Dey M">M Dey</name></author><author><name sortKey="Kumar, R" uniqKey="Kumar R">R Kumar</name></author><author><name sortKey="Sriram, R" uniqKey="Sriram R">R Sriram</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Orosz, Z" uniqKey="Orosz Z">Z Orosz</name></author><author><name sortKey="Lehoczky, O" uniqKey="Lehoczky O">O Lehoczky</name></author><author><name sortKey="Szoke, J" uniqKey="Szoke J">J Szoke</name></author><author><name sortKey="Pulay, T" uniqKey="Pulay T">T Pulay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Canalizo Almeida, S" uniqKey="Canalizo Almeida S">S Canalizo-Almeida</name></author><author><name sortKey="Mercadillo Perez, P" uniqKey="Mercadillo Perez P">P Mercadillo-Pérez</name></author><author><name sortKey="Tirado Sanchez, A" uniqKey="Tirado Sanchez A">A Tirado-Sánchez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wani, Y" uniqKey="Wani Y">Y Wani</name></author><author><name sortKey="Fujioka, Y" uniqKey="Fujioka Y">Y Fujioka</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Cutan Aesthet Surg</journal-id><journal-id journal-id-type="iso-abbrev">J Cutan Aesthet Surg</journal-id><journal-id journal-id-type="publisher-id">JCAS</journal-id><journal-title-group><journal-title>Journal of Cutaneous and Aesthetic Surgery</journal-title></journal-title-group><issn pub-type="ppub">0974-2077</issn><issn pub-type="epub">0974-5157</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26157316</article-id><article-id pub-id-type="pmc">4477464</article-id><article-id pub-id-type="publisher-id">JCAS-8-119</article-id><article-id pub-id-type="doi">10.4103/0974-2077.158454</article-id><article-categories><subj-group subj-group-type="heading"><subject>Correspondence</subject></subj-group></article-categories><title-group><article-title>Giant Acrochordon of Labia Majora: An Uncommon Manifestation of a Common Disease</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Garg</surname><given-names>Shilpa</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Baveja</surname><given-names>Sukriti</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1">Department of Dermatology, Army College of Medical Sciences, Base Hospital, Delhi Cantonment, New Delhi, India E-mail:<email xlink:href="docshilpagarg@gmail.com">docshilpagarg@gmail.com</email></aff><pub-date pub-type="ppub"><season>Apr-Jun</season><year>2015</year></pub-date><volume>8</volume><issue>2</issue><fpage>119</fpage><lpage>120</lpage><permissions><copyright-statement>Copyright: © Journal of Cutaneous and Aesthetic Surgery</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions></article-meta></front><body><p>Dear Editor,</p><p>Acrochordon (fibroepithelial polyp or skin tag) is a common benign neoplasm seen predominantly in obese individuals with an average of 46% incidence in the general population.[<xref rid="ref1" ref-type="bibr">1</xref>] Measuring about 1 to 5 mm in size, they are usually located in the intertriginous areas. We report an unusual presentation of acrochordon.</p><p>A 50-year-old postmenopausal woman presented with a mass hanging from labia majora since 3 years. While cleaning her private parts she first noticed a lemon sized mass which gradually increased in size. Patient experienced discomfort while walking due to the weight and rubbing of the mass between her thighs and became apprehensive of its growing size. There was no pain, pruritus, fever, redness, ulceration, bleeding, discharge, sudden increase in size, aggravating/relieving factors or diurnal change in size.</p><p>Patient was overweight (body mass index 27.3 kg/m<sup>2</sup>). Dermatological examination revealed a single, skin-coloured, pedunculated, pear-shaped, non-tender, soft fleshy mass with wrinkled surface measuring 16 × 9 cm and arising from a thin stalk from posterior part of left labia majora [<xref ref-type="fig" rid="F1">Figure 1</xref>] and distorting its shape. There was no redness, discharge or ulceration. The mass was nonpulsatile, nonreducible, with no impulse on coughing, no palpable thrill or bruit with no regional lymphadenopathy. Systemic and genitourinary examination was normal. Blood sugar and lipid profile were normal. The mass was diagnosed as acrochordon due to its pedunculated attachment, soft consistency and free mobility.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Giant acrochordon of the left labia majora (a) preoperative (b) Immediate post-operative (c) Length of the excised acrochordon (d) and 20 days after surgery (e) Mature stratified squamous epidermis with the underlying stroma showing increase in the fibrocollagenous tissue, thick-walled blood vessels, stellate shaped fibroblast and sparse perivascular chronic mononuclear inflammatory cell infiltrate (H&E, 10×) (f)</p></caption><graphic xlink:href="JCAS-8-119-g001"></graphic></fig><p>The lesion was elliptically excised. Histopathological examination revealed mature stratified squamous epithelium, increased fibrocollagenous tissue in the stroma, thickened blood vessels, stellate fibroblast and sparse perivascular chronic mononuclear inflammatory infiltrate with no evidence of malignancy [<xref ref-type="fig" rid="F1">Figure 1</xref>].