Atypical vulval cutaneous manifestation of chronic lymphocytic leukaemia following genital herpes masquerading as vulvar carcinoma: a case report

Abstract

Chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) is the most common adult leukaemia in Western countries, characterised by monoclonal proliferation of mature B lymphocytes and accounting for approximately 1% of all new cancers in the UK. Although it primarily affects lymphoid tissues, extra nodal involvement can occur, most frequently involving the skin and central nervous system. Involvement of the female genital tract is rare and presents significant diagnostic challenges. We report an unusual case of vulval involvement by CLL mimicking vulval carcinoma. An elderly woman presented with a 6-week history of vulval ulceration. Initial biopsy demonstrated chronic inflammation without evidence of malignancy. She was subsequently diagnosed with low-level CLL and managed conservatively with active surveillance. Over time, she developed worsening vulval pain, extensive ulceration, and recurrent infections requiring multiple hospital admissions. Imaging findings and clinical progression raised strong suspicion of vulval malignancy with nodal involvement; however, repeated biopsies remained non-diagnostic. Multidisciplinary histopathological review ultimately confirmed vulval infiltration by low-grade B-cell lymphoma consistent with CLL. The clinical picture was further complicated by concurrent herpes simplex virus type 2 infection and secondary bacterial infection. This case highlights the importance of considering leukaemia cutis in non-healing vulval ulcers in patients with CLL. Early multidisciplinary involvement, repeated adequate biopsies, and appropriate viral testing are essential to avoid misdiagnosis and ensure optimal management.