Case-control Study of Breast Cancer and Dietary Fat Intake in Saudi Females

Breast cancer is the most common cancer worldwide and is the leading type of cancer among women. The breast cancer burden predictably will continue to increase in the coming years; there could be a nearly 50% increase in global incidence and mortality between the years 2002 and 2020 because of demographic changes alone. The etiology of breast cancer is multifactorial; however, the exact cause of breast cancer is still unclear because the disease presumably represents a complex interplay of genetic susceptibility and environmental factors, such as dietary fat intake, hazardous effects of hormonal exposures, and long-term use of hormone replacement therapy.

, scitechnol, SciTechnol, subscription journals, International Publisher, International Publishers, Publisher of Science, Publisher of Technology, Publisher of Medicine">

Journal of Womens Health, Issues and Care ISSN: 2325-9795

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.

Case Report, J Womens Health Issues Care Vol: 2 Issue: 5

Glomus Tumor in Vulva with Uncertain Malignant Potential

Smita Mahapatra1*, Asaranti Kar2, Tushar Kar3 and Upasana Das2
1Department of Transfusion Medicine, SCB Medical College, Cuttack, Orissa, India
2Department of Pathology, SCB Medical College, Cuttack, Orissa, India
3Department of Obstetrics and Gynaecology, SCB Medical College, Cuttack, Orissa, India
Corresponding author : Dr. Smita Mahapatra
Department of Transfusion Medicine, S.C.B. Medical College, N-1/256, IRC Village, Nayapalli, Cuttack-753007, Orissa, India
Tel: 91-9437094138
E-mail: [email protected]
Received: February 28, 2013 Accepted: September 06, 2013 Published: September 11, 2013
Citation: Mahapatra S, Kar A, Das U, Kar T (2013) Glomus Tumor in Vulva with Uncertain Malignant Potential. J Womens Health, Issues Care 2:5. doi:10.4172/2325-9795.1000120

Abstract

Glomus Tumor in Vulva with Uncertain Malignant Potential

Glomus tumors of female genital tract are rare. Herein we report a case of glomus tumor in the vulva in a 39 years female presenting with a 4 cm painful vulvar growth. The mass was totally excised. The histopathological diagnosis was supported with immunohistochemistry and considering the size of the tumor more than 2 cm, the final diagnosis of glomus tumor with uncertain malignant potential was made. After the excision, the patient had no recurrence, on follow up. To the best of our knowledge only very few cases of glomus tumor with uncertain malignant potential have been described in vulva till date.

Keywords: Glomus tumor; Vulva

Case-control Study of Breast Cancer and Dietary Fat Intake in Saudi Females

Breast cancer is the most common cancer worldwide and is the leading type of cancer among women. The breast cancer burden predictably will continue to increase in the coming years; there could be a nearly 50% increase in global incidence and mortality between the years 2002 and 2020 because of demographic changes alone. The etiology of breast cancer is multifactorial; however, the exact cause of breast cancer is still unclear because the disease presumably represents a complex interplay of genetic susceptibility and environmental factors, such as dietary fat intake, hazardous effects of hormonal exposures, and long-term use of hormone replacement therapy.

Keywords

Glomus tumor; Vulva

Introduction

Glomus tumor is an unusual, benign soft tissue tumor arising from neuromuscular cells of the glomus apparatus which function as temperature regulation via arteriovenous shunting of blood. It is found in deep dermis of the extremities [1]. They can occur anywhere in the body and are occasionally found in gastrointestinal, respiratory and female genital tracts. In the female reproductive tract, glomus tumor has been described in the external genitalia [2,3], vagina [4,5], uterine cervix [6] and myometrium [7]. We are presenting this a case as of glomus tumor in vulva with uncertain malignant potential which is extremely rare.

