Two Sides of the Same Coin: Human Papillomavirus-driven Vulval Intraepithelial Neoplasia and Squamous Cell Carcinoma in a Postmenopausal Woman: A Rare Case Report.

INTRODUCTION

Vulvar cancer, a rare malignancy of the female genital tract, accounts for approximately 4% of all gynaecological cancers. Among vulvar malignancies, Squamous Cell Carcinoma (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, highlighting diffuse p16 positivity on immunohistochemistry. This finding underscores the potential role of Human Papillomavirus (HPV) in the pathogenesis of vulvar SCC.

CASE REPORT: A 73-year-old multiparous, post-menopausal woman presented with a five-month history 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 indicated VIN Grade 3. The biopsy from the clitoral lesion revealed features of SCC. Immunohistochemical 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.

CONCLUSION

This case emphasizes the diverse presentation of vulvar lesions and the critical role of HPV in vulvar carcinogenesis, particularly in postmenopausal women.