</p><p>In women, genital acrochordon is more common in the vagina than vulva and cervix[<xref rid="ref2" ref-type="bibr">2</xref>] with peak incidence at 20-40 years of age. It is rare in postmenopausal women. Large lesions may arise due to proliferation of mesenchymal cells within the hormonally sensitive subepithelial stromal layer of the lower genital tract. Acrochordons are associated with type 2 diabetes mellitus, insulin resistance, obesity, dyslipidemias, pregnancy, genetic predisposition, human papilloma virus 6 and 11, acromegaly, Gardner syndrome, Birt-Hogg-Dube syndrome and Nonne-Milroy-Meiges syndrome.[<xref rid="ref3" ref-type="bibr">3</xref>]</p><p>The vulval acrochordons reported in the literature have ranged in size from 2.3 to 30 cm.[<xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref>] Ulceration, infection and inflammation can occur in giant acrochordons of vulva. Acrochordons rarely recur if not completely excised.[<xref rid="ref3" ref-type="bibr">3</xref>]</p><p>The differential diagnosis of vulval acrochordon includes hernia, hydrocele of canal of Nuck, neurofibroma, lipoma, fibroma, bartholin's cyst, vulval varicosities, haemangiomas, angioneurofibroma, hamartoma, lymphadenoma, angiomyofibroblastoma, cellular angiofibroma, sarcomas, angiomyxoma and dermato fibro-sarcoma protuberans.</p><p>Malignancy should be excluded in every case of fibroepithelial stromal polyp. Stellate and multinucleate stromal cells present near the epithelial-stromal interface are the most characteristic feature of acrochordon. Stromal cells may be positive for desmin, actin, vimentin, oestrogen and progesterone receptors. On the other hand sarcomas have identifiable lesion margins, homogeneous cellularity and lack the stellate and multinucleate stromal cells near the epithelial-stromal interface.</p><p>We report an unusual presentation of a very common lesion presenting with large size, vulval location and appearance in postmenopausal overweight woman with no associated factors. Surgical excision with histopathological examination serves as diagnostic and therapeutic modality for such lesions.</p></body><back><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ahmed</surname><given-names>S</given-names></name><name><surname>Khan</surname><given-names>AK</given-names></name><name><surname>Hasan</surname><given-names>M</given-names></name><name><surname>Jamal</surname><given-names>AB</given-names></name></person-group><article-title>A huge acrochordon in labia majora — An unusual presentation</article-title><source>Bangladesh Med Res Counc Bull</source><year>2011</year><volume>37</volume><fpage>110</fpage><lpage>1</lpage><pub-id pub-id-type="pmid">22352232</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dey</surname><given-names>M</given-names></name><name><surname>Kumar</surname><given-names>R</given-names></name><name><surname>Sriram</surname><given-names>R</given-names></name></person-group><article-title>Giant acrochordon of vulva</article-title><source>Med Sci (Turkey)</source><year>2014</year><volume>3</volume><fpage>1299</fpage><lpage>304</lpage></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Orosz</surname><given-names>Z</given-names></name><name><surname>Lehoczky</surname><given-names>O</given-names></name><name><surname>Szoke</surname><given-names>J</given-names></name><name><surname>Pulay</surname><given-names>T</given-names></name></person-group><article-title>Recurrent giant fibroepithelial stromal polyp of the vulva associated with congenital lymphedema</article-title><source>Gynecol Oncol</source><year>2005</year><volume>98</volume><fpage>168</fpage><lpage>71</lpage><pub-id pub-id-type="pmid">15963814</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Canalizo-Almeida</surname><given-names>S</given-names></name><name><surname>Mercadillo-Pérez</surname><given-names>P</given-names></name><name><surname>Tirado-Sánchez</surname><given-names>A</given-names></name></person-group><article-title>Giant skin tags: Report of two cases</article-title><source>Dermatol Online J</source><year>2013</year><volume>13</volume><fpage>30</fpage><pub-id pub-id-type="pmid">18328224</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wani</surname><given-names>Y</given-names></name><name><surname>Fujioka</surname><given-names>Y</given-names></name></person-group><article-title>A vulvar fibroepithelial stromal polyp appearing in infancy</article-title><source>Am J Dermatopathol</source><year>2009</year><volume>31</volume><fpage>465</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">19542922</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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