Vulvar Lesions in a 66 Year Old

Richard K. Cochran, M.D.

Specimen Type:



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


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.


  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.