Vestibular Papillomatosis: 8 Cases Series
M Mseddi*, S Miladi, Kh Sellami, F Frikha, E Bahloul, A Masmoudi, H Turki
Department of Dermatology, Hedi Chaker University Hospital, Sfax,
Tunisia
*Corresponding author: Madiha Mseddi, Department of Dermatology, Hedi Chaker
University Hospital, Sfax, Tunisia. Tel: +21698241548; Email:madiha.mseddi@laposte.net
Received Date: 17 March, 2017; Accepted Date: 18 April, 2017; Published Date: 25 April, 2017
Citation: Mseddi
M, Miladi S, Sellami Kh, Frikha F, Bahloul E, et al. (2017) Vestibular
Papillomatosis 8 Cases Series. Clin Exp Dermatol Ther: CEDT-118. DOI: 10.29011/2575-8268/100018
Introduction: Vestibular papillomatosis is an anatomical variant of the
vestibular mucosa that is rarely reported in the literature.
Patients and Methods: We conducted a retrospective study of 8 cases of VP diagnosed in
the department of Dermatology of Hedi Chaker University hospital of Sfax. The
study period went from June 2005 to January 2016.
Results: There are 8 women between the ages of 20 and 38 (average age
26). Seven of them were married. The unmarried patient denied any sexual
activity. Four of them were sent for suspicion of condyloma acuminatum. Two
patients were impaired by vulvar pruritus and two patients reported
dyspareunia. Three patients were pregnant (term of 16, 28 and 30 weeks of
amenorrhea). A patient (unmarried) consulted for the unsightly aspect. The
lesions were discovered fortuitously by the gynecologist (4 cases) or by the
patient herself. The examination found multiple papillomatous, pinky, filiform,
translucent lesions of the same color as the vulvar mucosa, arranged
symmetrically on the internal slopes of the labia minora and each having a base
separated from each other’s. The typical clinical appearance of the lesions and
the symmetrical character allowed us to carry the diagnosis of vestibular
papillomatosis.
Discussion: Vestibular papillomatosis is an uncommon benign condition which
was first recognized by Altmeyer in 1981.This condition is very rare so that
its incidence is difficult to estimate. It has been recorded in healthy young
women in the range of 1 to 33%. The clinical resemblance and localization of VP
has caused controversy about its etiology. VP has been reported with HPV but a
consistent association has not been proven. Its diagnosis is based solely on
clinical presentation. Five clinical parameters were suggested by
Moyal-Barranco, et al.in order to facilitate the differential diagnosis of VP
from genital warts. Dermatoscopy of VP reveals abundant and irregular vascular
channels in the transparent core of cylindrical papillae. The Histology of this
condition is characterized by finger-like protrusions of a loose connective
tissue covered by normal vulvar epithelium. Some vacuolated epithelial cells
can occur.
Conclusion: Vestibular papillae are normal anatomical variant and may
be considered as the female equivalent of pearly penile papules in men. A
correct diagnosis prevents unnecessary concern, laboratory tests and treatments.
1. Introduction
Many physiological variations could be seen in the external
female genital organs. Vestibular papillomatosis (VP) is an anatomical variant
of the vestibular mucosa that is rarely reported in the literature. Owing to
its papillomatous appearance, it had been thought to be a Human Papilloma Virus
(HPV) disease, for a long time [1]. Currently, it could be misdiagnosed as
genital warts [2]. Dermatologists as well as gynecologists must recognize this
condition to avoid unnecessary laboratory tests and treatments. We report 8
cases of VP that had been diagnosed in our department during the last decade.
2. Patients and Methods
We conducted a retrospective study of 8 cases of VP diagnosed in
the department of Dermatology of Hedi Chaker University hospital of Sfax. The
study period went from June 2005 to January 2016. Diagnosis was clinical.
Epidemiological and clinical data as well as details of sexual activity
(marital status, sexual intercourse) and gynecological and obstetric history
(number of pregnancies, live births) were recorded.
3. Results
There are 8 women between the ages of 20 and 38 (average age
26). Seven of them were married. The unmarried patient denied any sexual
activity. Four of them were sent for suspicion of condyloma acuminatum. Two
patients were impaired by vulvar pruritus and two patients reported
dyspareunia. Three patients were pregnant (term of 16, 28 and 30 weeks of
amenorrhea). A patient (unmarried) consulted for the unsightly aspect. The
lesions were discovered fortuitously by the gynecologist (4 cases) or by the
patient herself. The examination found multiple papillomatous (Figure 1),
pinky, filiform, translucent lesions of the same color as the vulvar mucosa
(Figure 2 and 3), arranged symmetrically on the internal slopes of the labia minora
and each having a base separated from each other’s. The typical clinical
appearance of the lesions and the symmetrical character allowed us to carry the
diagnosis of vestibular papillomatosis.
