Metastastic Vulvar Squamous Cell Carcinoma Mimicking Genital Herpes
Metastastic Vulvar Squamous Cell Carcinoma Mimicking Genital Herpes
Metastastic Vulvar Squamous Cell Carcinoma Mimicking Genital Herpes
INTRODUCTION
Abbreviations used:
Metastatic disease to the skin can be difficult to
diagnose clinically because it often mimics many HSV: herpes simplex virus
SCC: squamous cell carcinoma
infectious, inflammatory, and neoplastic skin condi-
tions. Cutaneous metastases can present as dermal or
subcutaneous nodules, exophytic tumors resem-
bling melanoma or nonmelanoma skin cancer, Bilateral inguinal lymphadenopathy was noted.
erythematous patches and plaques resembling Direct fluorescent antibody testing and viral cultures
erysipelas or eczema, or indurated plaques resem- were negative for HSV and varicella zoster viruses.
bling morphea or scleroderma.1 Rarely, cutaneous Tissue culture was negative for bacteria, fungi, and
metastases present as grouped papulo-vesicles acid-fast bacilli. Histopathologic examination of a
resembling herpes group virus infections.1 vesicle edge found focal epidermal necrosis, intra-
epidermal spongiform vesiculation, and mononu-
clear cells with hyperchromatic nuclei, prominent
CASE REPORT nucleoli, and atypical mitotic figures filling superfi-
A 76-year-old woman with a history of stage IV cial and deep dermis and extending into the subcu-
vulvar squamous cell carcinoma (SCC) and recurrent taneous fat (Fig 2, A and B). The atypical
genital herpes simplex virus (HSV) infections was mononuclear cells abut but do not arise from the
seen by the inpatient dermatology consult service for epidermis, and these cells stained strongly with
a 1-week history of a burning sensation in the groin antibodies against AE1/AE3 and CAM5.2, confirming
that was followed by the appearance of a vesicular their epithelial origin (Fig 2, C ). The current biopsy
rash. Invasive, poorly differentiated SCC of the of the suprapubic skin was compared with the
anterior aspect of the vagina with metastases to the patients prior vulvar SCC biopsy and results were
right pubic ramus and inguinal and iliac lymph nodes found to be compatible with metastatic poorly
was diagnosed 4 months before presentation. The differentiated vulvar SCC. The patient was dis-
patient was treated with a combination of cisplatin charged to hospice 5 days after biopsy and subse-
and radiation, with her treatment course complicated quently died 1 day later.
by radiation dermatitis, a vesicovaginal fistula,
bladder outlet obstruction, and sacral decubitus
ulcers, for which the patient required debridement DISCUSSION
and placement of a suprapubic catheter. Vulvar cancer is uncommon, accounting for only
Physical examination found a cachectic white 5% of female genitourinary malignancies.2 Vulvar
woman with grouped tense vesicles on an erythem- SCC accounts for more than 90% of all vulvar
atous base involving the suprapubic skin (Fig 1). malignancies and presents in 2 different histologic
From the Department of Dermatology, University Hospitals Case JAAD Case Reports 2016;2:387-9.
Medical Center. 2352-5126
*
Coefirst authors. 2016 by the American Academy of Dermatology, Inc. Published
Funding sources: This work was supported by grants from The by Elsevier, Inc. This is an open access article under the CC BY-
Char and Chuck Fowler Family Foundation and The Derma- NC-ND license (http://creativecommons.org/licenses/by-nc-nd/
tology Foundation. 4.0/).
Conflicts of interest: None declared. http://dx.doi.org/10.1016/j.jdcr.2016.08.004
Correspondence to: Jeffrey F. Scott, MD, University Hospitals Case
Medical Center, Department of Dermatology, 11100 Euclid Avenue,
Cleveland, OH 44106. E-mail: Jeffrey.scott@uhhospitals.org.
387
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