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A clinicopathologic study of labia minora hypertrophy: signs of localized lymphedema were universal.
J Low Genit Tract Dis. 2014 Jan; 18(1):13-20.JL

Abstract

OBJECTIVE

To describe the clinical and pathologic features of women undergoing labioplasty for labia minora hypertrophy (LH) and to determine whether localized lymphedema plays a role in its pathogenesis.

MATERIALS AND METHODS

A retrospective case series of consecutive cases of labioplasties performed for LH was retrieved from a 10-year period. Clinical, histopathologic, and immunohistochemical features were evaluated.

RESULTS

Thirty-four labioplasty specimens from 31 women were identified. The women had a median/mean age of 36/35 years (range = 14-62 y) and had noted the presence of LH for a median/mean period of 36/86 months (range = 5-264 mo). A minority of patients had antecedent vaginal delivery (29%) and vulvar trauma (12%) and were either overweight (20%) or obese (27%). About half complained of vulvar appearance and approximately a third each had symptoms of pain, dyspareunia, or irritation. After a median/mean follow-up time of 40/44 months, 3 patients had recurrent LH (9%). The volume of excised tissue was greater for the patients with recurrent LH, than those without (mean of 9.8 vs 5.6 mL, respectively); however, no clinicopathologic finding predicted recurrence of LH. Histopathologically, all LH specimens showed diagnostic signs of chronic lymphedema, and compared with vulvar controls, LH had a significantly greater number of lymphangiectases (mean 15/mm vs 3/mm, p = .001) and showed greater mean maximal lymphatic dilation (0.12 vs 0.04 mm, p = .004), respectively. In addition, lichenification (94%), indicating chronic irritation, and sebaceous hyperplasia (60%), perisebaceous inflammation, and Demodex folliculorum infestation (3%), a constellation of findings commonly seen in phymatous rosacea, were evident.

CONCLUSIONS

Rather than an anatomic variant, LH seems to be a manifestation of chronic lymphedema, either acquired or primary with delayed onset. Because persistent lymphedema can lead to functional debilitation, recurrent skin infections, elephantiasis, and, rarely, malignancy, early excision and treatment of factors that promote lymphedema would be effective management of this rare condition.

Authors+Show Affiliations

Department of Pathology, Albany Medical College, Albany, NY.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23760147

Citation

Barrett, Mary M., and J Andrew Carlson. "A Clinicopathologic Study of Labia Minora Hypertrophy: Signs of Localized Lymphedema Were Universal." Journal of Lower Genital Tract Disease, vol. 18, no. 1, 2014, pp. 13-20.
Barrett MM, Carlson JA. A clinicopathologic study of labia minora hypertrophy: signs of localized lymphedema were universal. J Low Genit Tract Dis. 2014;18(1):13-20.
Barrett, M. M., & Carlson, J. A. (2014). A clinicopathologic study of labia minora hypertrophy: signs of localized lymphedema were universal. Journal of Lower Genital Tract Disease, 18(1), 13-20. https://doi.org/10.1097/LGT.0b013e31828d3989
Barrett MM, Carlson JA. A Clinicopathologic Study of Labia Minora Hypertrophy: Signs of Localized Lymphedema Were Universal. J Low Genit Tract Dis. 2014;18(1):13-20. PubMed PMID: 23760147.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A clinicopathologic study of labia minora hypertrophy: signs of localized lymphedema were universal. AU - Barrett,Mary M, AU - Carlson,J Andrew, PY - 2013/6/14/entrez PY - 2013/6/14/pubmed PY - 2014/8/22/medline SP - 13 EP - 20 JF - Journal of lower genital tract disease JO - J Low Genit Tract Dis VL - 18 IS - 1 N2 - OBJECTIVE: To describe the clinical and pathologic features of women undergoing labioplasty for labia minora hypertrophy (LH) and to determine whether localized lymphedema plays a role in its pathogenesis. MATERIALS AND METHODS: A retrospective case series of consecutive cases of labioplasties performed for LH was retrieved from a 10-year period. Clinical, histopathologic, and immunohistochemical features were evaluated. RESULTS: Thirty-four labioplasty specimens from 31 women were identified. The women had a median/mean age of 36/35 years (range = 14-62 y) and had noted the presence of LH for a median/mean period of 36/86 months (range = 5-264 mo). A minority of patients had antecedent vaginal delivery (29%) and vulvar trauma (12%) and were either overweight (20%) or obese (27%). About half complained of vulvar appearance and approximately a third each had symptoms of pain, dyspareunia, or irritation. After a median/mean follow-up time of 40/44 months, 3 patients had recurrent LH (9%). The volume of excised tissue was greater for the patients with recurrent LH, than those without (mean of 9.8 vs 5.6 mL, respectively); however, no clinicopathologic finding predicted recurrence of LH. Histopathologically, all LH specimens showed diagnostic signs of chronic lymphedema, and compared with vulvar controls, LH had a significantly greater number of lymphangiectases (mean 15/mm vs 3/mm, p = .001) and showed greater mean maximal lymphatic dilation (0.12 vs 0.04 mm, p = .004), respectively. In addition, lichenification (94%), indicating chronic irritation, and sebaceous hyperplasia (60%), perisebaceous inflammation, and Demodex folliculorum infestation (3%), a constellation of findings commonly seen in phymatous rosacea, were evident. CONCLUSIONS: Rather than an anatomic variant, LH seems to be a manifestation of chronic lymphedema, either acquired or primary with delayed onset. Because persistent lymphedema can lead to functional debilitation, recurrent skin infections, elephantiasis, and, rarely, malignancy, early excision and treatment of factors that promote lymphedema would be effective management of this rare condition. SN - 1526-0976 UR - https://www.unboundmedicine.com/medline/citation/23760147/A_clinicopathologic_study_of_labia_minora_hypertrophy:_signs_of_localized_lymphedema_were_universal_ L2 - http://dx.doi.org/10.1097/LGT.0b013e31828d3989 DB - PRIME DP - Unbound Medicine ER -