Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 100722

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : March | Volume : 17 | Issue : 3 | Page : EC11 - EC16 Full Version

Clinicopathological Spectrum of Vulvar Lesions-A Retrospective Study

Published: March 1, 2023 | DOI:
Sesha Deepthi Pratti, Pratti Lohi S Rajlaxmi, Yadavalli RD Rajan

1. Associate Professor, Department of Pathology, KIMS, Amalapuram, Andhra Pradesh, India. 2. Consultant, Department of Dermatology, SS Hospital, Amalapuram, Andhra Pradesh, India. 3. Consultant, Department of General Surgery, SS Hospital, Amalapuram, Andhra Pradesh, India.

Correspondence Address :
Yadavalli RD Rajan,
Consultant, Department of General Surgery, SS Hospital, Amalapuram, Andhra Pradesh, India.


Introduction: Vulvar lesions constitute a wide spectrum ranging from non neoplastic inflammatory lesions to malignancies. Some show nodular masses and others remain asymptomatic. This poses challenges to clinicians in differentiating non neoplastic inflammatory dermatoses from benign and malignant lesions. Along with the clinical history and physical examination, a biopsy of the lesion plays an important role in proper diagnosis and treatment.

Aim: The aim of the present study was to identify the morphological spectrum of vulvar lesions with clinical and histological findings.

Materials and Methods: This was a retrospective observational study conducted in the Konaseema region of India for two years from January 2019 to January 2021. A total of 85 female patients with vulvar lesions were included in the study. Biopsy samples were obtained from all the 85 cases and were formalin-fixed, routinely processed, and paraffin embedded. Haematoxylin and Eosin (H&E) staining was done. Special stains were done wherever necessary. The results were analysed using Microsoft excel.

Results: The age of patients ranged from 18-88 years. The most common age of patients was in the 4th decade (30 cases amounting for 35.29%). The mean age of the study population was 39.5±15 years. Among the 82 cases, 40 (48.78%) were non neoplastic lesions, and 42 (51.21%) were neoplastic lesions. Among the neoplastic category, 27 (64.2%) were benign lesions and 15 (35.71%) were malignant lesions. The non neoplastic category included five infections (12.5%) and 35 non infectious inflammatory lesions (87.5%). The infections included one case of MC and 4 cases of condyloma acuminatum. The non infectious, and non neoplastic inflammatory lesions included 10 cases of Lichen Sclerosus Atrophicus (LSA), one case of Lipomatoushamartoma, four cases of Lichen planus, six cases of epidermal cysts, 10 cases of Bartholin cysts and four cases of Gartner duct cyst. The benign lesions in the neoplastic category included four cases of Hidradenomapapilliferum, four cases of Aggressive Angiomyxoma (AA), 12 cases of Fibroepithelial Stromal Polyps (FEP), and a case of Leiomyoma. The malignant lesions included 14 cases of squamous cell carcinoma and a case of extramammary Paget’s disease.

Conclusion: Vulvar lesions can be due to eclectic causes and pose a diagnostic difficulty both clinically and histopathologically due to their similar presentation. Thorough clinical and pathological examination along with proper clinicopathological correlation is required for accurate diagnosis and treatment.


Haematoxylin & Eosin, Vulvar lichen sclerosus, Vulvar neoplasms

Vulvar lesions constitute a wide spectrum ranging from non neoplastic inflammatory lesions to malignancies. This varied presentation is attributed to the epithelial linings of the vulvar region derived from all three layers i.e., ectoderm, endoderm, and mesoderm along with their hormonal and immune responses (1). The aetiology of vulvar lesions ranges from infective, inflammatory conditions to benign and malignant neoplasms. These could be due to sexually transmitted infections or due to sporadic or genetically-linked neoplasms. The most common presentation of the vulvar lesions is pruritis. Some show nodular masses and others remain asymptomatic. Most of the infectious lesions can be treated medically.

Benign lesions usually require excision whereas, the malignant lesions do not have a good prognosis. This poses challenges to clinicians in differentiating non neoplastic inflammatory dermatoses from benign and malignant lesions (2). Squamous cell carcinoma of the vulva constitutes 4% of the gynaecological malignancies with a preceding Vulvar Intraepithelial Neoplasia (VIN), which starts as a patch and that needs to be differentiated from other inflammatory and benign lesions (3). Early diagnosis of the lesion prevents radical surgery and reduces mortality and morbidity. The aim of the present study was to identify and study the morphological spectrum of vulvar lesions with clinical and histological findings.

Material and Methods

This is a retrospective observational study that includes the clinical presentation and histopathological evaluation of biopsy samples received from 85 patients presenting with vulvar lesions in Konaseema region. The duration of the study was two years, from January 2019 to January 2021 at SS Hospital, Amalapuram.

Inclusion criteria: All the patients above the age of 18 years, presenting with vulvar lesions were included in the study.

Exclusion criteria: Patients presenting with pre-existing malignancies were excluded.

The patient’s clinical history including age, chief complaints, and physical examination findings was noted.

Study Procedure

All the biopsy samples were formalin-fixed, routinely processed, and paraffin-embedded. H&E staining was done. Histopathological diagnoses were made and compared clinically. Informed consent was taken from the patients for the clinical photographs. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and adheres to the declaration of Helsinki.

Statistical Analysis

The data was analysed using Microsoft excel 2019. Categorical data was represented in the form of frequencies. Continuous data were represented as mean.


