A Rare Presentation of Lichen Sclerosus Involving the Vaginal Canal After Radiation Therapy: A Case Report and Review of the Literature

Abstract

Vaginal lichen sclerosus (LS) is an extremely rare entity. Classically, LS is referred to as a chronic, inflammatory skin disease with a distinct predilection for the anogenital skin that is observed in post-menopausal women and typically manifests clinically as white, atrophic plaques. Here, we report a case of a 61-year-old patient who presented for a follow-up visit three years after vaginal brachytherapy as an adjuvant treatment for endometrial adenocarcinoma. This lesion was biopsied and confirmed to be vaginal LS on histological analysis. While LS has been previously observed to impact mucosal areas outside of the anogenital region, such as the mouth, reported cases of vaginal LS are very rare in the literature. Our case highlights both the underrecognized location of this disease as well as radiation as a potential risk factor.

Keywords: female lichen sclerosis; lichen sclerosus; lichen sclerosus clinical manifestasions; post radiation lichen sclerosus; vaginal lichen sclerosis.

Figure 1. (A) Low power view (4x), demonstrating lichen sclerosus of the vagina evidenced by the widespread hypocellular edematous zone bounded by thin, atrophic epithelium on the surface and inflamed stroma showing chronic inflammatory infiltrate (arrow). (B) Medium power view (10x) highlighting a thin atrophic surface epithelium (arrow); the opposite side reveals normal stratified squamous epithelium.

Figure 2. High-power review (20x) of the vaginal biopsy demonstrating eosinophilic homogenization of the collagen in the subepithelial layer, including edema and chronic inflammatory infiltrates. A minor component of the vacuolar interface reaction pattern can be appreciated below the basal epithelium.