Aggressive angiomyxoma (AAM) is a rare, slow-growing, locally infiltrative mesenchymal tumor of the pelvis and perineum, most often affecting women. Its nonspecific presentation and tendency to mimic more common vaginal or periurethral masses frequently delay diagnosis. Early recognition is critical to guide appropriate surgical planning, optimize resection, and reduce recurrence risk. In this case, a 61-year-old woman with prior vaginal hysterectomy presented with symptoms of pelvic organ prolapse, urinary incontinence, and occasional bleeding. Examination revealed a 10 × 3-cm protruding anterior vaginal wall mass with a spongy texture. MRI demonstrated a well-defined tubular lesion in the left distal vaginal wall extending towards the vulva. Intraoperative evaluation, including cystourethroscopy, diagnostic laparoscopy, and general surgery consultation, ruled out bowel involvement. The mass was excised via vaginal approach with preservation of surrounding structures. Histopathology confirmed AAM. Margins could not be assessed due to specimen disruption. At 6-week follow-up, the patient was asymptomatic with well-healed incisions, and ongoing surveillance with gynecologic oncology was arranged. This case highlights the importance of including AAM in the differential diagnosis of anterior vaginal wall masses. Multidisciplinary collaboration and advanced imaging are essential for accurate diagnosis and surgical planning. Given the tumor's locally infiltrative nature and high recurrence rate, long-term follow-up is warranted. Awareness of this rare pathology can aid timely recognition and improve patient outcomes.

Background/Objectives: Human papillomavirus (HPV) infection is the principal etiological factor in cervical cancer and its precursor lesions. Although vulvar condyloma is typically associated with low-risk HPV types, high-risk HPV genotypes may coexist. This study evaluated the association between vulvar condyloma, cervical cytological abnormalities, high-risk HPV positivity, and cervical histopathological outcomes. Methods: This retrospective observational study included 407 women evaluated at the Department of Obstetrics and Gynecology, Izmir City Hospital, between January 2025 and January 2026. Patients underwent cervical cytology, HPV testing, vulvar examination, and colposcopic biopsy when clinically indicated. Patients were categorized according to the presence or absence of histopathologically confirmed vulvar condyloma. Logistic regression analyses were performed to identify factors associated with vulvar condyloma. Results: Vulvar condyloma was identified in 180 patients (44.2%). Abnormal cervical cytology was recorded in 66/180 patients (36.7%) with vulvar condyloma and 41/227 patients (18.1%) without condyloma (p < 0.001). High-risk HPV positivity was observed in 104/180 (57.8%) and 86/227 (37.9%) patients, respectively (p < 0.001). In multivariate analysis, adjusted ORs were 2.30 for HPV16 positivity (95% CI 1.36-3.89, p = 0.002), 3.29 for HPV18 positivity (95% CI 1.40-7.73, p = 0.006), and 2.01 for abnormal cervical cytology (95% CI 1.24-3.25, p = 0.005). Recorded CIN2+ was 15/180 (8.3%) in the condyloma-positive group and 7/227 (3.1%) in the condyloma-negative group in the overall cohort; in the biopsy-restricted analysis, CIN2+ was 15/82 (18.3%) and 7/41 (17.1%), respectively. Conclusions: Vulvar condyloma was independently associated with abnormal cervical cytology and high-risk HPV infection, particularly HPV16/18 positivity. These robust associations suggest that vulvar condyloma may represent a clinically visible marker of concurrent cervical HPV-related disease. Careful cervical evaluation is warranted in women presenting with vulvar condyloma, whereas CIN2+ findings should be interpreted cautiously until confirmed in larger prospective cohorts with standardized histopathological verification.

Persistent treatment-resistant anogenital plaques should not be repeatedly managed as chronic eczema without histopathological confirmation. Early biopsy of atypical or non-resolving lesions facilitates timely diagnosis of Bowen disease, prevents prolonged diagnostic delay, and enables treatment before progression to invasive squamous cell carcinoma.

