JW Crawshaw

April, 1916

Illustration from the New Zealand Medical Journal 1916 vol XV, No 66, p.41

The patient is 48 years of age. Just after the birth of her last child, 8 years ago, she noticed what she describes as a “fleshy wart” growing from the right labium majus. This increased in size very slowly, but was no trouble or inconvenience to her till about 4 years ago it developed a pedicle and became pendulous. It then increased in length more rapidly and caused considerable discomfort in walking and sitting. She volunteered the statement that it increased in size—became fuller, she described it—the week after menstruation ceased. The fullness lasted about a week, after which time the tumour shrank, the skin becoming slacker and more wrinkled.

Before removal, the specimen was 5 inches in total length. The pedicle was ½ inch long and about 3/16 inch in circumference at its widest part. The point of its attachment was about ¾ inch from the anterior end of the labium. In the upright position the tumour hung down half way to the knees.

As regards the structure and frequency of pediculated growths of the labium majus, Herman divides them into lipomata and fibromata. He mentions that the former are rare, and that he has never seen a large one. Howard Kelly, in his book on operative gynaecology, does not distinguish between lipomata and fibromata, simply saying that they are soft or hard in proportion to the relative amount of fatty tissue and fibrous tissue.

Kelly states that it is one of the rarest of gynaecological affections and that he could only find records of 20 cases. The tumours varied greatly in size. He describes one he saw which was practically of the same dimensions as the one I show. The tumour was 3 inches in length, hanging by a slender pedicle 2 inches long, and 3 inches thick, from the middle of the right labium majus. At the other end of the scale was one which hung down to the patient’s knees. Another one weighed 24 lbs. The ages of the patients also varied widely. The youngest patient was 18 years and the oldest was 61 years. The rate of growth in all the cases was slow. One had been growing for seventeen years before the patient had it removed.

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