Differential Diagnosis for a 22-year-old woman with a vulvar mass
- Single most likely diagnosis
- Bartholin's cyst: This is the most likely diagnosis given the location of the mass at the base of the labium majus, which is a common site for Bartholin's glands. The description of the mass as mobile, soft, nontender, and flesh-colored also supports this diagnosis. Bartholin's cysts can occur after trauma, which could be related to the patient's history of a vulvar contusion during a gymnastics competition.
- Other Likely diagnoses
- Vulvar abscess: Although less likely given the nontender nature of the mass, a vulvar abscess could still be considered, especially if there's any concern for infection. However, the absence of pain and the soft, mobile nature of the mass make this less likely.
- Epidermal inclusion cyst: These cysts can occur on the vulva and present as flesh-colored, mobile masses. They are generally benign and could be considered in the differential diagnosis.
- Lipoma: A lipoma could present as a soft, mobile, flesh-colored mass, although they are less common in the vulvar area.
- Do Not Miss diagnoses
- Squamous cell carcinoma: Although rare in a young woman, any vulvar mass warrants consideration of malignancy to avoid delayed diagnosis. This would be more concerning if the mass were fixed, ulcerated, or if the patient had risk factors such as immunosuppression or a history of high-risk HPV.
- Malignant melanoma: Similar to squamous cell carcinoma, melanoma of the vulva is rare but potentially deadly if missed. Any pigmented lesion or a lesion with unusual characteristics should prompt consideration of this diagnosis.
- Rare diagnoses
- Adnexal tumors (e.g., hidradenoma, syringoma): These are rare tumors of the sweat glands that could present as vulvar masses. They are generally benign but would be an unusual finding.
- Vulvar lymphangioma or hemangioma: These vascular lesions could present as soft, flesh-colored masses but are rare in the vulvar area and more commonly seen in other parts of the body.