A 7-year-old female spayed Labrador retriever was presented for a 3-year history of progressive hemorrhage from the vulva. The dog previously underwent cystourethroscopy and vaginoscopy 1 year prior, and a small, raised hemorrhagic lesion was identified in the caudal vaginal wall. Following pinch biopsies of the lesion, bleeding ceased during the remainder of the procedure but recommenced within a week following discharge from the hospital. Histopathology of the vaginal biopsy revealed chronic neutrophilic and lymphoplasmacytic vaginitis. One year later, the dog was reevaluated for persistent and progressive bleeding from the vulva. At that time, dual phase abdominal computed tomography identified a focal, 0.5 cm x 1.0 cm region of asymmetric contrast enhancement within the vaginal wall. Cystourethroscopy and vaginoscopy identified a progressively enlarged bleeding polypoid mass lesion in the caudodorsal vaginal wall. Biopsy of the lesion followed by monopolar electrocautery ablation of the proliferative tissue was performed. Histopathology revealed hemorrhage lined by a layer of stratified squamous epithelium and neutrophilic exocytosis with no neoplastic cells identified. The underlying etiology of the lesion was not definitively determined. Vulvovaginal bleeding resolved following the procedure and remains resolved at the time of writing 7 months later. This case report describes successful endoscopic-guided electrocautery ablation of a vaginal hemorrhagic lesion in a dog.

Condyloma acuminata is an uncommon epithelial proliferative and infiltrative growth associated with human papillomavirus (HPV) subtypes 6 and 11. Giant condyloma acuminata is a more aggressive variant characterised by extensive growth, anatomical disfigurement, psychosocial morbidity and a high recurrence rate. Extragenital involvement in an immunocompetent individual is uncommonly reported in the literature. We report a case of an immunocompetent young woman who developed a rapidly progressive verrucous growth involving the vulva, lower vagina, perianal region and also extragenital sites (inframammary fold and axilla). Pelvic MRI demonstrated a large exophytic lesion without underlying stromal involvement. Complete surgical excision with histopathological confirmation demonstrated condyloma acuminata with low-risk HPV type 11. Early recurrence occurred within 3 months, which was managed by topical medication. This case highlights the importance of clinical examination, the role of MRI followed by surgical excision with long-term follow-up even in immunocompetent patients.

A 50-year-old multiparous woman presented with a giant, deforming, and symptomatic 11 × 7 × 4 cm vulvar varicoid mass progressing since 2015, completely involving the left labium majus, left labium minus, clitoris, and extending into the left mid-vagina (Fig. 1A). Despite a prior vaginal hysterectomy in December 2023 and a subsequent left ovarian vein coil embolization in May 2024 to address pelvic venous congestion, the mass expanded. Preoperative MRI venogram and laparoscopic exploration confirmed persistent, tortuous pelvic venous collateral pathways and irregular coil configurations from the prior failed embolization. To manage this refractory mass, the patient underwent pelvic exploration with the placement of a laparoscopic titanium metal clip on the left internal iliac artery, immediately distal to its posterior branches and just proximal to the origin of the uterine branch (Fig. 1B). Within five minutes of clip application, a dramatic 70% reduction in the total volume and turgor of the giant mass was observed (Fig. 1C). Exploiting this immediate decompression, a complete surgical excision of the collapsed varicoid tissue was successfully performed with minimal intraoperative blood loss, and the vulvar defect was closed via primary repair (Fig. 2A, 2B). While vulvar varicosities are typically managed via conventional venous-directed modalities [1,2], refractory giant lesions [3] present a significant surgical challenge due to severe intraoperative bleeding risks. Although internal iliac artery ligation or clipping is a well-established strategy for hemorrhage control in obstetrics and pelvic trauma [4], its application to reduce arterial inflow and venous backflow in the management of vulvar varicosities has not been previously described. This case introduces a technical innovation by demonstrating that targeted pelvic arterial inflow reduction can acutely decompress refractory venous networks, facilitating safe surgical excision and minimizing hemorrhage.

