Spectrum of vulvar lesions: patient’s anxiety, clinician’s concern and pathologist’s diagnostic challenge

Authors

  • Dharitri M. Bhat Department of Pathology, Government Medical College, Nagpur, Maharashtra, India
  • Vrushali A. Mahajan Department of Pathology, Government Medical College, Nagpur, Maharashtra, India
  • Dinkar T. Kumbhalkar Department of Pathology, Government Medical College, Nagpur, Maharashtra, India
  • Waman K. Raut Department of Pathology, Government Medical College, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20192458

Keywords:

Human papilloma virus, Lichen sclerosus atrophicus, Vulvar lesions, Vulvar intraepithelial neoplasia, Vulvar amoebic ulcer

Abstract

Background: A wide variety of inflammatory, premalignant and malignant lesions can occur on the vulva. Some of the lesions are limited to the vulva, while some also involve other parts of the body. Although vulvar diseases can cause a significant issue in the patients, they are less commonly discussed than those of cervix, uterus and ovary. Most of the asymptomatic lesions remain un-noticed, and are seen during routine gynecological checkups. Common complaints in symptomatic lesions are lumps, discomfort, itching and pain. Since the symptoms are nonspecific; determining the location of the lesion can assist with the diagnosis. Being a genital part with skin covering on outer aspect and mucosal lining inside, it is associated with various dermatological, nutritional, and hormonal as well as sexually transmitted diseases. The present study thus was conducted to categorize vulvar lesions based on their histological diagnosis and also to study the morphological spectrum of precursor lesions for malignancy.

Methods: Present study includes all types of vulvar lesions sent for pathological study in the Department of pathology, at GMC Nagpur over the period of one year.

Results: Total 34 lesions were studied including a wide diagnostic range from inflammatory, dermatological to benign, premalignant and malignant. Inflammatory lesions including various infections and LSA (Lichen sclerosus atrophicus) were the most commonly seen lesions along with collection of neoplastic lesions.

Conclusions: Proper diagnostic categorization of the lesions is essential for initiating therapy and reducing patient’s anxiety. Morphology of these lesions along with their diagnostic significance is discussed.

References

Margesson LJ, Haefner HK. Vulvar lesions: differential diagnosis based on morphology. Dellavalle RP, ed. Up to Date Waltham MA: up to date. Available at; Https://www.uptodate.com. Accessed on 28 April 2019.

Farage M, Maibach H. Lifetime changes in the vulva and vagina. Arch Gynecol Obstet. 2006;273(4):195-202.

Laga AC, Lazar JFA, Haefner HK, Granter SR. Noninfectious inflammatory disorders of the vulva. In: Crum C et al ed. Diagnostic Gynaecology and Obstetrics Pathology. 3rd ed. Elsevier; 2011:50-86.

Medscape. Vulvovaginitis; 2018. Available at https://emedicine.medscape.com. Accessed May 2019.

Mohan H. Spectrum of vulvar lesions: a clinicopathologic study of 170 cases. Int J Reproduct Contra Obstet Gynecol. 2016;l(3):175-80.

Tyring SK. Vulvar squamous cell carcinoma: guidelines for early diagnosis and treatment. Am J Obstet Gynecol. 2003;189(3 Suppl):S17-23.

Hoang LN, Park KJ, Soslow RA, Murali R. Squamous precursor lesions of the vulva: current classification and diagnostic challenges. Pathol. 2016;48(4):291-302.

Hanprasertpong J, Chichareon S, Wootipoom V, Buhachat R, Tocharoenvanich S, Geater A. Clinico-pathological profile of vulva cancer in southern Thailand:analysis of 66 cases. J Med Assoc Thai. 2005;88(5):575-81.

Bowen AR, Vester A, Marsden L, Florell SR, Sharp H, Summers P. The role of vulvar skin biopsy in the evaluation of chronic vulvar pain. Am J Obstet Gynecol. 2008;199(5):467.e1-6.

Leighton PC, Langley FA. A clinico-pathological study of vulval dermatoses. J Clin Pathol. 1975;28(5):394-402.

Healthline. Ulcers Vulva: Symptoms, Causes, Diagnosis, traatment and more; 2018. Available at; https://www.healthline.com. Accesed on May 2019.

