title: Childhood asymmetrical labium majus enlargement sonographic and MR imaging appearances.
abstract: BACKGROUND
  Childhood asymmetrical labium majus enlargement (CALME) has been described sparsely in recent surgery, pathology, pediatric and gynecology literature; however, no comprehensive description from a radiology perspective has been developed.
  
  
  OBJECTIVE
  The purpose of this case series is to describe the imaging findings of CALME and to review the current understanding of this recently described clinical entity with regard to clinical presentation, pathophysiology, differential diagnosis and treatment options.
  
  
  METHODS
  This is a retrospective analysis of 3 girls, ages 5-7 years, who presented for imaging evaluation with subsequent pathologically proven CALME. Each child's clinical history, length of symptoms, imaging appearance and pathological findings were reviewed.
  
  
  RESULTS
  All three girls presented with unilateral enlargement of the labium majus (two right-side, one left-side) with no history of trauma or other inciting cause. Two girls had painless labial enlargement that was recognized for weeks, and one had similar symptoms for 1 year prior to presentation. One girl was evaluated initially with sonography, and all three children underwent MR imaging. Sonographic evaluation showed asymmetrical labial enlargement without a definable mass. In each girl, the MR imaging findings were characterized by relatively ill-defined T1-weighted hypointense signal, T2-weighted hypo- to isointense signal with interspersed hyperintense septae, and heterogeneous patchy and feathery strands of enhancement on post-contrast imaging. Biopsy from each child showed benign fibrous tissue with intervening mature fibroadipose tissue, vessels and nerves without findings of inflammation or neoplasia.
  
  
  CONCLUSIONS
  The MR imaging appearance of CALME is consistent. Recognition and appreciation of this unique pediatric entity by the radiologist may be essential for appropriate diagnosis and can help to guide therapy. Current preferred treatment approach is conservative.
authors: Department of Radiology, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY, 10305, USA.
authors: Ami
authors: A
authors: Gokli
authors: Department of Radiology, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY, 10305, USA. jneuman@northwell.edu.
authors: Jeremy
authors: J
authors: Neuman
authors: Department of Radiology, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY, 10305, USA.
authors: Ruby
authors: R
authors: Lukse
authors: Department of Radiology, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY, 10305, USA.
authors: June
authors: J
authors: Koshy
authors: Department of Pathology, Staten Island University Hospital, Staten Island, NY, USA.
authors: Fanyi
authors: F
authors: Kong
authors: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors: Tal
authors: T
authors: Laor
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D014844:Vulva / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: Children; Labia; Labium majus; Magnetic resonance imaging; Pediatric; Ultrasound; Vulva