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An Unusual Case of Large Vulvar Soft Fibroma in an Adult Patient and Review of Literature

Orhan Sahin

We present a case of large vulvar fibroma that was effectively treated with surgical excision. The present case is among the largest case reported in the literature. A 25-year-old female patient applied to our clinic with a complaint of a growing mass in external genitalia. Patient’s complaint began 10 years ago as a small papillomatous lesion in the right labia majora, which increased in size progressively reaching to present size of 20-30 cm in 2-3 years after the first symptom. The mass was prediagnosed as vulvar soft fibroma, and surgical excision was decided with the request and approval of the patient. For histopathologic evaluation of the specimen, H&E and HPV immunohistochemistry staining were applied. Under light microscopy, polypoid lesions covered with acanthotic squamous epithelium were seen in serial sections. Stroma was rich in collagen with homogenous structure and had fibroblastic proliferation in loose-lined, randomized bundles. Thick-walled and ectatic vascular proliferations were observed especially in the central part of the lesion. Chronic inflammatory cell infiltration was present in the subepithelial area. Immunohistochemically, there was no positivity for HPV Biocare / BPV1 in squamous epithelial cells. The histopathological findings were compatible with fibroepithelial polyp. The patient had no postoperative complication, and there was no residue or recurrence at the last assessment on postoperative 3rd month. In order to avoid this unwanted consequence, vulvar fibroma should be excised without delay and also histologically differentiated from other tumors originating from vulva that can be potentially malignant.