Department of Pathology, Albany Medical College, Albany, NY.
J Low Genit Tract Dis. 2014 Jan;18(1):13-20. doi: 10.1097/LGT.0b013e31828d3989.
To describe the clinical and pathologic features of women undergoing labioplasty for labia minora hypertrophy (LH) and to determine whether localized lymphedema plays a role in its pathogenesis.
A retrospective case series of consecutive cases of labioplasties performed for LH was retrieved from a 10-year period. Clinical, histopathologic, and immunohistochemical features were evaluated.
Thirty-four labioplasty specimens from 31 women were identified. The women had a median/mean age of 36/35 years (range = 14-62 y) and had noted the presence of LH for a median/mean period of 36/86 months (range = 5-264 mo). A minority of patients had antecedent vaginal delivery (29%) and vulvar trauma (12%) and were either overweight (20%) or obese (27%). About half complained of vulvar appearance and approximately a third each had symptoms of pain, dyspareunia, or irritation. After a median/mean follow-up time of 40/44 months, 3 patients had recurrent LH (9%). The volume of excised tissue was greater for the patients with recurrent LH, than those without (mean of 9.8 vs 5.6 mL, respectively); however, no clinicopathologic finding predicted recurrence of LH. Histopathologically, all LH specimens showed diagnostic signs of chronic lymphedema, and compared with vulvar controls, LH had a significantly greater number of lymphangiectases (mean 15/mm vs 3/mm, p = .001) and showed greater mean maximal lymphatic dilation (0.12 vs 0.04 mm, p = .004), respectively. In addition, lichenification (94%), indicating chronic irritation, and sebaceous hyperplasia (60%), perisebaceous inflammation, and Demodex folliculorum infestation (3%), a constellation of findings commonly seen in phymatous rosacea, were evident.
Rather than an anatomic variant, LH seems to be a manifestation of chronic lymphedema, either acquired or primary with delayed onset. Because persistent lymphedema can lead to functional debilitation, recurrent skin infections, elephantiasis, and, rarely, malignancy, early excision and treatment of factors that promote lymphedema would be effective management of this rare condition.
描述小阴唇肥大（LH）行小阴唇整形术患者的临床和病理特征，并确定局部淋巴水肿是否在其发病机制中起作用。
从 10 年期间检索到连续行小阴唇整形术治疗 LH 的回顾性病例系列。评估了临床、组织病理学和免疫组织化学特征。
从 31 名女性的 34 个小阴唇整形标本中确定了标本。女性的中位/平均年龄为 36/35 岁（范围= 14-62 岁），并注意到 LH 的存在中位/平均时间为 36/86 个月（范围= 5-264 个月）。少数患者有阴道分娩（29%）和外阴创伤史（12%），超重（20%）或肥胖（27%）。大约一半的患者抱怨外阴外观，大约三分之一的患者有疼痛、性交困难或刺激症状。在中位/平均随访时间为 40/44 个月后，有 3 例患者出现 LH 复发（9%）。复发 LH 的患者切除组织的体积大于未复发 LH 的患者（分别为 9.8 毫升和 5.6 毫升）；然而，没有临床病理发现可以预测 LH 的复发。组织病理学上，所有 LH 标本均显示慢性淋巴水肿的诊断性征象，与外阴对照相比，LH 的淋巴管扩张数量明显更多（平均 15/毫米和 3/毫米，p=0.001），最大淋巴管扩张程度也更大（0.12 毫米与 0.04 毫米，p=0.004）。此外，明显的有角化过度（94%），表明慢性刺激，以及皮脂增生（60%）、皮脂腺周围炎和毛囊蠕形螨感染（3%），这些都是肥大性酒渣鼻常见的表现。
LH 似乎不是一种解剖学变异，而是获得性或原发性慢性淋巴水肿的表现，其发病较晚。由于持续的淋巴水肿会导致功能障碍、反复发作的皮肤感染、象皮病，极少数情况下还会导致恶性肿瘤，因此早期切除和治疗促进淋巴水肿的因素将是治疗这种罕见疾病的有效方法。
