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Paper text:
there are many reasons for perpetuation of this practice ; the most common are cultural and religious beliefs .
most of these complications are immediate , though a few may present several years later .
a 39-year - old , nigerian woman was referred to our dermatological clinic due to painful genital swelling .
her medical history included a female genital mutilation ( fgm ) at the age of 5 years and an appendectomy 10 years before .
she had begun to notice a genital swelling 1 year prior and gradually increasing in size .
the patient had no history of difficulty with urination or with her sexual relations , but she recognized psychological discomfort since the cyst had begun to increase in size .
the clinical examination showed a nodular lesion covered with preserved mucosa , 30 mm  20 mm in diameter , smooth surface , and not attached to deeper layers .
the lesion was located in the scar of the mutilation . under local anesthesia and in lithotomy position
it was easily removed by making a vertical incision in the skin and making a dissection along the lines of cleavage .
the nodule was a well - encapsulated unilocular cyst containing serous gray material [ figure 1 ] .
( a ) nodular lesion covered with preserved mucosa , not attached to deeper layers . located in the scar of female genital mutilation .
( c ) a well - encapsulated unilocular cyst containing serous gray material the histological examination showed a cystic lesion containing abundant laminated keratin .
diagnosis of infundibular inclusion cyst secondary to genital mutilation was established [ figure 2 ] .
( a ) histological examination showed a cystic lesion containing abundant laminated keratin ( h and e , 2.5 ) .
( b ) walls were formed by keratinizing epithelium with the presence of granular layer ( h and e , 40 ) the clinical follow - up of the patient after 6 months of the excision revealed no recurrence , with good appearance of the vulva and without pain .
fgm is a very important event which is still taking place across the world , especially in sub - saharan africa and in parts of the middle east and asia .
women with fgm are increasingly found in europe , as a result of migration . the world health organization ( who ) defines this technique as any procedure that entails injury or removal of part or all of the external female genitalia , whether for cultural or nontherapeutic indications .
this procedure is classified by the who into four types : type i , partial or total removal of the clitoris ; type ii , partial or total removal of the clitoris and the labia minora ; type iii ( infibulation ) , excision of part or all of the external genitalia and narrowing of the vaginal orifice ; type iv , includes all other harmful procedures unclassified .
immediate complications as a complication of a female circumcision seen are infection , urinary retention , or hemorrhage .
late and long - term complications are urinary incontinence , recurrent urinary tract infections , adverse psychosexual sequelae , dyspareunia , obstetrical problems , and clitoral inclusion cysts . delay from circumcision to the development of the cyst is variable , but a delay of more than 30 years , as in the present patient , is very infrequent .
it is thought that the formation of the cysts results from the embedding and invagination of squamous epithelium and sebaceous glands in the line of the scar which then desquamates and produce a cystic mass .
the cyst can be small from childhood without causing discomfort , although it may require excision because of inflammation , secondary infection , or malignant transformation . in the puberty ,
the cyst can increase in size rapidly in response to estrogen . in a study of 37 patients with clitoral epidermoid inclusion cyst in a hospital of nigeria ,
to our knowledge , this is the first case reported in europe that developed the cyst more than 30 years after fgm .
a high index of suspicion is required in a woman with vulvar swelling , especially in the case of history of fgm , trauma , or surgery in the genital area .
this is the first case reported in europe that developed a vulvar inclusion cyst more than 30 years after fgm .
this report aims to raise the awareness of the medical community to the dangers that arise from a remote complication of fgm .
this is the first case reported in europe that developed a vulvar inclusion cyst more than 30 years after fgm .
this report aims to raise the awareness of the medical community to the dangers that arise from a remote complication of fgm .
this is the first case reported in europe that developed a vulvar inclusion cyst more than 30 years after fgm .
this report aims to raise the awareness of the medical community to the dangers that arise from a remote complication of fgm .
we present a case report of a patient with epidermal inclusion cyst as a late complication of female genital mutilation ( fgm ) . 
 we describe the management of the patient , and a review of the literature . 
 we report the clinical and pathological findings in a 37-year - old female patient from nigeria , with a clitoral mass of 1 year duration . 
 she declared to have an fgm since she was 5 years . 
 the lesion was excised successfully with good cosmetic results . 
 histological examination revealed epidermal cyst with the presence of granular layer . 
 an epidermal inclusion cyst can develop as a long - term consequence of fgm .