Dear Editor,

We read with great interest the article by Saquib et al, entitled: "Leiomyosarcoma of the Vulva Mimicking as Chronic Bartholin Cyst: A Case Report", which was recently published in the Oman Medical Journal.1 Firstly, we would like to congratulate the authors who have nicely described a case of asymptomatic leiomyosarcoma of the vulva mimicking chronic Bartholin gland cyst.

As a reader, we believe it will add a great benefit if additional information could be included such as the pre- and intraoperative, and macroscopic figures as they will be of great help to clearly describe the clinical procedures or findings.2 Knowing that this article was written by a gynecology team, it is deemed possible to provide such figures. Since the lesion was diagnosed in postmenopausal woman, regardless of the location, duration, and asymptomatic clinical situation, suspicion of malignancy were highly considered. The surrounding epithelium’s appearance needs to be observed to exclude other premalignant skin changes of the affected vulva and compare with the contralateral vulva. Since the case is a rare clinical diagnosis, we would be grateful if we were given a chance to see how the lesion looks, to be able to compare with the Bartholin gland cyst. In addition, it would be beneficial if the immunohistochemical figures could be added as well. We believe that such a nicely written article without complete figures could be less educational, especially among the non-gynecology personnel.

We congratulate the primary team for managing the case well. Proper action was undertaken in which she was subjected to a second surgery by performing a modified left inguinal lymphadenectomy, hemivulvectomy, and bilateral inguinal lymph node biopsy.3 As highlighted in the literature, the best option is complete surgical excision with negative margins histologically and followed by radiotherapy.4 In the absence of metastasis, the prognosis for a completely excised tumor is good. Nevertheless, it is crucial for the patient to have continuous close follow-up following excision of tumor to diagnose late local recurrence promptly.

references

1. 1. Saquib S, Cherawala M, Abdel Rahman O, Keloth TE. Leiomyosarcoma of the vulva mimicking as chronic bartholin cyst: a case report. Oman Med J 2020 Jul;35(4):e153.
2. 2. Green BN, Johnson CD. How to write a case report for publication. J Chiropr Med 2006;5(2):72-82.
3. 3. Schnürch HG, Ackermann S, Alt CD, Barinoff J, Böing C, Dannecker C, et al. Diagnosis, therapy and follow-up care of vulvar cancer and its precursors. guideline of the DGGG and DKG (S2k-Level, AWMF registry number 015/059, November 2015. Geburtshilfe Frauenheilkd 2016 Oct;76(10):1035-1049.
4. 4. Chokoeva AA, Tchernev G, Cardoso JC, Patterson JW, Dechev I, Valkanov S, et al. Vulvar sarcomas: short guideline for histopathological recognition and clinical management. Part 1. Int J Immunopathol Pharmacol 2015 Jun;28(2):
   168-177.