Woody Vulva: An Unusual Presentation of Vulvar Tuberculosis

Goyal, Bhupesh K.; Pradhan, Sarita; Jose, Tony; Duggal, Bhupinder S.; Sengupta, Prashant

doi:10.1007/s13224-012-0325-7

Cited by 3 publications

(7 citation statements)

References 6 publications

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“…Esthiomene, woody vulva, elephantiasis, cutaneous lymphangiectasia and lymphangioma circumscriptum have been recognized sequelae of such lymphatic obstruction, that may be associated with active inguinal tuberculous lymphadenitis [10,36,38,41,53]. Biopsies of 3 patients with clinically edematous vulval lesions and inguinal lymphadenopathy in the present study demonstrated the common finding of prominent dilated lymphatic and blood vessels ( Figures 6B and 6C).…”

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (supporting

confidence: 50%

“…In the last 40 years, additional descriptive terms have been employed, including nodules, ulcers, abscesses, papules, papulonecrotic discrete lesions or vulval hypertrophy and edema. To date, most of the described vulval histomorphology has focused on classic TB or tuberculous hypersensitivity responses [36][37][38][39][40][41][42][43][44][45][46].…”

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (mentioning

confidence: 99%

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Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Gb¹,

Ramdial²,

Nargan³

et al. 2017

J AIDS Clin Res

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Objective: Vulval tuberculosis (TB) is reported rarely. The histomorphological spectrum and diagnostic mimicry thereof in patients with concomitant HIV infection/ AIDS is unreported to date. This study aimed to appraise the histopathologic spectrum of vulval TB in HIV co-infected patients and to identify histopathological diagnostic challenges, mimicry and pitfalls.Methods: Ten year retrospective study that reappraised the histomorphological features of vulval TB in HIV-infected patients. Results:The clinical descriptions of the biopsied lesions from 19 patients that form the study cohort encompassed nodules (9), ulcers (5), hypertrophy/edema (3) and abscesses (2). The main microscopic features included necrotizing and non-necrotizing granulomatous inflammation, ulceration with a zoned inflammatory response and chronic suppurative inflammation. The necrotizing component had the typical morphology of caseative necrosis or of suppuration/karyorrhexis or an admixture of both necrosis types. Vasculitis, of varied histomorphology, was present in 15 biopsies. Infective special stains were pivotal diagnostic tools. The presence of mycobacteria on Ziehl Neelsen stains (ZNs) and absence of nonmycobacterial infective agents on additional infective stains, underpinned TB diagnosis, especially in biopsies that lacked prototypical granulomatous inflammation or of infective mimickers that manifest with a granulomatous phenotype. ZNs also confirmed mycobacteria in vasculitic foci. The absence of mycobacteria on ZNs facilitated the diagnosis of tuberculids. Conclusion:Lesions with a common clinical appearance had heterogeneous histomorphological features, while lesions with common histopathological features demonstrated divergent clinical morphology. Infective, especially Ziehl Neelsen, stains are pivotal in the histopathological work-up of infective/inflammatory vulval biopsies. It is possible that the rarely reported anergic mononuclear or abscessing features, pseudotumoral spindle cell reactions, ulcers with a zoned inflammatory response and the presence of vasculitis of varied type, are clues to the HIV-TB tissue partnership. Increased clinicopathological investigation of and reporting on vulval TB in the HIV/AIDS afflicted population is pivotal to ascertain this.

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Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (supporting

confidence: 50%

Section: Glands (Eg) (A) (Hematoxylin and Eosin) Dilated Lymphatic (mentioning

confidence: 99%

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Gb¹,

Ramdial²,

Nargan³

et al. 2017

J AIDS Clin Res

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“…Vulvar tuberculosis is usually asymptomatic . When symptoms are evident, it can present with thickening and darkening of the vulvar skin and can also be associated with swelling, pruritic rash, and narrowing of the introitus . Ulceration, necrotic lesions, sinus tracts, and lymphedema have also been reported .…”

Section: Mycobacterium Tuberculosismentioning

confidence: 99%

“…Tuberculosis of the vulva is extremely rare and accounts for only 2% of cases of pelvic tuberculosis, an already uncommon entity. It should be considered in any population where tuberculosis is endemic.…”

Section: Mycobacterium Tuberculosismentioning

confidence: 99%

“…As this disease can have an incredibly varied presentation, differential diagnosis depends on signs and symptoms at presentation. For example, when hypertrophic vulvar tuberculosis lesions are present, lichen simplex chronicus must be considered in the differential, while the differential of vulvar tuberculosis ulcers includes RNSRGU, herpes, chancroid, and other etiologies . As a general rule, biopsy of the affected area is usually needed for diagnosis, and nearly all reported cases were biopsy‐confirmed.…”

Section: Mycobacterium Tuberculosismentioning

confidence: 99%

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Vulvar infections: beyond sexually transmitted infections

et al. 2017

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The vulva is an under-studied area of the female genitourinary tract which is prone to maceration, overgrowth of organisms, and atypical presentations of common dermatologic conditions. In current practice, dermatologists must recognize and manage vulvar infections and infestations beyond the more commonly recognized sexually transmitted infections. Herein, this article reviews the literature on a selection of under-recognized viral, bacterial, fungal, and parasitic vulvar infections and infestations.

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