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CASE SNIPPET
Year : 2012  |  Volume : 58  |  Issue : 4  |  Page : 307-308

Vulval tuberculosis masquerading as vulval carcinoma


1 Department of Pathology, National Institute of Pathology, Safdurjang Hospital Campus, New Delhi, India
2 V.M.M.C. and Safdarjung Hospital, New Delhi, India

Date of Web Publication4-Jan-2013

Correspondence Address:
V Mallya
Department of Pathology, National Institute of Pathology, Safdurjang Hospital Campus, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.105463

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How to cite this article:
Mallya V, Yadav Y K, Gupta K. Vulval tuberculosis masquerading as vulval carcinoma. J Postgrad Med 2012;58:307-8

How to cite this URL:
Mallya V, Yadav Y K, Gupta K. Vulval tuberculosis masquerading as vulval carcinoma. J Postgrad Med [serial online] 2012 [cited 2020 Oct 20];58:307-8. Available from: https://www.jpgmonline.com/text.asp?2012/58/4/307/105463


Tuberculosis of the vulva and vagina is an extremely rare entity and is seen in only 1-2% of genital tuberculosis cases. [1],[2],[3] Tuberculosis more commonly affects the upper genital tract that is the endometrium and  Fallopian tube More Details and is seen in women of the reproductive age group and is a major cause of infertility in these women. [1],[4],[5] We present a case of vulval tuberculosis in a 75-year-old post-menopausal woman who presented to the gynecology department with a firm nodular swelling of the vulva. She gave a history of burning micturition since two months with itching in the vulval region. She gave no history of fever, cough or abdominal pain or a tuberculosis contact. Tests for acquired immunodeficiency syndrome (AIDS) and syphilis were negative. On examination her abdomen was soft with no organomegaly. The labia were red, nodular and firm [Figure 1]. No inguinal lymph nodes were palpable. A clinical diagnosis of vulval carcinoma was made. Ultrasound and computed tomography (CT) scan of the pelvis and abdomen were normal. Erythrocyte sedimentation rate (ESR) was found to be 60 mm in the first hour. A punch biopsy of the lesion was taken. The biopsy showed epidermal hyperkeratosis with acanthosis. Dermis showed large areas of necrosis with epithelioid cells forming granulomas admixed with foreign body and langhans giant cells [Figure 2]. A diagnosis of vulval tuberculosis was made. The patient was put on anti-tuberculous treatment for six months. The labial swelling disappeared and a biopsy taken after the therapy showed absence of caseating granulomas. Tuberculosis of the female genital tract is a frequent cause of chronic pelvic inflammatory disease and infertility in developing countries. [1] It is not very common in post-menopausal women. [5] The endometrium and fallopian tubes are infected by hematogenousspread. [1] Cervix and very rarely the vulva and vagina can get involved by direct extension from the upper genital tract or by lymphatic spread with the primary lesion being healed at the time of presentation. [1] Primary inoculation or sexual transmission of tuberculosis is most uncommon. [5] Grossly, vulval tuberculosis appears as shallow ulcers with undermined edges or it may be hypertrophic resembling elephantiasis vulva simulating a carcinoma. [1],[2] The usual organism is Mycobacterium tuberculosis, though atypical mycobacteria have been described in a renal transplant patient. [5] Our patient was a 75-year-old lady who presented with the hypertrophic form of tuberculosis simulating a carcinoma.
Figure 1: Labia minora was firm, hypertrophied and erythematous (arrow mark)

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Figure 2: The dermis showing epithelioid cells forming granulomas admixed with langhansgiant cells (arrow mark) (H and E ×200)

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Vulval tuberculosis though very rare responds very well to six months of standard anti-tuberculous therapy. [1],[4] The patient responded well to six months of anti-tuberculous therapy and at the end of the regime the lesions had healed. With the recent advent of the AIDS pandemic, vulval lesions need to be scrutinized to rule out tuberculosis.

 
 :: References Top

1.Manoj K,Soma M, Ajay L,Ashish A,Rakesh S,Paliwal RV. Tubercular sinus of labia majora: Rare case report. Infect Dis ObstetGynecol2008;2008;817515.  Back to cited text no. 1
    
2.Lam SK, Chan KS, Chin R. A rare case of vulval tuberculosis.Hong Kong J GynaecolObstet Midwifery 2007;7:56.  Back to cited text no. 2
    
3.Sardana K, Koranne RV, Sharma RC, Mahajan S. Tuberculosis of the vulva masquerading as a sexually transmitted disease. J Dermatol 2001;28:505-7.  Back to cited text no. 3
    
4.Chowdhury NN. Overview of tuberculosis of the female genital tract. J Indian Med Assoc 1996;94:345-6, 361.  Back to cited text no. 4
[PUBMED]    
5.Wilkinson EJ, Xie DL. Benign diseases of vulva. In: Kurman RJ, editor. Blaustein's pathology of female genital tract.5 th ed. New Delhi: Springer India Private Limited; 2004. p. 51-2.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]

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