For 14 years, she lived with painful swellings

Monday January 7 2019



Dr Lugano Wilson

Dr Lugano Wilson 

For the past 14 years, Susan* lived with swelling of armpit and vulva [the external opening of vagina].

It began with a small bump on the left armpit and gradually over these years, it increased in size, got really painful and itchy. A few months later, the same appeared on the right armpit.

Susan thought it might go away. But six years later, swelling of a similar type appeared on both sides of the vulva.

The vulva swelling was very painful associated with lower abdominal pain radiating to her back. Still no medical help, a few months later, the swelling developed into ulcers, discharging a foul smell and a thick fluid that looked infectious.

Not only that, her menstrual cycle went from regular to irregular. For the past three months, she hasn’t gotten her periods.

The 29-year-old comes from Kigoma and was referred to Dar es Salaam from Bugando Medical Centre based in Mwanza where she initially sought diagnosis.

Though the physical examination was performed on her, it wasn’t very clear due to narrowing of the vagina opening due to swelling and ulcers.

I had to review her before we could take a further decision.

A battery of tests were ordered including biopsy that was taken for histological diagnosis during excision of the tumour , thus it was irresistibly concluded that the patient had a benign tumour known as ‘Angiomyofibroblastoma’. And she had to undergo a surgery.

In pursuit of freeing herself from the bondage of sickness, the father’s favourite daughter, Susan, had been to many hospitals, prayer houses, prophetic congregations and traditional healers.

One thing that Susan kept reiterating was how her father has been her major support system. He has been with her till date through thick and thin in search for a treatment.

She said, “Baba ananipenda sana ndo maana anauza kila kitu ili nitibiwe.” [Loosely translated in english - My father’s love to me is so immense, such that he had to sell everything in a bid to facilitate my treatment].

Suffering from this for so many years, Susan had to quit college where she was pursuing nursing studies.

Angiomyofibroblastoma of the vulva is a benign tumour of the soft tissues that occur in the vulva abbreviated as AMFB of the vulva. It’s rare tumour that mostly affects females in the age of 25-50 years.

We tried to look into the causative risk factor but our endeavours ended in vain. We searched for various literatures in the course of broadening our understanding. Our research concluded that some tumours have revealed certain genetic abnormalities.

An important reminder is that AMFB is not a sexually transmitted disease.

Symptoms

Normally this tumour grows at a very slow rate as we have seen that it took 6-14 years to manifest in Susan’s case.

It may present with no pain or tenderness but hers was painful and tender on touch.

These soft tissue tumours are well circumscribed with very clear borders. AMFB can present as a polyp in the vulva or vagina. They are firm and rubbery on palpation, of course I was able to feel it in theatre after when it was cut , I can vouch for that it was solid and very firm.

It’s said that some ladies may present with a sense of pressure in the affected region when and if the tumour grows to a large size. Many of them are less than 5cm but some can grow unidentified up to 14cm especially when they are symptomless.

Large ones present with pain in pelvic region, they urinate more often and they also have back pain.

Another important symptom is that they present with pain during sexual intercourse.

Complications

Susan’s surgery was performed but there was more to be done to evade complications.

Emotionally, Susan wasn’t stable. She was distressed and distorted completely having suffered this for the past 14 years. Hence she needed emotional support, therapy.

She had pre and post surgery infections and had to undergo post surgical wound pressure dressing and the subsequent plastic surgery.

One thing I learnt from Susan and her father is that ‘support’ matters. No matter how bad the condition, disease is - family needs to be there for them.

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