Genital herpes is a common sexually transmitted infection, yet its clinical presentation can be highly variable, particularly in immunocompetent individuals. Atypical manifestations often lead to misdiagnosis and delayed treatment. We report a case of a 59‑year‑old female who presented with a six‑month history of vulvar erythema, exudation, increased discharge, pruritus, and pain. She had been repeatedly diagnosed with vulvitis and contact dermatitis, receiving multiple courses of antibiotics, corticosteroids, and antihistamines without sustained improvement. Two vulvar biopsies revealed non‑specific dermatitis with eosinophilic infiltration, and extensive microbiological workup was negative for common pathogens. After hospitalization, localized saline cleansing helped reveal pinpoint erosions on the labia, prompting HSV‑2 DNA testing by polymerase chain reaction (PCR), which confirmed the diagnosis. Serological testing suggested a previous HSV‑2 exposure rather than a primary infection. The patient was treated with valacyclovir, resulting in complete resolution within eight days. This case underscores the importance of considering HSV infection in patients with chronic or recurrent vulvitis, especially when conventional treatments fail. In this instance, saline cleansing served as a simple bedside observation to unmask subtle lesions, though it should not be regarded as a validated diagnostic maneuver without further evidence. Early recognition and targeted antiviral therapy remain essential to prevent prolonged morbidity.

Background: Vulvar extramammary Paget disease (EMPD) is a rare intraepithelial adenocarcinoma that typically affects postmenopausal women and often mimics benign inflammatory or infectious vulvar conditions, leading to delayed diagnosis. Optimal diagnosis and therapy remain challenging due to its nonspecific presentation and variable extent of disease. Case Presentation: We report a 58-year-old Lebanese postmenopausal woman with more than one year of persistent vulvar pruritus and an erythematous lesion refractory to topical antifungal and corticosteroid therapy. Clinical evaluation revealed a 5 cm vulvar lesion without lymphadenopathy. Vulvar biopsy confirmed extramammary Paget disease, and staging work-up excluded associated malignancies. Although histology suggested non-invasive disease, the lesion was extensive with ill-defined margins and was reviewed by a multidisciplinary tumor board. A key feature of this case is the discordance between non-invasive biopsy findings and the decision to proceed with radical surgery due to concern for occult invasion. The patient underwent radical vulvectomy with left superficial and deep inguinal lymph node dissection. Final histopathology confirmed disease confined to the epidermis with negative margins and no nodal involvement (0/8). Postoperative imaging at 6 months showed no recurrence or metastasis. Conclusions: This case highlights prolonged diagnostic delay despite multiple treatments and the management challenge posed by extensive clinical disease with non-invasive biopsy findings. It underscores the importance of considering EMPD in chronic refractory vulvar lesions. Management should be individualized in multidisciplinary settings. Given the short follow-up, long-term outcomes cannot be established, and careful surveillance remains essential due to the risk of late recurrence.

Aggressive angiomyxoma is a rare mesenchymal tumor involving soft tissue of the vulvovaginal and perineal region in females of reproductive age. A 42-year-old, para-2 female presented with an elongated swelling on the left labia majora for 10 years. She presented to us because she was feeling uncomfortable while sitting. Local examination showed an elongated mass measuring 8 x 6 cm in the longitudinal direction protruding from the lower part of the left labia majora. The mass was soft, spongy, and non-tender without any involvement of adjacent structures. Sonography of the local area showed an echogenic soft-tissue mass with increased color flow, likely a lipoma of the vulva. She underwent a wide local excision of the tumor. On histopathology, it was diagnosed as an aggressive angiomyxoma of the vulva. Angiomyxoma arises from the mesenchymal tissue, and it is locally invasive with a high recurrence rate. It has to be differentiated from Bartholin cyst, lipoma, Gartner cyst, and pelvic hernia. The diagnosis can be aided by imaging modalities such as ultrasonography, magnetic resonance imaging, and computed tomography. Wide excision is the treatment of choice. Histology, along with immunohistochemistry, can confirm the lesion. Long-term follow-up is needed as recurrences are high.

Female genital tuberculosis should be considered in the differential diagnosis of postmenopausal women presenting with abnormal vaginal bleeding, even in the absence of pulmonary tuberculosis history. For confirmed vulvar and cervical lesions, biopsy with acid-fast staining and culture enables prompt diagnosis and cure, while suspected endometrial involvement requires histopathological and microbiological confirmation.