Track

Case Reports

Abstract

39-year-old P3 female with a remote history of vulvar intraepithelial neoplasia (VIN2) presented to the gynecologic clinic with painful recurrent spontaneous vulvar fissures and lesions that flare prior to, and resolve during, menstruation. On exam, she had hypopigmented plaques with warty-appearing lesions between the labia majora and minora with a few shallow excoriations. Topical corticosteroids failed to alleviate her symptoms, and no other topical therapy was attempted. One of the warty lesions was biopsied and read as squamous mucosa with atypia of uncertain significance, prompting biopsy of the additional warty lesions. Both biopsies were reviewed. The squamous epithelium showed mild thickening without cytologic atypia, but with numerous karyorrhectic cells with perichromatin halos in the superficial squamous layers. These changes resembled the “pseudobowenoid” features sometimes associated with topical podophyllin therapy. Standard mitotic figures were not identified, and the ki-67 proliferative index was low. P16 showed patchy expression with wild-type p53. In-situ hybridization for HPV types 6,11,16, and 18 were negative. Similar features have been previously reported as flat condylomas with pseudobowenoid change which are thought to be associated with rare low-risk HPV subtypes (other than types 6 and 11). However, there has been scant mention in medical literature since the initial report in 1996. At 2 months post follow-up, our patients’ warty lesions had not recurred, although she had minimal improvement of her excoriations and discomfort.  Knowledge of this entity can ensure that such lesions are not overcalled and overtreated as high grade squamous intraepithelial lesions.