4. Discussion
Vestibular papillomatosis is an uncommon benign condition which
was first recognized by Altmeyer in 1981 [1]. It was first described as small
lesions with smooth projections of the vulvar mucosa and named
pseudocondylomata because of the similar appearance with condyloma acuminatum
[2]. In 1987, Campion described three types of subclinical vulvar lesions, one
of which was the vestibular papillae thought to be associated with HPV
infection. A few years later, in 1991, the report by the International Society
for the Study of Vulvar Diseases (ISSVD) described papillomatosis of the vulvar
vestibule as the presence of multiple papilthen they have been reported under a
variety of names: Hirsutoid papilloma’s of vulva, vulvar squamos
papillomatosis, micropapillomatosis labialis and squamos vestibular micropapilloma
[3]. This condition is very rare so that its incidence is difficult to
estimate. It has been recorded in healthy young women in the range of 1 to 33%.
The clinical resemblance and localization of VP has caused
controversy about its etiology. VP has been reported with HPV but a consistent
association has not been proven. Some authors suggest that vestibular
papillomatosis, though not caused by HPV infection could possess a risk of
further genital HPV infection, but no data from prospective trials substantiate
such a view. Its diagnosis is based solely on clinical presentation. Five
clinical parameters were suggested by Moyal-Barranco et al in order to
facilitate the differential diagnosis of VP from genital warts. The vestibular
papillae of 1 to 2 mm of diameter have the same color as the adjacent mucosa.
The lesions are soft and are symmetrical or may be linear [1], may cover labial
minora and the introitus vaginea to variable extent, the bases of individual
vestibular papillae projections remain separate. However condyloma acuminatum
is hard and irregular; its projections can coalesce in a common base and the
lesions are not confined to the vestibule or the inner aspects of labia minora.
In addition, application of 5% acetic acid causes whitening of the lesions in
warts whereas vestibular papillae remain unchanged.
Dermatoscopy of VP reveals abundant and irregular vascular
channels in the transparent core of cylindrical papillae.in the other hand,
dermatoscopy of warts shows multiple irregular projections with tapering
ends which are whiter and broader than vestibular papillae; haemorrhages may
also be present [2]. The Histology of this condition is characterized by
finger-like protrusions of a loose connective tissue covered by normal vulvar
epithelium. Some vacuolated epithelial cells can occur [3].
5. Conclusion
Vestibular papillae are normal anatomical variant and may be
considered as the female equivalent of pearly penile papules in men. A correct
diagnosis prevents unnecessary concern, laboratory tests and treatments.
Figure 1: Multiple vulvar papilloma of the inner side of the labia minora.
Figure 2and3:Translucent vestibular papillomatosus: pregnant woman.
Age
|
Marital status/sexual intercourse |
Circumstances of discovery |
Clinical examination |
20 |
married |
Vulvar pruritus |
Multiple papillomatous, pinky, filiform translucent lesions arranged symmetrically on the internal slopes of the labia minora |
24 |
- Pregnant (16 weeks) |
Fortuitously |
- |
26 |
- |
Dyspareunia |
- |
22 |
Unmarried (no sexual activity) |
Unsightly aspect |
- |
24 |
married |
Vulvar pruritus |
- |
28 |
- Pregnant (28 weeks) |
Fortuitously |
- |
30 |
- Pregnant (30 weeks) |
Fortuitously |
- |
38 |
- |
Dyspareunia |
- |
Table 1: Clinical presentation of the 8 cases.
- Kakkar S, Sharma PK (2017) Benign vulvar vestibular papillomatosis: An underreported condition in Indian dermatological literature. Indian Dermatol Online J 8: 63-65.
- Ozkur E, Falay T, Turgut Erdemir AV, Gurel MS, Leblebici C (2016) Vestibular papillomatosis: An important differential diagnosis of vulvar papillomas. Dermatol Online J 22: 13030.
- Diaz Gonzales JM, Martinez LE, Pena RA, Molina HA, Dominguez CJ (2013) Vestibular papillomatosis as a normal vulvar anatomical condition. Dermatol Online J 19: 20032.