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Literature Review of Periclitoral Cysts in the Prepubertal Population
Kayla L Nelson1, Sarah K McQuillan2, Philippa Brain2
1Obstetrics and Gynecology, University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada.
Insights
Pediatric clitoral cysts are rare but require evaluation for enlargement. Surgical resection is the primary treatment for confirmed clitoral cysts in children.
Area of Science:
- Pediatric Gynecology
- Pediatric Urology
- Dermatology
Background:
- Clitoral cysts are uncommon in pediatric patients, necessitating careful diagnostic approaches.
- Distinguishing benign from malignant clitoral masses is crucial for appropriate management.
Purpose of the Study:
- To review the evaluation of clitoral abnormalities in children.
- To discuss the development and differentiation of benign versus malignant clitoral tumors.
- To summarize reported cases of pediatric clitoral tumors.
Main Methods:
- A comprehensive literature review was performed using Medline and PubMed.
- Search terms included "clitoris" and "cyst" for English-language articles published up to February 2015.
- Reference tracing was utilized to ensure thoroughness.
Main Results:
- Fifteen cases of benign, spontaneously forming clitoral cysts were identified, with 11 presenting before puberty.
- Other reported benign lesions included angiokeratoma, hemangiopericytoma, granular cell tumor, hemangiomas, and neurofibromas.
- Malignant clitoral tumors are exceedingly rare, with documented cases of schwannomas, rhabdomyosarcomas, lymphoma, and endodermal sinus tumor.
Conclusions:
- Clitoral cysts should be considered in the differential diagnosis of clitoral enlargement in prepubertal children.
- Clinical evaluation, hormonal profiles, and imaging (ultrasound, MRI) aid in differentiating cysts from hormonal or intersex conditions.
- Surgical excision is the standard treatment for confirmed clitoral cysts.
Study Objective:
Clitoral cysts in the pediatric population are rare conditions that require careful evaluation. In this review of the literature we discuss the evaluation of clitoral abnormalities in the pediatric population, the development of clitoral cysts, and how to differentiate benign from malignant tumors. In addition, a summary of relevant cases of clitoral tumors in the literature are discussed.
Design:
Literature review.
Data Source:
A MedLine and advanced PubMed search was conducted of all English language articles published using the search terms "clitoris" and "cyst" until February 2015. Reference tracing was completed for all articles for completeness.
Main Outcome:
Literature review of clitoral cysts in the prepubertal population.
Results:
In total, we found 15 cases of benign, spontaneously forming clitoral cysts reported. Eleven of those cases document symptom onset before puberty. Reports of other benign clitoral lesions in the pediatric population include 1 angiokeratoma, 1 hemangiopericytoma, 1 granular cell tumor, 6 hemangiomas, and approximately 30 neurofibromas. Clitoral malignancies in the pediatric population are even more rare with only 3 cases of clitoral schwannomas, 2 rhabdomyosarcomas, 1 lymphoma, and 1 endodermal sinus tumor documented in the literature.
Conclusion:
Clitoral cysts must be considered as a possible cause of clitoral enlargement in the prepubertal population. Clitoral tumors are distinguished clinically from hormonal abnormalities and intersex disorders by their hormonal profile, and the presence of an underlying mass. Ultrasound and magnetic resonance imaging might be useful imaging modalities to further characterize the clitoral enlargement. When confirmed as the most likely diagnosis, surgical resection is the mainstay of treatment for clitoral cysts.
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