Case for Diagnosis
Cystic Vulvar Lesion
Lesión quística vulvar
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Ponce, T. Montenegro, D. Cameselle" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Ponce" "email" => array:1 [ 0 => "sauloponce90@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "T." "apellidos" => "Montenegro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "Cameselle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario Insular – Materno Infantil, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complejo HospitalarioUniversitario Insular – Materno Infantil, Las Palmas deGran Canaria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión quística vulvar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 870 "Ancho" => 1305 "Tamanyo" => 231959 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, EMA x20. B, CK7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4. C, Estrogen receptor x10. D, Progesterone receptor x20. E, CK20<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4. F, CEA x20.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 21-year-old woman with no relevant past history and who was only undergoing treatment with oral contraceptives visited our department with a vulvar lesion that had appeared 2 months earlier; the lesion had gradually grown and was causing discomfort on contact with clothing.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a pediculated papule in the transition between the clitoris and labia minora; the lesion had a maximum diameter of 0.6<span class="elsevierStyleHsp" style=""></span>cm and was brownish in color with a firm consistency (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Surgical resection of the lesion was performed by shaving of the lesion. Histopathology revealed a well demarcated cystic structure covered with a single layer of columnar cells with a ciliated surface (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immune staining was positive for epithelial membrane antigen (EMA), estrogen receptor, and cytokeratin 7 (CK7), and negative for progesterone receptor, cytokeratin 20 (CK20), and carcinoembryonic antigen (CEA) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Ciliated vulvar cyst.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient has remained asymptomatic and has presented no recurrence of the lesion after 6 months of follow-up.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Ciliated vulvar cysts (CVC) are a rarely reported entity that normally appears in young women, although it has been reported in women of all ages.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> It has been linked to pregnancy and progesterone use, and some authors consider it a variant of the ciliated cutaneous cyst.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> The etiology is unknown, although different origins have been suggested: remains of Mullerian ducts (paramesonephric origin), vestiges of the terminal portion of the Wolffian ducts (mesonephric origin), the urogenital sinus, or the sweat glands.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The most widely accepted theory, however, is Mullerian heterotopia, due to the sequestration and migration of these tissues during embryo development. This theory is based on the histologic and immunohistochemical similarities with the Mullerian epithelium, and other lesions derived from it, such as retroperitoneal Mullerian cysts or transitional cell carcinoma of the fallopian tube.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">CVC presents as a solitary lesion of variable size that typically affects the upper portion of the labia minora.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> Histopathology reveals a cystic structure demarcated by a single layer of columnar or cuboid ciliated cells. Immune staining is normally positive for EMA, ER, progesterone receptor, and CK7, and negative for S-100, CEA, CK20, and smooth-muscle actin.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,5,6</span></a> The differential diagnosis includes other vulvar cystic lesions, such as Bartholin’s cyst, papilliferum hidradenoma, cyst of Nuck, inclusion cyst, and vestibular mucinous cyst.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> The differential diagnosis with Bartholin’s cysts is of note due to their frequency. These cysts are normally found in the middle-lower portion of the labia minora and may have an acinar origin (nonciliated columnar epithelium) or ductal origin (transitional or squamous epithelium).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The treatment of choice is surgical.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> The lesions may grow and become disfiguring, especially in young girls due to the smaller size of the anatomical structures.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a> No cases of local recurrence after surgery or of malignant transformation have been reported, although follow-up is very limited in the published cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, we present a new case of CVC, a rare entity with only 20 cases described in the literature to date. We also report the 5th case with an immunohistochemical study, with findings similar to those of the other 4 previously published cases, which support the theory of paramesonephric origin due to remains of Mullerian epithelium. It is important for dermatologists and gynecologists to be aware of this entity, with emphasis on the importance of histopathology and immune staining in vulvar cystic lesions. A greater number of cases and a more extensive study of these lesions are required to determine their true etiology.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-11-29" "fechaAceptado" => "2019-02-12" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ponce S, Montenegro T, Cameselle D. Lesión quística vulvar. Actas Dermosifiliogr. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.ad.2019.02.029">https://doi.org/10.1016/j.ad.2019.02.029</span></p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 905 "Tamanyo" => 66402 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Firm pediculated papule in the upper portion of the right labium minus.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1062 "Ancho" => 855 "Tamanyo" => 160756 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin–eosin x2. B, Hematoxylin–eosin x20.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 870 "Ancho" => 1305 "Tamanyo" => 231959 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, EMA x20. B, CK7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4. C, Estrogen receptor x10. D, Progesterone receptor x20. E, CK20<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 2 | 9 |
| 2024 October | 85 | 52 | 137 |
| 2024 September | 103 | 32 | 135 |
| 2024 August | 148 | 60 | 208 |
| 2024 July | 135 | 51 | 186 |
| 2024 June | 100 | 42 | 142 |
| 2024 May | 97 | 45 | 142 |
| 2024 April | 81 | 33 | 114 |
| 2024 March | 81 | 32 | 113 |
| 2024 February | 109 | 36 | 145 |
| 2024 January | 105 | 36 | 141 |
| 2023 December | 84 | 26 | 110 |
| 2023 November | 119 | 29 | 148 |
| 2023 October | 77 | 24 | 101 |
| 2023 September | 77 | 50 | 127 |
| 2023 August | 56 | 23 | 79 |
| 2023 July | 49 | 49 | 98 |
| 2023 June | 52 | 45 | 97 |
| 2023 May | 69 | 37 | 106 |
| 2023 April | 65 | 21 | 86 |
| 2023 March | 91 | 26 | 117 |
| 2023 February | 71 | 33 | 104 |
| 2023 January | 43 | 50 | 93 |
| 2022 December | 55 | 39 | 94 |
| 2022 November | 56 | 25 | 81 |
| 2022 October | 32 | 19 | 51 |
| 2022 September | 40 | 53 | 93 |
| 2022 August | 39 | 74 | 113 |
| 2022 July | 63 | 60 | 123 |
| 2022 June | 40 | 30 | 70 |
| 2022 May | 47 | 44 | 91 |
| 2022 April | 78 | 35 | 113 |
| 2022 March | 81 | 61 | 142 |
| 2022 February | 54 | 42 | 96 |
| 2022 January | 71 | 43 | 114 |
| 2021 December | 66 | 41 | 107 |
| 2021 November | 74 | 45 | 119 |
| 2021 October | 73 | 58 | 131 |
| 2021 September | 67 | 39 | 106 |
| 2021 August | 82 | 42 | 124 |
| 2021 July | 63 | 22 | 85 |
| 2021 June | 41 | 37 | 78 |
| 2021 May | 40 | 56 | 96 |
| 2021 April | 61 | 88 | 149 |
| 2021 March | 46 | 46 | 92 |
| 2021 February | 49 | 39 | 88 |
| 2021 January | 52 | 30 | 82 |
| 2020 December | 44 | 25 | 69 |
| 2020 November | 21 | 14 | 35 |
| 2020 October | 9 | 13 | 22 |
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