Giant fibroepithelial stromal polyp of vulva: a case report

Fibroepithelial stromal polyps (FESPs) are rare benign mesenchymal tumors of the vulva, usually measuring 1-2 cm and often discovered incidentally. Lesions larger than 5 cm are uncommon, and those exceeding 20 cm are extremely rare, with very few reported cases in the literature.

We report the case of a 24-year-old female who presented with a gradually enlarging vulvar mass over 4 years. Initially small, the lesion eventually grew to approximately 20 × 15 cm, causing difficulty in walking and mild discomfort. On physical examination, a large, pedunculated mass was noted arising from the right lateral vulvar wall, extending postero-inferiorly into the gluteal cleft and medial aspects of both thighs. Preoperative pelvic Magnetic Resonance Imaging (MRI) revealed a well-defined, homogeneously enhancing mass measuring 13 × 12.5 × 14.8 cm, suggestive of a giant fibroepithelial stromal polyp. The mass was surgically excised, and histopathological examination confirmed the diagnosis of fibroepithelial stromal polyp.

Giant vulvar fibroepithelial stromal polyps are exceptionally rare, particularly those measuring more than 20 cm. These lesions can present with significant morbidity due to their size and location, posing both diagnostic and therapeutic challenges. This case highlights the importance of considering FESP in the differential diagnosis of large vulvar masses and the role of imaging and histology in accurate diagnosis and management.

Early identification and surgical excision of large fibroepithelial stromal polyps are crucial to prevent complications and improve patient quality of life. This case adds valuable insight into this rare clinical entity.