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DOI: 10.48087/BJMS.2026.130207
Authors: Atef DARWISH1,2, Dina DARWISH2, Amany OMAR3, Ruba M ALSOLAIMAN4
Affiliations: 1- Department of Obstetrics and Gynecology, Assiut University, Egypt. 2- Senior consultant of Obstetrics and Gynecology, AlEmadi Hospital, Doha, Qatar. 3- Department of Pathology, Minia University, Egypt and AlEmadi Hospital, Doha, Qatar. 4- Specialist of Obstetrics and Gynecology, AlEmadi Hospital, Doha, Qatar.
Keywords: Hidradenoma Papilliferum, Pruritus vulvae , Vulvar, Apocrine, Case report.
Abstract
Background: Chronic pruritus vulvae is a common gynecological complaint most often attributed to infectious, inflammatory, or dermatologic causes. Consequently, management frequently relies on topical treatments, which may delay the identification of less common etiologies. Hidradenoma papilliferum is a rare, benign tumor arising from anogenital mammary-like (apocrine) glands, typically presenting as a small, slow-growing vulvar nodule. Although histologically well-characterized, its clinical diagnosis can be challenging, particularly when lesions are small, asymptomatic on palpation, or partially concealed, leading to misdiagnosis and prolonged patient discomfort. Case presentation: We present a 32-year-old single female patient who experienced months of persistent vulvar discomfort, itching, and occasional vaginal discharge that did not respond to multiple courses of systemic and local antibiotics in addition to intermittent topical steroids. Moreover, she received systemic antihistamines to mitigate her symptoms. Physical examination during a second-opinion visit revealed a small (<1 cm), non-tender vulvar nodule. Excision was easily performed under local anesthesia, and histopathology confirmed hidradenoma papilliferum as an uncommon, benign apocrine tumor. Following excision, the symptoms resolved completely, with no recurrence at six-month follow-up. Conclusions: Small vulvar lesions such as hidradenoma papilliferum should be included in the differential diagnosis of any case of persistent or refractory pruritus vulvae. Clinically, thorough vulvar palpation in such cases before insertion of a vaginal speculum is mandatory to exclude any external vulvar causative lesion and avoid diagnostic delay. Not all vulvar symptoms are infectious or dermatologic in origin, and early identification of localized lesions can prevent unnecessary treatments and patient frustration.