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LETTER TO EDITOR  
Year : 2023  |  Volume : 66  |  Issue : 1  |  Page : 220-222
Sebaceous gland hyperplasia in the labia minora skin: Report of two cases


1 Department of Histology and Embryology, University of Novi Sad; Centre for Pathology and Histology, University Clinica Centre of Vojvodina, Novi Sad, Serbia
2 Department of Histology and Embryology, University of Novi Sad, Novi Sad, Serbia
3 Department of Histology and Embryology, University of Novi Sad, Novi Sad; Department of Pathology and Cytology, General Hospital Vrbas, Vrbas, Serbia
4 Department of Pathology, Faculty of Medicine, University of Novi Sad; Centre for Pathology and Histology, University Clinica Centre of Vojvodina, Novi Sad, Serbia

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Date of Submission08-Sep-2021
Date of Decision19-Oct-2021
Date of Acceptance21-Oct-2021
Date of Web Publication18-Jan-2023
 

How to cite this article:
Djolai M, Popović M, Višnjić BA, Miljković D, Amidžić J, Dajko ST. Sebaceous gland hyperplasia in the labia minora skin: Report of two cases. Indian J Pathol Microbiol 2023;66:220-2

How to cite this URL:
Djolai M, Popović M, Višnjić BA, Miljković D, Amidžić J, Dajko ST. Sebaceous gland hyperplasia in the labia minora skin: Report of two cases. Indian J Pathol Microbiol [serial online] 2023 [cited 2023 Feb 8];66:220-2. Available from: https://www.ijpmonline.org/text.asp?2023/66/1/220/368000




Dear Editor,

Sebaceous gland hyperplasia (SGH) is a benign, hamartomatous condition of the skin adnexa, usually encountered in older people.[1] The face, more precisely the forehead and cheeks, are the most common localizations of SGH.[2] SGH is rare in younger age groups and rare in the areas of the skin like the external genitalia in women.[3]

According the PubMed and Google browsers linear SGH in labia minora skin was published only in one paper,[4] and just in one paper it was described as a cause of hypertrophy of labia minora.[5]

In this paper we are presenting two cases of SGH in the skin of labia minora in young women. One of those cases presents as a linear SGH which clinically manifests as hypertrophy of labia minora.

Our first patient, a 23-year-old woman, came for gynecological examination due to chronic difficulties caused by bilateral enlargement of the labia minora. After partial resection, tissue was sent for pathohistological examination under clinical diagnosis of bilateral labia minora hypertrophy (Hypertrophia labii minoris billateralis).

The material was two band-like fragments of modified skin, 2.6 × 2.0 × 0.5 cm and 3.0 × 2.0 × 0.5 cm large, without macroscopically visible changes. Both fragments were sampled completely, and after standard histological procedures, tissue was embedded in one paraffin block. Histological analysis revealed modified skin covered by normal to slightly acanthotic epidermis with minimal signs of keratinization and elongated rete ridges. Under the epidermis (inside the dermis), numerous, mildly enlarged lobules of sebaceous glands were observed in a diffused arrangement along the line of labia minora resection. Sebaceous lobules were arranged around small excretory ducts that were aberrantly placed, such as inserted directly onto the epidermis, rather than the hair follicles as usual. Sebaceous lobules were composed of regular, basaloid cells at the periphery, and focally, mildly enlarged sebocytes with centrally placed nuclei and no signs of atypia. Chronic, nonspecific inflammatory infiltrate was present in the dermis, around the sebaceous glands. Neither hair follicles nor any other element of the hair was observed in any of the examined tissue samples.

Changes in the labia minora were described as sebaceous gland hypertrophy (linear type) [Figure 1].
Figure 1: Linear SGH of labia minora overview (a). Lobular organization of sebaceous glands around the epithelial infolding (b). SGH with surrounding connective tissue of genital region (c)

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In the second case presented here, a patient aged 32 years was asymptomatic and she came for a routine gynecological checkup. The gynecologist noticed and removed a lesion of labia minora, which he diagnosed as Leukoplakia vulve lateris dextri. The removed tissue specimen was sent for a routine pathohistological examination. Macroscopically, lesion was nodular, 0.5 × 0.5 cm large, and it was entirely sampled for pathohistology. Under the microscope, examined slides showed nodular to polypoid lesion, the surface of which was covered by modified skin, without hairs. Epidermis was regular and intact. In the dermis, numerous enlarged lobules of sebaceous glands were arranged around the short excretory ducts, which were opening directly on the surface of the epidermis. The arrangement and the shape of these enlarged sebaceous lobules gave the nodular to polypoid appearance of the lesion. Sebaceous lobules were composed of regular basaloid cells on the periphery, and centrally positioned sebaceous cells with centrally placed nuclei. Sebaceous cells were focally enlarged, but without signs of atypia. Lobules were surrounded by focal, mononuclear inflammatory infiltrate.

