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Vestibular Bulb Hypertrophy Bahar 1367 Medical Journal of Th� Sh,lahan l..j.()� l;lamic Rcpuhlic of Iran �pnng 19:-;;-; VESTIBULAR BULB HYPERTROPHY H. DABIRASHRAFI,M.H. KARIMINE1AD.Y. BEH1ATNIA, AND N. MOGHDAMI TABRIZI Fromlhe [)eI'{{r/I1l(,lll 0/( )/J.I/e[riCl alld Gynccologv, MirzaKOllchek Khan (Zanan) Hospital. Tehran University of Medical Sciences, Tehran, Islamic Republic of fran ABSTRACT In this case report, a 36 year old female at 40 weeks' gestation is presented in whom large bilateral vestibular bulb masses were found on pelvic examination. The size of the masses was such as to cause concern that they may pose an impediment to normal parturition. Our pathological findings, management and results are presented. MllRI, Vol.2, No.1, 71-73,1988 INTRODUCTION Although cysts of the vagina and vulva are seen rather frequently. only on exceptional occasions does one encounter them in pregnant women and of a sufficient size to interfere with delivery. Spitzer' reported a very interesting and unusual case in which a cyst of Gartner's duct caused a face presenta­ tion. A more common conditiOli is an abscess of the Bartholin gland.' Venereal warts (condylomata) may reach a large size in pregnancy. but seldom to the extent of causing an obstruction.' We report a case of vestibu­ lar bulb tumors that raised concern in that they may obstruct delivery. Downloaded from mjiri.iums.ac.ir at 23:57 IRST on Thursday September 30th 2021 CASE REPORT t A36 year old white woman. G = 7. P = 6. Ah = ()was admitted to the hospital in active true lahor at 4() weeks of gestation. Her past history was unremarkable. Vaginal examination and a glance at the vestibular area revealed two large tumoral cystic masses,on either side of the introitus. These two tumors hecame enlarged during bearinu down. closing the entrance of the �aginal c;�nal., anZl they decreased in size after cessaton of uterine contrac· tion. The tumors were located bilaterally near the labIa minora in the vestibular alt:d at the beginn[ng of the lateral walls of the vagina. The d1mcnsIOns of the tuInO rs were 7x4x3 cm on the rightL and 5x4x3 cm on the left (Fig, I). With due caution. delivery was performed without Figure 1. Two ovoid milSS':S hulging hibtc ralh intn tilL' ,'cstihular complication. although a major concern was that the area of the vagina. 71 Vestibular Bulb Hypertrophy Figure 2, Thick-wallcd \'cs,,:ls an: pflll11inl'nt. NoLL'tile: �all�lioll celb in the upper ri�ht corncr (H & E. ori�inall11a�nirication X'+)), ',' yT • f • ..:;,. .. �. ". .., , ,,, '. \ • • .... .. , ';� 10 'oot • l" , •• " ' I ". .. tI' " . Downloaded from mjiri.iums.ac.ir at 23:57 IRST on Thursday September 30th 2021 30th September Thursday on IRST 23:57 at mjiri.iums.ac.ir from Downloaded , .- tt . ' - . , ., , " .' l, , , . " , ..� .. ti t , ... ..., <# , .... - -, , .. , , • • II I " -.. J , -/ J 72 tumors might obstruct the delivery or he crushed by the two ovoid masses of erectile tissue. much thicker passage of the fetal head. After delivery 10 lU of po,steriorly. They are comparahle to the hulh of the oxytocin was injected intramuscularly. penis in the male and comprise of a rich plexus of veins. 7 days after delivery. when the tumors became The microscopic characteristics and hilaterality of smaller (5x3x2 cm. on the right and 4x2x2 cm. on the the tumors in our patient indicate that in reality. these left). they were removed under general anaesthesia. tumors were vestibular hulh aberrations that increased Two days postoperatively. the patient was discharged in size and changed location (Fig. I). At the time of from the hospital in good health. Since that time. the delivery, our concern was that the tumors seemed to be patient has heen examined on sever,11 occasions and has rich in hlood vessels and might be crushed. producing a no complaints. hematoma. But fortunately. delivery was completed successfully without complications. Seven days after Pathology delivery the masses hccame smaller hut still were of The hIstological sections of right and left-side speci­ ahnormal size. Excision of the tumors revealed the mens reveal a very thick-walled vascular channel lined microscopic appearance of Grectile tissLic compatible by a layer of endothelial cells. The vascular wall with vestibular hulb structures. To the authors' know­ consists of smooth muscle hundles. arranged longitudi­ ledge. this is the first report of vestibular bulh hyperh'o nally along the vascular axis. Elastic fihers surround the phy during prcgnancy that raised concern as to their muscle bundles and form thick hands in some areas. obstruction of delivery. Nerve fibers and ganglion cells are scattered through­ out. The histological features are similar to corpus spongiosum of male external genitalia (Figs. 2-3). REFERENCES I. Myerscough PRe Munro Kerr's Orerative Ohstetrics. London. DISCUSSION flallicrc Tindall. IKJ-4. I YX2. 2. Prilchard .lA. MacDonald Pc. Gant NF: Dystocia from other The vestibule may be defined as the portion of the abnormalities of thc reproductivc tract. In: Pritchard .lA. Mac­ vulva which begins at the hymenal ring and extends Donald PC, Ganl NF, eds. Williams' Obstetrics, Norwalk. Appleton-Century Crofts. (,X7-fW;. IWi.'i. outward to blend with the more keratinized skin of the .'1. Woodruff .lD. Fricdrich EG.lr: Thevestihule. ('lin Obstet Gynccol minor labia, upward to the frenulum of the clitoris. and �X (I): 134-41. 19X.'i. downward to include the posterior fourchette. On 4. Rohhov S.I. Foss .IS. Prat.l. Kch Pc. Welch WR: Urogenital SillliS either side of the vestibule there are two structures that nrigin or mucinous and ciliated cysts or Ihc vulva. Obstet Gvnecol are called "vestibular bulbs". These organs consist of 51 (.I): .'147-SI. 197f1. Downloaded from mjiri.iums.ac.ir at 23:57 IRST on Thursday September 30th 2021 73 Downloaded from mjiri.iums.ac.ir at 23:57 IRST on Thursday September 30th 2021.
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