Case Report

A 39 year female presented with a painful swelling in vulva for the last six months. The swelling was 4 cms in diameter, firm, with overlying skin being normal. The swelling was clinically diagnosed as bartholin’s cyst. In pervaginal (PV) examination, there was no abnormal discharge/bleeding, no history of amenorrhea, cervix was parous and fornices were free. Introitus was normal and no abnormality was detected in vagina. Her hematological parameters were within normal limit. The mass was completely excised and was submitted for histopathological examination.
Grossly, it was smooth, well circumscribed and of 3×2×1 cm3 size. Cut-section was grayish white with solid to mucoid areas (Figure 1). Microscopic examination revealed tumor cells arranged in sheets in a hyalinized mixed stroma (Figure 2). The monotonous round cells had indistinct cell borders, pale eosinophilic cytoplasm, round central nuclei (Figure 3). The cells were arranged around the blood vessels at the periphery of the tumor (Figure 4). There was no cellular atypia or mitosis. It was histopathologically diagnosed as glomus tumor in vulva. Again for further confirmation, immunohistochemistry (IHC) was performed. The tumor showed positivity for smooth muscle actin (+++) (Figure 5) but it was negative for cytokeratin. Thus, diagnosis was confirmed as glomus tumor in vulva. Considering the size of the tumor more than 2 cm, the final diagnosis of glomus tumor with uncertain malignant potential was given. On follow up for duration of 12 months, the patient had responded to the treatment, there was no further recurrence of the tumor and she was symptom free.
Figure 1: Gross measuring 3×2×1 cm, cut section showing grayish solid to mucoid areas.
Figure 2: Tumor cells are arranged in sheets surrounding blood vessels in a hyalinized mixed stroma (H&E, X400).
Figure 3: Monotonous tumor cells with central nuclei and pale eosinophilic cytoplasm (H&E, X400).
Figure 4: Tumor cells arranged around blood vessels have centrally located nuclei with pale cytoplasm (H&E X 400).
Figure 5: Immunostaining positive for smooth muscle actin (IHC).

Discussion

Glomus tumor was initially described by Masson in 1924 typically involving the skin of the hand and especially the subungual region of the finger [8]. This tumor is a small benign neoplasm derived from the specialized cell of the glomus body, intimately associated with and surrounding arteriovenous anastomosis. The most important site is the subungual region, deep dermis and subcutis of upper and lower extremities, where arteriovenous anastomoses are numerous. Glomus tumor arising from female genital tract is rare. In vulva less than 10 cases have been reported in English literatures mostly as isolated case reports [9,10]. These tumors arise in females in 27-53 years age group with size being 1.0 cm or smaller. The patient with vaginal tumor of 5 cm size is present with vaginal bleeding [4]. The vulvar and clitoral lesions are painful, but other glomus tumors are incidentally detected during hysterectomy.
Glomus tumor is typically composed of 3 components: glomus cells, vasculature and smooth muscle cells. Again, they can be subcategorized as solid glomus tumor with poor vasculature and scanty smooth muscle component, glomangioma with prominent vascular component and glomangiomyoma with prominent vascular and smooth muscle component. Out of this solid tumor is the commonest (75%) followed by glomangioma and glomangiomyoma (5%) [11].
The causes of subcutaneous nodule like nodular hidradenoma, hemangiopericytoma, intradermal nevus and melanoma can be a differential diagnosis of glomus tumor. Both glomus tumor and nodular hidradenoma may show uniform aggregates of epitheliod cells in a myxoid stroma with variable number of blood vessels. But, in glomus tumor the tumor cells are arranged around the blood vessels at the periphery of the tumor as seen in our case lacking ductular differentiation and epithelial mucin production [11]. Hidradenoma immunohistochemically stain for cytokeratin, carcinoembryonic antigen and epithelial membrane antigen, while glomus tumor is negative for these. In our case, the tumor was negative for cytokeratin. In haemangiopericytoma, there is presence of mixture of spindled and epithelioid cells, staghorn vessels and indistinct cell borders which are negative for muscle specific marker actin which was positive in our case. The possibility of intradermal nevus and melanoma were excluded due to absence of proliferation of melanocytic cells.
Rarely, when glomus tumors exihibit large pleomorphic nuclei without increased cellularity and mitotic activity, they are referred as symplastic glomus tumors. The atypical changes are due to degenerative changes. Glomangiomatosis which is a rare and benign morphologic variant of glomus tumors show infiltrative growth of vessels whose walls are invested by glomus cells [12].
Majority of glomus tumors are benign which are cured by simple local excision. It is diagnosed as malignant when large in size (>2.0 cm), deep location or moderate to high nuclear grade and increased mitotic figures (>5/50 high power fields) or the presence of atypical mitotic figures. In malignancy, the metastasis exceeds 25% [12]. Glomus tumors with uncertain malignant potential are diagnosed when they exhibit any one of the following features; high mitotic activity with superficial location, large size, deep location. Thus, considering the size of the tumor more than 2 cm, our case was diagnosed as glomus tumor with uncertain malignant potential. Glomus tumor is typically immunopositive for actin, occasionally for desmin [13], thus actin and myosin immunohistochemical stains highlight benign glomus tumor than malignant counterpart, whereas opposite is true for vimentin [14].
Simple surgical excision is curative as seen in our case which was followed for 12 months and was found disease free. The previous reported case of vulvar glomus tumor of 3 cm diameter had a disease free survival for more than 10 years [15]. Though rare while dealing with painful vulvar growth, glomus tumor has to be kept in mind for the better management of the patient Local recurrence may occur after incomplete excision.

References
















Track Your Manuscript

Media Partners

Associations