Spandana Gabbeta, Kumar Naina, Pradeep Immanuel, Veldi Srujana, Aparna Jarathi, Devalla Anusha
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bibinagar, 508126, Hyderabad Metropolitan Region, Telangana, India.
Department of Pathology, All India Institute of Medical Sciences, Bibinagar, 508126, Hyderabad, Telangana, India.
Infect Disord Drug Targets. 2025 Jun 24. doi: 10.2174/0118715265378101250611104752.
Vulvar cancer, a rare malignancy of the female genital tract, accounts for approximately 4% of all gynaecological cancers. Among vulvar malignancies, Squamous Cell Car-cinoma (SCC) constitutes about 90% of the cases, frequently arising from precursor lesions, such as Vulvar Intraepithelial Neoplasia (VIN). This case report describes an unusual presentation of both premalignant and malignant vulvar lesions in a postmenopausal, post-hysterectomized woman, high-lighting diffuse p16 positivity on immunohistochemistry. This finding underscores the potential role of Human Papillomavirus (HPV) in the pathogenesis of vulvar SCC.
A 73-year-old multiparous, post-menopausal woman presented with a five-month his-tory of vulvar growth accompanied by intense vulval itching and vaginal discharge. Initially referred by the dermatology department as a case of condyloma acuminatum for gynaecological evaluation, her local examination revealed three distinct lesions on the vulva: an exophytic, cauliflower-like warty lesion on the left labia majora; a blackish, pigmented maculopapular lesion on the right labia majora; and a friable, warty lesion over the clitoris extending beneath the clitoral hood. A wide local excision was performed, and histopathological examination of the left and right labial growths indi-cated VIN Grade 3. The biopsy from the clitoral lesion revealed features of SCC. Immunohistochem-ical analysis demonstrated diffuse p16 positivity in the tumor cells of the clitoral lesion, supporting an HPV-associated etiology. Subsequently, the patient underwent a modified radical vulvectomy with bilateral lymphadenectomy. Histopathological findings confirmed SCC of the vulva, staged as IB, with no lymph node involvement.
This case emphasizes the diverse presentation of vulvar lesions and the critical role of HPV in vulvar carcinogenesis, particularly in postmenopausal women.
外阴癌是女性生殖道的一种罕见恶性肿瘤，约占所有妇科癌症的4%。在外阴恶性肿瘤中，鳞状细胞癌（SCC）约占病例的90%，常起源于前驱病变，如外阴上皮内瘤变（VIN）。本病例报告描述了一名绝经后、子宫切除术后女性的癌前和恶性外阴病变的不寻常表现，突出了免疫组化中弥漫性p16阳性。这一发现强调了人乳头瘤病毒（HPV）在外阴SCC发病机制中的潜在作用。
一名73岁多产绝经后女性，有五个月的外阴肿物病史，伴有剧烈外阴瘙痒和阴道分泌物。最初皮肤科将其作为尖锐湿疣病例转诊至妇科进行评估，其局部检查发现外阴有三个不同的病变：左侧大阴唇有一个外生性、菜花状疣状病变；右侧大阴唇有一个黑色色素沉着斑丘疹病变；阴蒂上有一个易碎的疣状病变，延伸至阴蒂包皮下方。进行了广泛局部切除，左右阴唇肿物的组织病理学检查显示为VIN 3级。阴蒂病变活检显示为SCC特征。免疫组化分析显示阴蒂病变肿瘤细胞中弥漫性p16阳性，支持HPV相关病因。随后，患者接受了改良根治性外阴切除术及双侧淋巴结清扫术。组织病理学结果证实为外阴SCC，分期为IB期，无淋巴结转移。
本病例强调了外阴病变的多样表现以及HPV在外阴致癌作用中的关键作用，尤其是在绝经后女性中。
