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ARAÞTIRMALAR (Research Reports)
OLGU SUNUMU(Case Reports)
Effective Treatment of Vulvar Syringoma with
Topical Steroid: A Case Report
Vulvar Syringomanýn Topikal Steroid ile Etkili Tedavisi: Bir Olgu Sunumu
Abstract
Çaðdaþ Türkyýlmaz
Syringomas are common intraepidermal sweat gland tumors. Lesions may involve the upper lip, axillae, hands and feet, abdomen, however vulvar involvement is relatively rare. Most Department of Obstetrics and GynecologyErciyes University Medical Faculty of these neoplasms are asymptomatic and detected on routine gynecologic examination.
There have been various treatment modalities such as surgical excision, cryosurgery, carbondioxide laser ablation, topical atropine, corticosteroid or tretinoin applications. Because of Mahmut Tuncay Özgün
complications of invasive treatments including scar and deformity, topical corticosteroids can be employ safetly and effectively in treatment of vulvar syringoma. Therefore, in treatment of vulvar syringoma, local treatments should be used initially and invasive methots should Key words: Vulvar syringoma;topical steroids;genital itching
Tolga Atakul
M.D.
Department of Obstetrics and GynecologyErciyes University Medical Facultydrtolga@ yahoo.com Cem Batukan
Assoc. Prof., M.D.
Department of Obstetrics and GynecologyErciyes University Medical Facultycbatukan@erciyes.edu.tr Hülya Akgün
Assoc.Prof., M.D.
Department of PathologyErciyes University Medical Facultyhakgun@erciyes.edu.tr Özet
Syringoma sýk görülen intraepidermal ter bezi tümörüdür. Lezyonlar üst ekstremite, aksilla,
abdomen, el ve ayaklarda sýk görülmesine raðmen vulvar tutulum nadirdir. Bir çoðu asemptomatik
This study was presented at XI th National Gynecology and olup rutin jinekolojik muayenede tespit edilir. Cerrahi eksizyon, kryoterapi, CO2 laser ablasyon, Obstetrics Congress, 14-19 May 2008, Antalya- Turkey. topikal atropin, kortikosteroid ve tretinoin uygulamalarýný içeren tedavi modaliteleri mevcuttur.
Ýnvasiv tedavi yöntemlerinin neden olduðu skar ve deformite gibi komplikasyonlardan dolayý,topikal steroidler vulvar syringomanýn tedavisinde güvenli ve etkili bir þekilde kullanýlabilir.
Bu yüzden vulvar syringomanýn tedavisinde baþlangýçta lokal tedaviler düþünülmeli, invasiv tedavi metotlarý son seçenek olarak tavsiye edilmelidir.
Anahtar Kelimeler: Vulvar syringoma;lokal steroidler;genital kaþýntý
Corresponding Author:
Dr. Çaðdaþ Türkyýlmaz
Department of Obstetrics and Gynecology
Faculty of Medicine University of Erciyes
Kayseri, Turkey
Erciyes Týp Dergisi (Erciyes Medical Journal) 2009;Supplement 1: S41-S45 Effective Treatment of Vulvar Syringoma with Topical Steroid: A Case Report Introduction
left) In gynecologic examination, any suspicious similar Syringomas are benign tumors of eccrine sweat gland lesions or another pathologic signs were not detected.
derivation that occur frequently in women. These Transvaginal sonography revealed no pathologic findings neoplasms usually develop at puberty. Clinically, they in genital systems. No similar lesions were detected appear as multiple, tiny, firm, skin-colored papules. The elsewhere on her body. The results of laboratory tests and sites of predilection are the eyelids, malar regions, neck smear were normal. A biopsy of the vulvar lesions was and chest. Localization of syringoma to vulva is very performed after three days. Physical examination and rare. In the majority of cases with vulvar syringomas are microscopic examination revealed the typical features of asymptomatic and usually detected on routine gynecologic syringoma. There were numerous tubular structures examination (1). Therefore, the diagnosis of vulvar embedded in fibrous stroma in the papillary and reticular syringoma is often overlooked. Vulvar syringomas should dermis. Based on these findings, the patient was diagnosed be included in the differential diagnosis of any multicentric with vulvar syringoma. Immunohistochemical studies papular lesion of the vulva, vulvar pain syndrome and revealed no estrogen and progesterone receptors in the tumor cells. Following the histopathologic diagnosis,topical corticosteroid cream including 1 mg diflucortolone Several methods have been previously used to treat vulvar valerate and 10 mg isoconazole nitrate (Travocorte cream, syringomas; including excision (2), cryotherapy (3), Schering, Germany) was applied twice a daily on vulvar electrosurgery (4) and carbon dioxide laser treatment (1).
lesions for one month. Two weeks after the beginning of These invasive methods have some complications such this treatment, a remarkable improvement was observed as scarring, deformity, pigmentary changes, and delayed both objectively and subjectively in the patient's complaint.
wound healing. Regarding non-invasive treatment The papules of her left labium majus had become methods, topical atropine (5), topical tretinoin (6) and dramatically reduced and the pruritus had also rapidly topical corticosteroids (7) have been used successfully in disappeared. Four weeks after the onset of treatment, the treatment of syringomas. However, the topical vulvar lesions disappeared and genital itching was ended corticosteroids caused to recovery in the genital pruritus (Picture 1- right). Furthermore, 6Êmonths after the end and vulvar lesions quickly in our patient. Therefore, after of treatment, no signs of any recurrence were observed.
the diagnosis of vulvar syringoma with skin biopsy, non-invasive treatment modalities should be used initially.
