Case Number : Case 1882 - 15 Aug - Dr Uma Sundram Posted By: Guest

Islands of cells some of which are dark and some showing pale cytoplasm, along with the site of lesion (vulva) makes me think of syringoma showing clear cell change in some areas

For me there is an acanthotic epidermis with areas of dysmaturation and premature keratinization overlaying a dermis with broad condensated collagen.  This is consistent with differentiated VIN and lichen sclerosus. The main problem of the biopsy is the bad orientation that can simulate invasive areas. But considering the highly pleomorphic cells and irregular nests with jagged edges from my point of view there are real areas suspicious of invasion.

In Figure 4, epithelial cells showed enlarged nuclei with ground glass appearance. I suspect  pseudoepitheliomatous hyperplasia associated with herpes infection mimicking invasive carcinoma.

Herpesvirus infection in the setting of lichen sclerosus.

Herpes mimicking invasive SCC.  The biopsy is misoriented which may make the dermis seem more sclerotic.

A symptomatic herpes infection should show ballooning degeneration of epidermis, multinucleated keratinocytes and inflammatory infiltrate.

Can it be Bowenoid papulosis? A clinician hardly ever biopsies a lesion of herpes on the genitals. The clinical features are so distinctive and we have serology and viral culture for confirmation.