Squamous Cell Carcinoma of the Vulva in Geriatric With Clinical Features of Papillomatous Plaque Resembling Anogenital Warts Caused by Human Papillomavirus Types 6 and 11

Abstract

Squamous cell carcinoma (SCC) of the vulva is caused by disturbances in the proliferation and differentiation of the squamous epithelium, which can be associated with human papillomavirus (HPV) infection. Vulvar SCC is usually caused by high-risk HPV types, although there are some cases that are caused by low-risk HPV types. The clinical manifestations of vulvar SCC vary, one of which can resemble anogenital warts. A case of vulvar SCC was reported in a 75-year-old woman with a lesion that appeared as a yellowish-white papillomatous plaque on the vulva. From the history taking, it was found that the skin disorder had a chronic course. A skin biopsy was performed on the patient and from histopathological examination found hyperplastic, parakeratotic, and acanthotic stratified squamous epithelial cells with koilocytosis. In addition, there was evidence of tumor cell invasion in the connective tissue stroma with polymorphic and hyperchromatic nuclei, supporting a diagnosis of well-differentiated vulvar SCC. Genotyping polymerase chain reaction revealed the presence of HPV types 6 and 11 deoxyribonucleic acid. The risk of malignancy in low-risk HPV must be considered, especially in the elderly. HPV-dependent SCC caused by low-risk HPV types 6 and 11, though uncommon but still possible, with clinical manifestations that resemble anogenital warts.

Keywords: anogenital warts; low-risk human papillomavirus (HPV); sexually transmitted; squamous cell carcinoma (SCC).

Figure 1

(a-b) White-to-yellowish genital lesion.

Figure 2

(a-b) Histopathological examination results. (a) The epithelial cells that appear to have transformed into a tumor mass (black asterisks) consisting of round to polygonal cells with invasion into the underlying connective tissue stroma, which consists of round to oval cells that are hyperplastic, dense, and clustered. (b) Koilocytosis is observed in some nuclei (red arrows), indicating HPV-associated cytopathic changes.