Vulvar Lesions in a 66 Year Old

Richard K. Cochran, M.D.

Specimen Type:

Vulva

History:

This 66 year old woman presented with whitish plaque-like vulvar lesions. A vulvar biopsy was performed.

Pathologic Features:

Examination of the hematoxylin and eosin stained sections revealed compact hyperkeratosis in the stratum corneum (Figs 1 and 2). The underlying epidermis was thinned and composed of keratinocytes that had round to ovoid, regular nuclei with a uniform chromatin distribution (Figs 2 and 3). Vacuolar change was present in the basal keratinocytes along the epidermal-dermal junction. The papillary dermis was edematous and relatively acellular (Figs 2 and 3). Beneath this zone of edema, a predominantly lymphocytic chronic inflammatory cell infiltrate was present in the dermis (Figs. 1 and 4).

Differential Diagnosis:

  • Lichen Sclerosus
  • Lichen Planus

Diagnosis:

Lichen Sclerosus

In lichen planus, as in lichen sclerosus, there is compact hyperkeratosis of the stratum corneum as well as vacuolar change in the basal keratinocytes along the epidermal-dermal junction. Hypergranulosis is usually present but may be absent in mucosal vulvar lesions. The band-like chronic inflammatory cell infiltrate in lichen planus is present in the papillary dermis and abuts and may obscure the epidermal-dermal interface. Eosinophilic Civatte bodies (necrotic basal keratinocytes) are present. Edematous changes in the papillary dermis, as seen in lichen sclerosus, are not present in lichen planus1,2.

References:

  1. Fu, YS, ed., Pathology of the Uterine Cervix, Vagina, and Vulva, 2nd edition, Saunders, 2002. pp 145-147, 152-155.
  2. Robboy, SJ, Mutter, GL, Prat, J, Bently, RC, Russell, P, and Anderson, MC, eds. Robboys Pathology of the Female Reproductive Tract, 2nd edition, Churchill Livingstone, 2009. pp. 31-35.