Lymphoma-like-Lesion of the Vulva in a 43-year-old woman – a case report

Fragestellung/Objective: Lymphoma-like-lesion (LLL) of the lower genital tract in women, first described in 1985, is a rare entity with reported 43 cases involving the cervix in the English literature. LLLs are benign florid reactive inflammatory processes mimicking morphologically lymphomas. To the best of our knowledge we report the third case in literature localised at the vulva. Since aetiology of these lesions is unclear, effective treatment is unknown. We observe the course of this disease over a period of 8 months.

Methodik/Case: A 43-year old otherwise healthy woman presented with a one months history of ulceration of the vulva without pain. She had no signs of generalized infection, no lymphadenopathy was present. Her last gynaecologic examination one year before was uneventful with insertion of a hormonal IUD. She reported a conisation (CIN III) and excision of condylomata acuminata 11 years before. She also had had a history of a laparoscopy due to cystic ovaries. Infection screening of the ulceration site and the vagina revealed bacterial vaginosis, but tested negative for HSV, VZV, Trichomonas, Candida and Chlamydia. Biopsy showed ulcerated mucosa with diffuse polyclonal B-cell Infiltration consistent with the diagnosis of LLL, no association with HPV or EBV was found. Immunologic testing of the patient was negative, as was investigation for Borrelia. Follow-up for 6 months showed only partial remission with local therapy with cortisone. Therefore a second biopsy after therapy was performed with confirmation of the first diagnosis. Swabs from recurrent inguinal folliculitis showed a Proteus mirabilis infection. The patient received a 30-days antibiotic therapy according to antibiogram. The patient has not yet come for follow-up examination.

Schlussfolgerung/Discussion: A Lymphoma-like-lesions of the lower female genital tract is a rare medical condition. Even more exact histologic, immunophenotypic as well as genetic testing is essential to avoid misdiagnosis and inappropriate treatment. LLL should be considered as a differenzial diagnosis in non-neoplastic ulcerous lesions of the vulva, local cortisone treatment might be a therapy option.