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