Giant fibroepithelial polyp of the vulva, a rare case report

Fibroepithelial polyps (FEPs) are benign mesenchymal skin tumors that usually occur in skin folds. FEPs clinically vary in appearance and size; typically, small papillomatous tumors grow <5 cm; however, large pedunculated forms can rarely grow >5 cm, called giant FEPs. In females during reproductive years, giant FEPs can occur in the genitals, commonly in vagina and rarely in the vulva and cervix.

The present case is of a 27-year-old sexually active nulliparous, who presented with the complaint of large, soft, single bag-like pedunculated growth from her left labium majus. It started as a tiny pedunculated growth of 0.5 cm more than five years ago and gradually enlarged to its present size, measuring 15 × 12 × 4 cm. The mass remained asymptomatic without any swelling, erosion or lymphadenopathy. The huge size and dragging sensation caused discomfort, so the patient sought for treatment. The mass was excised under local anesthesia, weighing 310 g, and pathologic examination was consistent with giant FEP. Over a long follow-up, no recurrence was noted; later patient also gave normal vaginal birth.

Even though the starting tiny size of the FEP is unnoticeable to the patient and not significant clinically. However, it is suggested that detailed clinical evaluation should be sought as soon possible to reduce the future discomfort due to slow growing nature and becoming huge in size over time. As in our case, large pedunculated FEP remained asymptomatic over years, typical nature of benign lesions. In present case excision was successful, however, It is important for clinicians to differentiate FEPs from malignancies, as early treatment can prevent complications such as ulceration.

FEPs may sometimes be misinterpreted for malignancy due to their appearance; however, clinical and pathologic expertise can help them differentiate. The treatment is very simple, and the patient should be counselled and encouraged to consider it at the earliest, so the erosion and ulceration of the tumor can be avoided. The recurrence is infrequent; however, follow-up is advised for an early intervention if it is encountered.