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 Car-cinoma (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, high-lighting 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 his-tory 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 indi-cated VIN Grade 3. The biopsy from the clitoral lesion revealed features of SCC. Immunohistochem-ical 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.