Long-standing vulvar lipoma in a 65-year-old postmenopausal woman

Vulvar lipoma is a rare benign mesenchymal tumor, identified in different age groups [1–4]. The etiology of vulvar lipomas is not clearly identified, while trauma of the vulva is recorded in some cases [5]. The usual presentation of vulvar lipomas is a slowly growing single or multiple painless swelling [6, 7].
Vulvar lipomas should be differentiated from other vulvar swellings which have the same clinical presentation, especially liposarcomas [2–4].
Ultrasound is the first cost-effective diagnostic tool which can differentiate vulvar lipomas from other vulvar swellings [2]. Magnetic resonance imaging (MRI) is a useful complementary diagnostic tool in cases of vulvar lipomas to differentiate between vulvar lipomas and liposarcomas [8, 9].
This case report presents a rare case of a long-standing vulvar lipoma in a 65-year-old postmenopausal woman.
A 65-year-old Kuwaiti post-menopausal woman, para 6, presented to the gynecology clinic with a painless, slowly growing swelling of the right vulva over the last 5 years, causing heaviness and discomfort during walking. The local examination revealed a single, soft, painless, freely mobile swelling of the right vulva measuring 13 × 7.5 cm, with intact overlying skin, without any change in size on straining or coughing.
The swelling had no associated inguinal lymphadenopathy, and no extension in the vagina or towards the pubic bones. The mass was provisionally diagnosed as a vulvar lipoma by radiological evaluation.
After the ultrasound, and the MRI results, the studied woman was admitted to the hospital. After hospitalization, and control of the hypertension, and diabetes, the vulvar mass was excised completely under general anesthesia, and the excised mass was sent for histopathological examination.
The ultrasound evaluation showed non-specific swelling, with homogeneous echogenicity, formed of fat lobules separated by fibrous bands. A departmental decision was taken to confirm the provisional diagnosis using MRI before surgical excision, because vulvar lipomas are rare diseases, and for exclusion of liposarcomas. Magnetic resonance imaging evaluation showed a homogeneous, well-defined, hyper-intense lesion measuring 13 × 7.5 cm, and fat-suppressed MRI demonstrated a marked decrease in the signal intensity.
After the MRI results, the studied woman was admitted to the hospital, and after the stabilization of her hypertension and diabetes, the vulvar mass was excised...


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