Jump to content

Dr. Mona Abdel Halim's Blog

  • entries
    56
  • comments
    78
  • views
    12,273

Verrucous lesions on the vulva, not necessarily condylomas!!


Dr. Mona Abdel-Halim

2,475 views

 Share

I came across an interesting case last week that I would like to share with you. A female patient 58 years old was referred to me and my colleague, Dr Eman El Nabarawy, with a lesion on the vulva that had been there for 15 years. The patient was diagnosed by her gynecologist to have genital wart (condyloma), in spite of the much localized nature of the lesion and the very long duration. The patient being a widow for 5 years with no sexual relations was not convinced and seeked the advice of a dermatologist who sent her to me for biopsy.
The lesion was in the form of a plaque with a papillomatous smooth surface and a central fibroepithelial polyp (skin tag) like part. The biopsy revealed mild hyperkeratosis with focal parakeratosis, acanthotic papillomatous epidermis with fibrovascular cores and sparse perivascular lymphohistiocytic infiltrate. No koilocytes were detected. I diagnosed this case with my colleague as squamous papillomatosis of the vulva.
It was a nice opportunity to revise the differential diagnosis of verrucous lesions on the vulva. Interestingly to say we found many lesions that can appear on the vulva that can mimic condyloma on first sight such as: squamous papillomatosis, seborrheic keratosis, verrucous nevi and epidermolytic acanthoma. Although squamous papillomatosis of the vulva commonly involves the vestibule, we found a case report describing a case exactly similar to ours where the lesions were outside the vestibule (Mehta et al., 2009*).
Clinicopathological correlation is mandatory in diagnosing many skin diseases and clinicians should respect history given by the patients including duration of the lesions. Always put in your mind that verrucous lesions on the vulva are not necessarily condylomas!!!


*Mehta V, Durga L, Balachandran C and Rao L: Verrucous growth on the vulva. Indian Journal of Sexually Transmitted Diseases and AIDS 2009; 30(2): 125-126
 Share

7 Comments


Recommended Comments

Dear Mona, this is so interesting, because from the clinical point of view for gynecologist everything might look like a condyloma, however, as you perfectly described the differential diagnosis is broad, and we need to be aware of that. I usually tell my residents that one should be very careful in diagnosing condylomata, and not vacuolated cytoplasms are coilocytes.
Link to comment
Dr. Phillip McKee

Posted

It just goes to prove the point that clinicopathological although essential, does not always work and sometimes it is the pathologist who solves the problem
Link to comment
Mark A. Hurt MD

Posted

Dear Mona, do you think there is any relationship between these lesions and pearly penile papules of the penis?
Link to comment
Guest Dr Gonzalo de Toro

Posted

Another diagnosis to keep in mind is vulvar lymphangiomas. Martin Sangueza shows a really "condylomatous" cases in the last RADLA
Link to comment
Dr. Richard Carr

Posted

Dear Mona - I found this blog very interesting. To continue the theme...

I think many "lymphangioma-like" lesions of the vulva are due to chronic localised
lymphoedema. Localised vulval chronic lymphoedema can also present with warty plaques
and fibroepithelial-polyp like lesions in addition to swelling and masses (sometimes
truely massive).

Histologically in addition to lymphangioma localised chronic lymphoedema of the
vulva can mimic simple fibroepithelial polyps and aggressive angiomyxoma. Helpful
clues are fibrosis and inflammatory infiltrates and a good history (other diseases
and procedures not to mention body mass index!)

Refs
Lu S, Tran TA, Jones DM, Meyer DR, Ross JS, Fisher HA, Carlson JA. Localized lymphedema (elephantiasis): a case series and review of the literature. J Cutan Pathol. 2009 Jan;36(1):1-20. Epub 2008 Jun 17.

D'Antonio A, Caleo A, Boscaino A, Mossetti G, Iannantuoni N.
Vulvar lymphoedematous pseudotumours mistaken for aggressive angiomyxoma: report of two cases.
Gynecol Obstet Invest. 2010;69(3):212-6.

Fadare O, Brannan SM, Arin-Silasi D, Parkash V.
Localized lymphedema of the vulva: a clinicopathologic study of 2 cases and a review of the literature.
Int J Gynecol Pathol. 2011 May;30(3):306-13.
Link to comment
Guest Dr Gonzalo de Toro

Posted

I agree with Dr. Carr that the term "localized vulvar lymphedema" is an appropriate generic descriptor for the spectrum of lesions whose fundamental and underlying etiology is thought to be chronic lymphedema and maybe we must reserve the term Lymphangioma is patiens without obesity, chronic immobilization or surgeries/radiotherapy which can cause damage to deep lymphatics.
Link to comment
Dr. Hafeez Diwan

Posted

This blog addresses a very important issue, and together with the comments, provides a nice overview of the topic. An incorrectly diagnosed "condyloma" can be distressing to the patient, have broad medical and social implications, and can also come back to haunt the pathologist. A colleague told me some time ago about a case where a pathologist was sued for a misdiagnosis of condyoma.
Link to comment
×
×
  • Create New...