Invasive methods should be used in intractable vulvarpruritus.
In this paper, we report a 42-year-old woman who hadsevere pruritus secondary to vulvar syringoma which wastreated with topical corticosteroids twice a daily for onemonth.
Case Report
A 42-year-old multigravid woman was admitted to our
clinic because of genital itching for two weeks. She had
experienced intermittent vulvar pruritus for 10 years.
She had been treated with different combined antifungal
and antibiotic regimens but her complaints did not respond
to these therapies. She had noted no change in her
symptoms during menstruation. She had no history of
eczema, contact hypersensitivity and systemic disease.
She had no known family history of syringomas. She had
been treated with unilateral salpingo-oopherectomy due
to benign ovarian cyst 8 years ago. Physical examination
revealed multiple soft, yellowish-to-skin-colored, 2–3
mm diameter papules on the left labia majus. (Picture 1-
Erciyes Týp Dergisi (Erciyes Medical Journal) 2009;Supplement 1: S41-S45 Çaðdaþ Türkyýlmaz, Mahmut Tuncay Özgün, Tolga Atakul, Cem Batukan, Hülya Akgün Picture 1. Yellowish papules with 2-3 mm diameter on the vulva before (left) and after (right) treatment of vulvar
syringoma with topical steroid.
Discussion
Syringomas are common intraepidermal sweat gland
With respect to histopathological features, syringoma tumors which are most often found in adolescence years must be distinguished from several conditions. Fox- in women. Frequent sites of involvement include the Fordyce disease, epidermal cysts, senile angiomas, lichen lower eyelids and malar areas. Lesions may involve the simplex chronicus and condylomata acuminata, upper lip, axillae, hands and feet, buttocks, submammary candidiasis, lichen sclerosus and atrophicus should be region, abdomen, thigh, however vulvar involvement is considered in the differential diagnosis of vulvar syringoma relatively rare (8). Most of these neoplasms are (9). Histological examination is essential in all cases of asymptomatic and detected on routine gynecologic syringoma, as this is the only way to establish a definitive examination. These lesions often present as small, multiple, diagnosis and rule out malignancy. For his reason, to bilateral, skin-colored papules over the labia majora and establish the diagnosis and to exclude malignancy, are often associated with increased vulvar discomfort and histological examination is required.
itching. In typical vulvar syringomas, the papules arebilateral and symmetrically distributed.
An ideal treatment of syringomas includes selectivedestruction with little damage to the normal tissue. But, Immunohischemical studies have detected intralesional this is not easy to do because main pathologic changes progesterone and estrogen hormone receptors in these of syringomas are abnormally proliferated multiple eccrine neoplasms. This suggests that cyclical hormonal changes glands which are located into deep dermis at various are likely responsible for periodic exacerbation of genital levels. There have been various treatment modalities such pruritus during menstrual periods or pregnancy. However, as surgical excision, cryosurgery, electrodesiccation, our patient did not to experience pruritic symptoms during carbon dioxide laser ablation, topical atropine, corticosteroid or tretinoin applications. Surgical excisioncan remove syringomas completely, but scarring or Although the macroscopic appearance of vulvar syringoma deformity such as ectropion may be devoloping after wide is not pathognomonic, its histologic appearance is very excision. Cryosurgery has also many limitations in diagnostic. The microscopic findings of syringoma include accuracy and may leave scarring or pigmentary changes.
normal epidermis and dilated cystic sweat ducts embedded Electrosurgery and carbon dioxide laser treatment can in a fibrous stroma in the dermis. Some of these dilated be performed with satisfactory results, but the lesions ducts have comma-like tails. Typically, two rows of may recur. Because of these complications, topical epithelial cells line the duct walls.
corticosteroids can be employ safetly in treatment ofvulvar syringoma. In our case, cream with topical Erciyes Týp Dergisi (Erciyes Medical Journal) 2009;Supplement 1: S41-S45 Effective Treatment of Vulvar Syringoma with Topical Steroid: A Case Report corticosteroid was applied twice a daily on vulvar lesionsfor one month. Four weeks after the onset of treatment,vulvar lesions disappeared and genital itching was ended.
In our opinion, in treatment of vulvar syringoma, localtreatments should be used initially and invasive methodsshould be considered as a last choice.
In conclusion, it is important to keep syringoma alwaysin mind during the investigation of differential diagnosisfor papular lesions of the vulva. After the diagnosis ofthe vulvar syringoma, topical corticosteroids can be usedeasily without any complication. This treatment is a safe,easy, and effective option in the therapy of vulvarsyringomas.
Erciyes Týp Dergisi (Erciyes Medical Journal) 2009;Supplement 1: S41-S45 Çaðdaþ Türkyýlmaz, Mahmut Tuncay Özgün, Tolga Atakul, Cem Batukan, Hülya Akgün References
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