Observed changes were pathohistologically diagnosed as sebaceous gland hyperplasia of the labia minora [Figure 2].
Figure 2: Nodular SGH of labia minora overview (a and b). Lobular organization of sebaceous glands around the epithelial infolding (c)

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Ectopic, free sebaceous glands can be rarely found in the areas of the skin without hair or at the sites of mucocutaneous transition. Ectopic sebaceous glands are described in nipple areola of the breast as “Montgomery tubules,” in the labia and vulva as “Fordyce spots,” and at the penis as “Tyson's glands.”[6] The presence of the sebaceous glands in the vulvar skin is extremely rare, and if present, they are retained medial and posterior to the labia minora at the junction with vulvar vestibule.[1]

Lesions of the sebaceous glands are generally rare entities classified as adnexal tumors that present a complex diagnostic challenge for both pathologists and clinicians.[2]

SGH of typical localizations was described for the first time by Unna in 1874.[2],[7]

A universal definition of SGH is still a matter of debate, and its origin and etiology are also not specified. At this moment, the accepted definition of SGH is broad: benign hamartoma composed of epidermal adnexa with sebaceous differentiation.[8] Histologically and macroscopically, SGH usually presents nodular or nevoid formation,[8] most usual subtype which is compatible with the second case presented here, along with some not so frequent subtypes such as: linear, diffuse, familiar, gigantic and juxta-clavicular beaded lines.[2] Linear hyperplasia of sebaceous glands was first described by Fernadez and Tores in 1984, at periauricular and retroauricular sites, the neck and cheeks.[8]

Cases of vulvar SGH that have been presented in literature so far are almost 100% nodular lesions. Available literature showed just one case of linear SGH of labia minora, with identical histological appearance as presented in the first case.[4] Moreover, according to data available to us, that is the only linear SGH that clinically manifested as labia minora hypertrophy. Aside from the mentioned cases, linear SGH was described in only a few more cases as linear SGH of thorax and penis. SGH is a condition or a disease encountered in elderly people, usually as multiple lesions.[8]

SGH, in its typical localizations is found in approximately 1% of the population, while it is extremely rare in genital areas.[6] Roma et al.[6] in 2014 reported 12 cases, Gun and Hyon-Soo reported that until 2016, there were 7 cases,[1] and Kumar et al. in their paper published in 2018, reported about 20 cases.[3]

SGH does not raise suspicion during clinical examination, so it may be clinically diagnosed as fibroma, some reactive, inflammatory lesions of the vulva (cysts, pyogenic granuloma, condyloma acuminatum or hydradenitis suppurativa), tumors (basal cell carcinoma), melanotic macules, nevus sebaceus of Jadassohn and many other lesions,[1],[3] which implies that pathohistological analysis is the only accurate diagnostic procedure for confirmation of SGH.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gun Y, Hyon-Soo K. Clinicopathological characterization of vulvar sebaceous gland hyperplasia. Int J Clin Exp Pathol 2016;9:7560-5.  Back to cited text no. 1
    
2.
Eisen DB, Michael DJ. Sebaceous lesions and their associated syndromes: Part I. J Am Acad Dermatol 2009;61:549-60.  Back to cited text no. 2
    
3.
Kumar U, Nanda A, Lamba S. Sebaceous gland hyperplasia at episiotomy site: A causal or an incidental association. J Clin Diagn Res 2018;12:EDO1-2.  Back to cited text no. 3
    
4.
Dieh APT, Jones AS. An unusual presentation of sebaceous gland hyperplasia of the vulva. J Obstet Gynecol 2005;25:729-30.  Back to cited text no. 4
    
5.
Honoré LH, O'Hara KE. Benign enlargement of the labia minora: Report of two cases. Eur J Obstet Gynecol Reprod Biol 1978;861-4.  Back to cited text no. 5
    
6.
Roma AA, Barry J, Pai RK, Bilings SD. Sebaceous hyperplasia of the vulva: A series of cases reporting no association with the Muir-Torre Syndrome. Int J Gynecol Pathol 2014;33:437-42.  Back to cited text no. 6
    
7.
Choccalingam C, Gurusamy S, Samuel P. Sebaceous hyperplasia of labium major: Histopathological images. Our Dermatol Online 2017;8:96-7.  Back to cited text no. 7
    
8.
Mandal RK, Das A, Chakrabari I, Agarwal P. Nevoid sebaceous hyperplasia mistaken as nevus sebaceous: Report of four cases. Indian J Dermatol Venereol Leprol 2017;83:213-6.  Back to cited text no. 8
[PUBMED]  [Full text]  

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Correspondence Address:
Jelena Amidžić
Department of Histology and Embryology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad
Serbia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpm.ijpm_902_21

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