CALME is the acronym for "Childhood asymmetry labium majus enlargement". This is a non-neoplastic swelling disorder in which the labia minora (outer labia) of a girl are swollen or enlarged, usually on one side due to excessive tissue growth. This tissue mass causes one side of the labia majora to be larger than the other, resulting in an asymmetrical appearance (Sechi A et al. 2021).
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CALMEM79.-
DefinitionThis section has been translated automatically.
EtiopathogenesisThis section has been translated automatically.
The cause is not yet known, but this tissue growth may be caused by hormones. An increased sensitivity of the vulvar stroma to hormonal stimulation as well as an abnormal expression of the estrogen receptor in prepubertal age is being discussed.
Clinical featuresThis section has been translated automatically.
Symptoms may include:
- Mostly unilateral soft tissue tumor of the labia majora, causing an asymmetrical appearance. The overlying skin is inconspicuous, not reddened; it may have a light brown surface resembling orange peel. There are no signs of virilization, such as clitoral hypertrophy or evidence of ambiguous genitalia. The vaginal entrance is open.
- Mechanical irritation during forced physical activity, discomfort or pain in the crotch when wearing tight clothing
DiagnosticsThis section has been translated automatically.
The disease may become apparent shortly before puberty. In the early stages, the lesion can rapidly increase in volume. The diagnosis is confirmed by physical examination. Histologic examinations are optional.
Additional tests may include:
- Imaging techniques such as ultrasound or
- MRI (magnetic resonance imaging)
HistologyThis section has been translated automatically.
Non-encapsulated "physiological" tissue.
Differential diagnosisThis section has been translated automatically.
Fibroma, lipoma, neurofibroma, fibrolipoma, vascular malformations.
TherapyThis section has been translated automatically.
Resection of excess tissue. Surgery is recommended to remove the tissue mass, confirm the diagnosis and relieve the discomfort caused by the bulge of excess tissue.
Progression/forecastThis section has been translated automatically.
The benign tissue mass develops quickly and then stops growing after puberty. It occurs in young girls shortly before puberty.
The growth phase is usually short and lasts about 3 months (rarely longer - up to 3.5 years). This is followed by a phase of stabilization at a size of 3-6 cm, during which growth slows down (Salvatori C et al. 2018). Postoperative recurrences occur in 50% of cases.
Note(s)This section has been translated automatically.
The labia minora are the two large folds of fatty tissue that cover the vagina. They are also known as the outer lips of the vulva.
LiteratureThis section has been translated automatically.
- Altchek A et al. (2007) Prepubertal unilateral fibrous hyperplasia of the labium majus: report of eight cases and review of the literature. Obstet Gynecol 110:103-108.
- Gokli A et al. (2016) Childhood asymmetrical labium majus enlargement sonographic and MR imaging appearances. Pediatr Radiol 46:674-679.
- Salvatori C et al. (2018) Childhood Asymmetry Labium Majus Enlargement (CALME): Description of Two Cases. Int J Environ Res Public Health 15:1525.
- Sechi A et al. (2021) Keep CALME (childhood asymmetry labium majus enlargement) and follow up. J Dtsch Dermatol Ges 19:1276-1281.