Giant vulvar inclusion cyst in a 50-year-old female: a case report

Epidermal inclusion cysts (EICs) of the vulva are common benign lesions that are usually small and asymptomatic. However, giant vulvar EICs are extremely rare, particularly in women presenting after menopause, where vulvar malignancy must always be excluded. In countries with a high prevalence of female genital mutilation (FGM), vulvar EICs may occur secondary to chronic vulvar trauma.

We report the case of a 50-year-old married multiparous woman (para 3) with a 16-year history of progressive right vulvar swelling that became painful during the preceding 2 months after menopause. The swelling had spontaneously ruptured three times previously with discharge of whitish keratinous material before recurring again. Examination revealed a large right-sided lower vulvar cystic mass measuring approximately 15 × 11 cm, with smooth overlying skin and no inguinal lymphadenopathy. Ultrasound demonstrated a well-circumscribed avascular hypoechoic subcutaneous lesion measuring 16 × 12 cm. The patient underwent complete surgical excision under spinal anaesthesia in the lithotomy position through a longitudinal vulvar incision. Histopathological examination confirmed a fibrous-walled EIC lined by keratinized stratified squamous epithelium and filled with lamellate keratin debris without evidence of malignancy. The postoperative course was uneventful, and no recurrence was observed during 6 months of follow-up.

Giant vulvar EICs are uncommon and may clinically mimic vulvar malignancy or other benign vulvar tumors. Careful clinical examination, imaging, complete surgical excision, and histopathological assessment are essential for definitive diagnosis and exclusion of malignancy.

This case highlights the importance of considering EICs in the differential diagnosis of giant vulvar masses in women presenting after menopause. Complete surgical excision remains the definitive diagnostic and therapeutic approach.