Radiologic Evaluation of Childhood Asymmetrical Labium Majus Enlargement (CALME)

Congress:

ECR 2020

Poster Number:

C-07780

Type:

Educational Exhibit

Keywords:

Paediatric, Anatomy, Genital / Reproductive system female, Musculoskeletal soft tissue, MR, Ultrasound, Ultrasound-Colour Doppler, Diagnostic procedure, Normal variants, Hyperplasia / Hypertrophy, Not applicable

Authors:

A. Pérez Del Barrio ¹, V. Gomez-Dermit², M. Pelaz Esteban³, A. CANGA¹, E. GALLARDO⁴, P. Sanz Bellon¹, P. Menéndez Fernández-Miranda¹; ¹Santander/ES, ²miengo/ES, ³Liencres, Cantabria/ES, ⁴madrid/ES

DOI:

10.26044/ecr2020/C-07780

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-07780

Fig. 1: CASE 1: An 8-years-old Caucasian girl is referred to our hospital for the...

Fig. 2: Continuing with CASE 1: Axial T1-weighted MRI confirms a hypointense lesion in...

Fig. 3: Continuing with CASE 1: Axial MRI THRIVE sequence after contrast administration...

Fig. 4: CASE 2: An 8-years-old Caucasian girl was referred to our hospital for painless...

Learning objectives

To review the clinical findings, pathophysiology and current treatment of CALME. To describe the radiological features of this recently described entity. To discuss the differential diagnosis of CALME.

Background

Childhood Asymmetrical Labium Majus Enlargement, shortly named CALME, is defined as a site- and age-specific non-neoplastic physiologic growth in response to hormones. Although this entity constitutes one of the most common vulva masses in children, very few cases have been described in the literature. A retrospective analysis of two girls with CALME is done to discuss the clinical features, radiological findings, differential diagnosis, and current therapeutic approach.

Findings and procedure details

The typical case of CALME is a prepubertal female (mean age: 7-8 years) that complains of bulging of unilateral labium majus. On physical examination, a painless and poorly defined unilateral labial enlargement is shown, which can extend to the mons pubis. Not overlying skin changes are shown and not cystic or solid mass is palpated. The most accepted hypothesis concerning its pathophysiology is an asymmetrical physiologic growth of tissue with a hormonal response as the asymmetric female breast or male testis growth. However, the reason...

Conclusion

CALME is a site- and age-specific non-neoplastic physiologic normal vulvar tissue growth in response to hormones. US often provides the diagnosis. Recognition of this entity is important to avoid active treatment. MRI, biopsy or surgical resection should be reserved for patients with challenging diagnosis.

Personal information and conflict of interest

A. Pérez Del Barrio; Santander/ES - nothing to disclose V. Gomez-Dermit; Miengo/ES - nothing to disclose M. Pelaz Esteban; Liencres, Cantabria/ES - nothing to disclose A. Canga; Santander/ES - nothing to disclose E. Gallardo; Madrid/ES - nothing to disclose P. Sanz Bellon; Santander/ES - nothing to disclose P. Menéndez Fernández-Miranda; Santander/ES - nothing to disclose

References

Salvatori C, et al. Childhood Asymmetry Labium Majus Enlargement (CALME): Description of Two Cases. Int J Environ Res Public Health. 2018;15(7): 1525. Gokli A, Neuman J, Lukse R, Koshy J, Kong F, Laor T. Childhood asymmetrical labium majus enlargement sonographic and MR imaging appearances. Pediatr Radiol. 2016; 46(5):674-9. Gu MJ, Kim SY. Childhood asymmetry labium majus enlargement. Korean J Pathol. 2011; 45:529-531. Soyer T, Hançerliogullari O, Pelin Cil A, Evliyaoglu O, Cakmak M. Childhood asymmetric labium majus enlargement: is a conservative approach available? J Pediatr...