Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Medicina (Kaunas). 2023 Jan 20;59(2):206. doi: 10.3390/medicina59020206.
: There is a broad spectrum of vulvar pigmented lesions that differ based on their histopathological and clinical features. Chronic vulvar purpura is a rare entity, associated with a broad morphological spectrum, from lichen aureus, Zoon's vulvitis, pigmented purpuric dermatosis and with lichen planus as in our case. In this article we discuss a case of an 86-year-old white woman with hyperpigmentation on her upper vulva, next to the introitus, with complaints of urine incontinence. Biopsy revealed subepithelial stromal lichenoid inflammatory infiltrate containing plasma cells, lymphocytes and some neutrophilic granulocytes as well as dilated and congested vessels. Hemosiderin deposits and erythrocyte extravasation were found. There was evidence of hyperkeratosis with hyper granulosis and erosions. Spongiosis was also noted. Few melanocytes were identified with no sign of malignancy. These findings correlate with the diagnosis of vulvar lichen planus. Chronic vulvar purpura is a clinical term used for different chronic inflammatory dermatoses presenting as red bluish or violaceous discolorations on the vulva, often associated with cayenne-pepper-like speckling. Considering a great overlap of possible diseases, the final diagnosis could be challenging. It is important to exclude a melanocytic tumour in these cases.
: 外阴色素沉着病变范围广泛，根据其组织病理学和临床表现而有所不同。慢性外阴紫癜是一种罕见的疾病，与广泛的形态学谱相关，包括金黄色苔藓、佐恩氏外阴炎、色素性紫癜性皮炎以及我们病例中的扁平苔藓。本文讨论了一位 86 岁白人女性的病例，其外阴上部靠近阴道口处有色素沉着，伴有尿失禁的主诉。活检显示，上皮下基质苔藓样炎症浸润，其中含有浆细胞、淋巴细胞和一些中性粒细胞，以及扩张和充血的血管。还发现含铁血黄素沉积和红细胞外渗。有角化过度、颗粒层增厚和糜烂的证据。海绵形成也有报道。有少量黑素细胞，没有恶性的迹象。这些发现与外阴扁平苔藓的诊断相符。慢性外阴紫癜是一个临床术语，用于描述不同的慢性炎症性皮肤病，表现为外阴出现红色、蓝紫色或紫蓝色变色，常伴有辣椒样斑点。鉴于可能存在许多重叠的疾病，最终诊断可能具有挑战性。在这些情况下，排除黑素细胞肿瘤很重要。
