Introduction:
Clitoral mass is a rare disease in gynecology OPD and difficult to
differentiate from cancer. The uncertainty with the diagnosis of the
case made it more interesting requiring lateral thinking especially when
data and literature is limited regarding clitoral mass.
Rare case reports of pyogenic granuloma (vascular malformation) of the
labia can be multiple, rapidly growing lesions may involve clitoris. It
is seen in all age groups but rare in postmenopausal women. Encountered
generally after a minor injury or trauma, the vascular lesion grows
rapidly in weeks or months and can present as an erythematous,
pedunculated, exophytic, or sessile lesion, with a smooth or lobulated
surface. 2, 12 In 63% of the patients it been seen
to be associated with systemic disorder like rheumatoid arthritis,
hematological malignancies, and inflammatory bowel disease but can be
also associated with underlying malignancy .13 It is
diagnosed by histopathology requiring excision and closure as treatment
is suggested.2, 12 Invasive and minimally invasive
treatments option include surgical excision, curettage followed by
electro cauterization, cryotherapy with liquid nitrogen, sclerotherapy,
radiosurgery, silver nitrate cautery, microembolization, lasers,
imiquimod, timolol, propranolol, prednisolone, and clobetasol.
Photodynamic therapy with 5-aminolevulinic acid has also been used for
solitary lesions.14, 15 However; due to the risk of
malignancy surgical management is advised with meticulous dissection to
avoid the neurovascular damage of the clitoris.12
Verrucous carcinoma of the vulva is a form of squamous carcinoma with
unknown etiology that can present as clitoral mass in almost 4.88% of
cases. They are characterized by slow-growing, giant size, and less
metastasis. Treatment involves extensive excision of the lesion this may
involve radical vulvectomy, lymph node followed by reconstruction for
the defect. However most of the author suggests surgery as the main
treatment option with adequate margin is important because inadequate
might lead to local recurrence. Systemic lymph node dissection might not
be recommended as routine procedure for surgical
therapy.11
Clitoral cancer is a form of vulvar cancer, is an unpleasant dreadful
malignancy and is very rare both as primary and as secondary. Secondary
carcinoma of the clitoris is extremely rare and it can originate from
urinary system cancer (bladder, kidney), followed by endometrium and
gastrointestinal system.17 Tumors of clitoris are
aggressive in clinical course causing early death. Case reports have
shown involvement of young and elderly. Diagnosis is established by
histology and immunohistochemistry and needs aggressive surgical care
with radiotherapy and chemotherapy with prognosis being very poor.
Few cases of painful neuromas have been reported after FGM or cutting in
clitoris resulting in disorganized proliferation growth of the proximal
end of traumatized nerves causing severe pain and discomfort know as
Post-traumatic Clitoral Neuroma. Treatment is excision of the neuroma
in-toto during clitoral reconstruction have shown to decrease pain and
improvement in sexual function as well.3, 18