Asymmetrical labium majus enlargement (CALME) in childhood: A series of clinical cases

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Abstract

Childhood asymmetry labium majus enlargement (CALME) is a rare, benign disease of pre-pubertal age characterized by non-neoplastic unilateral proliferation of the soft tissues of the vulva without a peripheral capsule. The pathogenesis of CALME is not completely clear. Generally, the only treatment method is surgery because it is necessary to verify the diagnosis and exclude the neoplastic process. Most studies indicate the benign nature of CALME and the importance of a non-surgical approach if specific diagnostic criteria are met. The article presents clinical observations of CALME syndrome in girls, taking into account the modern differentiated approach to the management of patients with this disorder.

About the authors

Zalina K. Batyrova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Author for correspondence.
Email: linadoctor@mail.ru
ORCID iD: 0000-0003-4997-6090

Cand. Sci. (Med.), Senior Res. Officer

Russian Federation, Moscow

Zaira Kh. Kymykova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: linadoctor@mail.ru
ORCID iD: 0000-0001-7511-1432

Cand. Sci. (Med.)

Russian Federation, Moscow

Elena V. Uvarova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology; Sechenov First Moscow State Medical University (Sechenov University)

Email: linadoctor@mail.ru
ORCID iD: 0000-0002-3105-5640

D. Sci. (Med.), Prof., Corr. Memb. RAS

Russian Federation, Moscow; Moscow

Alina S. Badlaeva

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: linadoctor@mail.ru
ORCID iD: 0000-0001-5223-9767

Res. Assist.

Russian Federation, Moscow

Aleksandra V. Asaturova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: linadoctor@mail.ru
ORCID iD: 0000-0001-8739-5209

D. Sci. (Med.)

Russian Federation, Moscow

Polina V. Kulabukhova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: linadoctor@mail.ru
ORCID iD: 0000-0002-0363-3669

Cand. Sci. (Med.)

Russian Federation, Moscow

Fatima Sh. Mamedova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology; Russian Medical Academy of Continuous Professional Education

Email: linadoctor@mail.ru
ORCID iD: 0000-0003-1136-7222

Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Vladimir D. Chuprynin

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: linadoctor@mail.ru
ORCID iD: 0000-0002-2997-9019

Cand. Sci. (Med.)

Russian Federation, Moscow

Irina A. Yagovkina

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: linadoctor@mail.ru
ORCID iD: 0009-0000-5121-9609

Medical Resident

Russian Federation, Moscow

References

  1. Goldrat O, Lingier P, Massez A, Noël JC. Prepubertal Vulvar Fibroma: Neoplasm or Physiological Condition? J Pediatr Adolesc Gynecol. 2016;29(5):e67-70. doi: 10.1016/j.jpag.2016.02.003
  2. Батырова З.К., Уварова Е.В., Кумыкова З.Х. CALME, или доброкачественная асимметрия большой половой губы, в детском возрасте. В помощь практикующему врачу. Репродуктивное здоровье детей и подростков. 2024;20(1):52-6 [Batyrova ZK, Uvarova EV, Kumykova ZKh. CALME, or benign asymmetry of the labia majora in childhood. To help a practicing doctor. Pediatric and Adolescent Reproductive Health. 2024;20(1):52-6 (in Russian)]. doi: 10.33029/1816-2134-2024-20-1-52-56
  3. Vargas SO, Kozakewich HP, Boyd TK, et al. Childhood asymmetric labium majus enlargement: Mimicking a neoplasm. Am J Surg Pathol. 2005;29:1007-16. PMID: 16006794
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  5. Altchek A, Deligdisch L, Norton K, et al. Prepubertal unilateral fibrous hyperplasia of the labium majus: Report of eight cases and review of the literature. Obstet Gynecol. 2007;110(1):103-8. doi: 10.1097/01.AOG.0000266979.42237.cc
  6. Salvatori C, Testa I, Prestipino M, et al. Childhood Asymmetry Labium Majus Enlargement (CALME): Description of Two Cases. Int J Environ Res Public Health. 2018;15(7):1525. doi: 10.3390/ijerph15071525
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  10. Oh JT, Choi SH, Ahn SG, et al. Vulvar lipomas in children: An analysis of 7 cases. J Pediatr Surg. 2009;44(10):1920-3. doi: 10.1016/j.jpedsurg.2009.02.063
  11. Manson CM, Hirsch PJ, Coyne JD. Postoperative spindle cell nodule of the vulva. Histopathology. 1995;26(6):571-4. doi: 10.1111/j.1365-2559.1995.tb00277.x
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Supplementary files

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2. Fig. 1. Fibrous tissue with clusters of adipocytes and fine full-blooded vessels (a, b), some of which have a thickened wall (c). Staining: hematoxylin-eosin.

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3. Fig. 2. MRI T2-VI in the axial view (a), T2-VIFS in the axial view (b), T1-VI in the axial view (c), T2-VI in the frontal view (d). MR pattern of asymmetry of the labia with an enlargement in the right (indicated by the arrow), with signs of fibrosis area within the labia tissues.

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4. Fig. 3. Fibrous tissue with edema, clusters of adipocytes (a), nerve trunks (b) and fine dilated vessels, some of which have a thickened wall (c). Staining: hematoxylin-eosin.

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5. Fig. 4. Appearance of the patient's external genitalia.

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6. Fig. 5. Fibrous tissue with clusters of adipocytes and fine full-blooded vessels (a–c). Staining: hematoxylin-eosin.

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