Hypertrophic plaques on the vulva

Abstract

An otherwise healthy woman in her 40s presented with a 2-year history of itching of the vulva. She had been diagnosed with dermatitis and prescribed topical corticosteroids, but to little effect. She denied high-risk sexual contacts or exposure to potential contact allergens. Physical examination revealed well-demarcated white-red and hypertrophic plaques, with scattered dotlike erosions. As shown in Figure 1, vulvar skin changes were visualized as the patient retracted the surrounding tissues. Histopathologic examination revealed a proliferation of Paget cells within the surface squamous epithelium (Figure 2), with the Paget cells displaying positive staining for carcinoembryonic antigen and cytokeratin (CK) 7, and negative staining for AE1/AE3, CK20, and melan-A.