Interesting Clinical Cases - A Case of cavernous hemangioma of vulva from Dr. Rajesh & Dr. Rakhi Gajbhiye (Nagpur)

Dr Rajesh Gajbhiye

Dr Rakhi Gajbhiye

Consultant gynecologists

Mauli Women’s Hospital,




A 21 years old girl came with swelling in vulva since 18 years. She was a case of bilateral vulval hemangioma. The swelling increases on standing and coughing and is reduced on lying down position. She was operated for right vulval hemangioma in 1990 at railway hospital. She was again operated for left vulval hemangioma in 1993.It was said to be cavernous hemangioma. She had a residual right hemangioma for which she was given injection of 3% Sodium tetradeacyl sulphate under short GA. this injection was repeated every six weeks for a year but there was no relief. In 1998 again she   was treated with local sclerosant injections fro one year but had no relief. She had undergone surgery for vesical calculus in January2008. CT scan report was vesical calculus with multiple phleboliths in pelvis. On local examination she had a swelling on right labia majora which on standing position was about 6x7 cm. It was reducible and soft on palpation. (Fig 1)

She was investigated and planned for excision of hemangioma. Her blood works were with in normal limits especially platelet count and coagulation profile was normal. Colour Doppler was done which showed no feeder vessel from large vessel and slow venous flow.  Her excision of hemangioma was done. There were cavernous spaces. Excision of spaces was done till the periosteum of pubic bone. At places feeder vessels were identified and hemostasis achieved. There were phelboliths scattered in that mass which were removed. Drain was kept and incision was closed for two days patient was fine but when the drain was being removed she had profuse bleeding. Immediately the pressure was given and three blood transfusions were given. Injectable Tranexamic acid was given round the clock. Subsequently the drain was removed. There was a wound gaping which responded to dressing. Patient is doing fine now but has mild swelling on left side.

Fig 1: Cavernous Hemangioma


Kondi-Pafiti A et al in their clinicopathological study of nine cases found one capillary hemangioma of the endometrium, one capillary and one cavernous hemangioma of the cervix, six vulva lesions (one capillary, and one cavernous hemangioma and four angiokeratomas) and one hemangiosarcoma of the mons pubis. Gupta et el in their study of vascular tumors of female genital tract, found The vascular tumors occurred most commonly in ovary (six), followed by vulva (two), and one each in cervix and vagina. Clinical diagnoses ranged from cystadenoma in ovarian tumors to endocervical polyp in cervical tumor. Histologically, all were benign vascular neoplasms, ranging from hemangioma (five), lymphangioma (one), lymphangioma circumscriptum (one) to angiomatosis (two) and arteriovenous malformation (one). Klippel-Trenaunay-Weber syndrome is a sporadic genetic syndrome characterized by localized hemangiomas, venous varicosities, and asymmetric osseous hypertrophy of the ipsilateral extremities. Most commonly seen in association with hemangiomas, Kasabach-Merritt syndrome is defined by the presence of thrombocytopenia and a consumptive coagulopathy

Bava et al reported a case of a vulvar hemangioma complicated by life-threatening hemorrhage not responsive to corticosteroids therapy, which showed no signs of spontaneous involution. The therapeutic approach consisted of 3 steps of selective arterial embolization followed 5 months later by surgical excision and reconstruction of the vulva. Selective embolization rarely is used in the treatment of hemangiomas but may be required in cases of intractable bleeding, severe heart failure, large and poorly involuting hemangiomas, and as preparation for surgery

Vulvar venous malformations should be distinguished from vulvar varicosities, hematomas, soft-tissue neoplasms, and other vascular anomalies. Doppler ultrasound, MRI, and direct-injection venography are the most accurate diagnostic modalities.


1.    Kondi-Pafiti A, Kairi-Vassilatou E, Spanidou-Carvouni H, Kontogianni K, Dimopoulou K, Goula K. Vascular tumors of the female genital tract: a clinicopathological study of nine cases. Euro J Gynecol Oncol. 2003; 24(1):48-50.

2.    Bava GL, Dalmonte P, Oddone M, Rossi U., Life-threatening hemorrhage from a vulvar hemangioma., J Pediatric Surg. 2002 Apr;37(4):E6.

3.    Kasabach-Merritt coagulopathy complicating Klippel-Trenaunay-Weber syndrome in pregnancy. Obstet Gynecol. 1995 May;85(5 Pt 2):831

4.    Gupta R, Singh S, Nigam S, Khurana N Int J Gynecol Cancer. 2006 May-Jun;16(3):1195-200

5.    Neubert AG, Golden MA, Rose NC, Kasabach-Merritt coagulopathy complicating Klippel-Trenaunay-Weber syndrome in pregnancy. Obstet Gynecol. 1995 May;85(5 Pt 2):831-3




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