Veliath AJ, Bansal R, Sankaran V, Rajaram P, Parkash S. Genital amebiasis. Int J Gynaecol Obstet. 1987;25(3):249-56.

O'Keefe RJ, Scurry JP, Dennerstein G, Sfameni S, Brenan J. Audit of 114 non-neoplastic vulvar biopsies. Br J Obstet Gynaecol. 1995;102(10):780-6.

Chan MP, Zimarowski MJ. Vulvar dermatoses: a histopathologic review and classification of 183 cases. J Cutan Pathol. 2015;42(8):510-8.

Bhatia NN, Bergman A, Broen EM. Advanced hidradenitis suppurativa of the vulva. A report of three cases. J Reprod Med. 1984;29(7):436-40.

Wilkinson EJ, Massoll NA. Benign diseases of the vulva. In Kurman RJ, Ellenson LH,Ronnett BM ed. Blaustein’s Pathology of the Female Genital Tract. 6th edition.Springer; 2011:1-55.

Sermpetzoglou AZ, Myoteri D, Koulia K, Kontostolis V, Moschouris H, Dellaportas D. Aggressive Angiomyxoma of the Vulva: A Bizarre Perineal Lesion. Case Reports in Oncological Medicine. 2015:Article ID 292304.

Cohen PR, Young AW, Tovell HM. Angiokeratoma of the vulva: diagnosis and review of the literature. Obstet Gynecol Surv. 1989;44(5):339-346.

LiVolsi VA, Brooks JJ. Soft tissue tumors of the vulva. In: Wilkinson EJ (ed) Contemporary issues in surgical pathology, Pathology of the vulva and vagina. Churchill Livingston., New York. 1987;9:209-38.

Tochika N, Takeshita A, Sonobe H, Matsumoto M, Kobayashi M, Araki K. Angio myofibroblastoma of the vulva: report of a case. Surg Today. 2001;31(6):557-9.

Laskin WB, Fetsch JF, Tavassoli FA. Angiomyofibroblastoma of the female genital tract: analysis of 17 cases including a lipomatous variant. Hum Pathol. 1997;28(9):1046-55.

Varras M, Akrivis C, Demou A, Kitsiou E, Antoniou N. Angiomyofibroblastoma of the vagina in a postmenopausal breast cancer patient treated with tamoxifen:clinicopathologic analysis of a case and review of the literature. Int J Gynecol Cancer. 2006;16(2):581-5.

Odoi AT, Owusu-Bempah A, Dassah ET, Darkey DE, Quayson SE. Vulvar lipoma: is it so rare?. Ghana Med J. 2011;45(3):125-7.

Jayi S. Vulvar lipoma: a case report. J Med Case Reports. 2014;8:203.

Fonseca-Moutinho JA. Vulvar intraepithelial neoplasia: a current problem. Rev Bras Ginecol Obstet. 2008;30(8):420-6.

Scurry J, Campion M, Scurry B, Kim SN, Hacker N. Pathologic audit of 164 consecutive cases of vulvar intraepithelial neoplasia. Int J Gynecol Pathol. 2006;25(2):176-81.

Wade TR, Kopf AW, Ackerman AB. Bowenoid papulosis of the genitalia. Arch Dermatol. 1979;115(3):306-8.

Rosai J. Female reproductive system: Vulva. In Rosai J ed. Rosai and Ackerman’s Surgical Pathology.. Mosby Elsevier. 2011;2:1399-425.

Rodolakis A, Diakomanolis E, Vlachos G, Iconomou T, Protopappas A, Stefanidis C, et al. Vulvar intraepithelial neoplasia (VIN): diagnostic and therapeutic challenges. Eur J Gynaecol Oncol. 2003;24(3-4):317-22.

Robinson Z, Edey K, Murdoch J. Invasive vulval cancer. Obstet Gynaecol Reprod Med. 2011;21(5):129- 136.

Del Pino M, Rodriguez-Carunchio L, Ordi J. Pathways of vulvar intraepithelial neoplasia and squamous cell carcinoma. Histopathol. 2013;62(1):161-75.

Simcock B. Invasive vulval cancer. Obstet Gynaecol Reprod Med. 2008;18(3):64-8.

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Published

2019-05-28

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Original Research Articles