A Clitoral mass in postmenopausal women: a diagnostic dilemma

 Authors: Swati Kanchan1, Shripad Hebbar 2,Keerthi Kyalakond3, Sai Bhavana4 ,Dr. Sneha Subodh Singh5, Dr. Nehal Machado6,Dr Radhika Agrawal7

 1,2,3,4,5,6,7 Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal

Clitoral mass is not commonly encountered in Gynecology practice and the literature is scanty.

 Aim: Awareness regarding the rare causes of clitoral mass including malignancy and granuloma with their overlapping symptoms.

Interesting happened when Mri reported suspicious for CA and Histology reported later : granulomatous Lesion

Case Report:

56 years lady presented to OPD with c/o pain and swelling

At clitoris.H/o I&D at Gp and Antibiotics : however re-appeared.

No Significant Med/Surg/STI.

No h/o trauma/ Fever/ discharge/ UTI / IBS/IBD/ Weight loss or appetite

 

 

Examination:

General Physical Examination: Normal, BMI: 28

Analgesia given

Normal Vitals

Abdomen: NAD

Local examintaion :

Suspicious looking lesion- firm to hard, palpable clitoral mass involving the clitoral hood of noted with free urethra, no abnormalities of vulva or vagina.

No associated skin lesions or enlarged lymph nodes were palpable

Blood investigation revealed normal ESR and other serological markers.

MRI : suggestive of Vulval Malignancy with FIGO stage II

 with few sub-centi-meter, ovoid bilateral inguinal lymph nodes.

Histology: tumour mass contained a fibro collagenous

 stroma with dense lymphoplasmacytic infiltrate and likely Myo fibroblastic tumour of unknown aetiology

Immuno-hist: Granulomatous lesion

Further evaluation: Neg – TB/ granulomatous conditions

DISCUSSION:

Clitoral mass can be due to Cancer, Granuloma, epidermoid cyst,

peri-clitoral abscess, fibroid and Neuromas1 and clinical presentation is overlapping making it difficult to diagnose. Clitoral cancer is a form of vulvar cancer, is an unpleasant dreadful malignancy and is very rare.

Rare case reports of pyogenic  granuloma of the labia and clitoris in postmenopausal women with similar presentation and diagnosed by histopathology requiring excision.

Similarly, neuromas of clitoris are also a known entity seen mainly after FGM.

 

 Conclusion: A Multidisciplinary approach is important to diagnose and differentiate the clitoris granuloma from that of malignancy. The clinical examination and imaging  can be misleading at times and diagnosis is only by histopathology.

Clinical Significance: Multidisciplinary team involvement and through counseling is needed. Significance of clitoris is well established as the most vital part in sexual function, there is an urgent need to focus our attention on more and more case  reports and reviews on its literature of disease related to clitoris.

 

Limitations : 1. The limited knowledge in regard to clitoral pathology makes it difficult and needs more time to make a diagnosis.

2. There were difficulties in counselling patients who are anxious about the growth being cancerous esp. with limited literature.

 

References:1. Xie H, Ansar S, Anderson L, Saidi S, Kitzing YX, Anand S. Glomangiomyoma of the clitoris: A case report and literature review. Case Reports in Women's Health. 2021 Jan 1;29:e00269. 2. Arikan DC, Kiran G, Sayar H, Kostu B, Coskun A, Kiran H. Vulvar pyogenic granuloma in a postmenopausal woman: case report and review of the literature Case Reports in Medicine. 2011;2011.