Postmenopausal vulvar hemangioma: diagnostic insights from a low-resource setting

Vulvar hemangiomas are rare in adults, particularly among postmenopausal women, often leading to clinical misdiagnosis. In resource-constrained settings, the lack of advanced imaging and immunohistochemistry (IHC) necessitates a heavy reliance on histopathological evaluation. This report highlights the importance of including benign vascular tumors in the differential diagnosis of adult vulvar masses to ensure accurate management.

A 62-year-old postmenopausal woman presented with a two-month history of a painless, firm, non-pulsatile mass on the left labia majora measuring 1.2 × 0.7 × 0.5 cm. Given the lesion's mobility and the absence of high-flow features or regional lymphadenopathy, an excisional biopsy was performed to achieve both diagnosis and therapy. Although the absence of preoperative imaging limited the initial assessment of vascular flow, meticulous histopathological examination revealed a well-circumscribed dermal proliferation of bland, variably sized vascular channels associated with a reactive lymphoplasmacytic infiltrate. A diagnosis of vulvar hemangioma was established via meticulous morphological assessment, successfully excluding malignancy despite the lack of IHC.

This report contributes to the limited literature on geriatric vulvar hemangiomas by demonstrating that a de novo presentation in a postmenopausal woman can be definitively managed without advanced diagnostic technology. It establishes that in low-resource settings, meticulous hematoxylin and eosin-based morphological assessment is a robust standard for excluding malignancy, thereby preventing over-treatment and ensuring cost-effectively successful surgical outcomes.