Unilateral vulval swelling in cyclists: a report of 8 cases.
OBJECTIVE
To define the clinical features, imaging results, histopathologic patterns, and clinical outcomes seen in patients who develop vulval swelling as a result of intensive cycling.


METHODS
The case notes of 8 female cyclists were retrospectively reviewed.


RESULTS
The mean age of the patients was 45 years, and all were cycling long distances each week (range, 125-450 km; median, 210 km). All patients had a unilateral swelling of the labium majus. Five patients had magnetic resonance imaging showing asymmetry of the vulva with no enhanced signaling associated with inflammation. Histologic examination in 3 cases revealed dermal fibrosis and dermal edema associated with dilatation of lymphatic vessels. In 1 case, a perifollicular inflammatory infiltrate containing epithelioid granulomas was seen but Crohn's disease was excluded. In another case, fibromuscular hyperplasia was seen. Six patients had surgical excision of the swollen area, and 4 patients were able to resume cycling without problems up to 5 years of follow-up. The cosmetic appearance was initially considered satisfactory by 5 patients. However, 2 patients required a second surgical procedure to further improve the cosmetic appearance. In 1 case, there was a postoperative hematoma followed by an immediate recurrence of the swelling, which persisted.


CONCLUSIONS
Unilateral swelling of the labium majus occurring in cyclists can be related to dermal fibroedema associated with lymphatic dilatation or to an increase in adipose tissue. Surgical results were satisfactory in 5 of the 6 patients who underwent excision.
1Centre Pasteur Dermatologie, Nantes, France; 2Heatherwood & Wexham Park NHS Trust, Slough, UK; 3Hôpital Tarnier Cochin, Paris, France; 4Centre Medico Chirurgical Paris V, Paris, France; 5Clinique Breteche, Nantes, France; 6Department of Histopathology, Institut d'Histo Pathologie, Nantes, France; and 7St John's Institute of Dermatology, London, UK.
Phryné
P
Coutant-Foulc
Fiona M
FM
Lewis
Sophie
S
Berville
Bruno
B
Janssen
Pascal
P
Guihard
Jean Jacques
JJ
Renaut
Francoise
F
Plantier
Eduardo
E
Calonje
Micheline
M
Moyal-Barracco
D000293:Adolescent; D000328:Adult; D000368:Aged; D004487:Edema / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000469:parasitology; D006651:Histocytochemistry; D006801:Humans; D008279:Magnetic Resonance Imaging; D055595:Mechanical Phenomena; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D013177:Sports; D040521:Subcutaneous Tissue / Q000473:pathology; D014844:Vulva / Q000000981:diagnostic imaging / Q000473:pathology*; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000473:pathology*; D055815:Young Adult