A total of 85 cases of vulvar lesions were included in the present study. The age of patients ranged from 18-88 years. The most common age of patients was in the 4th decade (30 cases amounting for 35.29%). The mean age of the study population was 39.5±15 years. The common presenting complaints included itching, patches, hypopigmented lesions, nodular and warty masses and ulcers. Labia majora was the most common site involved. Among the 85 cases, 3 cases were not willing to get a biopsy done. Among the 82 cases, 40 (48.78%) were non neoplastic lesions, and 42 (51.22%) were neoplastic lesions. Among the neoplastic category, 27 (64.2%) were benign lesions and 15 (35.71%) were malignant lesions. The non neoplastic category included 5 infections (12.5%) and 35 non infectious inflammatory lesions (87.5%). (Table/Fig 1). The infections included one case of MC presenting as umbilicated pearly white lesions over the vulva, it being a clinical diagnosis, a biopsy was taken to rule out any malignancy. The clinical image of a patient with MC is shown in the (Table/Fig 2). The other infections included four cases of Condyloma Acuminatum which presented clinically as a warty polypoidal lesions of varied sizes, of which one patient was a 35-year-old female who is Human Immunodeficiency Virus (HIV) positive (Table/Fig 3).

The non infectious, and non neoplastic inflammatory lesions included 10 cases of Lichen Sclerosus et Atrophicus (LSA). This was most commonly seen in perimenopausal and postmenopausal women with hypopigmented patchy lesions of vulva associated with marked pruritis. One case of Lipomatous hamartoma with a size of 7×5×4 cm in a 55-year-old female excised from labia majora was diagnosed. Four cases of Lichen planus in a 88-year-old patient, six cases of epidermal cysts, 10 cases of Bartholin cysts and four cases of Gartner duct cyst were included in the non infectious non neoplastic inflammatory lesion category.

The benign lesions in the neoplastic category included four cases of AA (Table/Fig 4), 12 cases of FEP and a case of leiomyoma (Table/Fig 5), four cases of Hidradenoma Papilliferum (HP) (Table/Fig 6) presenting as a nodular lesion of 1.5×1 cm, and six cases of lobular capillary haemangioma {Pyogenic Granuloma (PG)}. The malignant lesions included 14 cases of squamous cell carcinoma and a case of extramammary Pagets disease. The least age of patients in the malignant category was 30 years and highest age was 72 years.


Vulvar lesions pose a diagnostic challenge to both clinicians and pathologists due to their overlapping symptoms and histopathological complexity. They range from dermatoses to invasive carcinomas. The usual symptoms of vulvar lesions includes itching, pain, swelling and mass in the vulvar region (4). Biopsy followed by histopathological examination is mandatory for all the vulvar lesions for accurate diagnosis and to decide subsequent therapy. For dermatoses, punch biopsy after proper clinical assessment to locate the site of biopsy is advocated. Whereas, lesions presenting with swelling or mass, excisional biopsy with surrounding normal tissue to comment on the invasion is required (2),(5). Topical agents like toluidine blue, diluted acetic acid have been used to identify the dysplastic/suspicious tissues (6).

The MC is a common viral skin infection caused by double-stranded Deoxyribonucleic Acid (DNA) pox virus, belonging to the genus Molluscipox (7). Four subtypes are known, of which MC Virus-1 (MCV-1) is the commonest. MCV-2 causes infection commonly 13in People Living With HIV/Acquired Immunodeficiency Syndrome (AIDS) (PLWHA) (8). The infection commonly affects children aged 2-5 years with an average incubation period of 2-7 weeks. Common sites of predilection are trunk, face and limbs in immunocompetent individuals and transmitted either by direct contact or through fomites or autoinoculation. Hot and humid climate increases the risk of acquiring the infection. Genital MC affects sexually active adults most commonly and transmitted through sexual contact. The lesions are seen on genitalia, pubis, inner thighs and rarely on face and scalp. The diagnosis is mostly clinical with the characteristic presentation of pearly white, dome shaped, discrete, umbilicated papules. PLWHA can present with large, non umbilicated or agminate or tender nodular lesions and are difficult to treat (9). Histopathological examination shows cup shaped indentation with hyperplastic epithelium and intracytoplasmic eosinophilic inclusion bodies called as Henderson-Peterson bodies. The differential diagnoses include syringoma and verruca. Basal cell carcinoma, keratoacanthoma, cryptococcosis, histoplasmosis need to be considered in large, atypical and extensive lesions. The lesions are usually self-limiting but take many months to heal. Treatment is done to reduce the stigma and transmission (8). The authors had four cases of female genital MC with classical presentation of asymptomatic pearly dome shaped umbilicated papules over labia and inner thighs as shown in the (Table/Fig 2). Histopathological evaluation was done to rule out the malignancy. It showed cup shaped indentation of hyperplastic epidermis with rete ridges proliferating downwards and encircling the dermis with characteristic Henderson-Peterson bodies within the epidermis.

Condyloma acuminata, also called genital warts are caused by Human Papilloma Virus (HPV). There are over 100 strains of HPV of which, 40 cause anogenital warts and the commonest are 6 and 11. High-risk subtypes causing malignancy are most commonly 16 and 18. HPV also causes cutaneous and mucosal warts, palmar and plantar warts, Bowen’s disease, epidermodysplasia verruciformis, non melanoma skin cancers and cervical, anogenital and oral intraepithelial neoplasia and carcinomas (10). In the present study, there were four cases of condyloma acuminata presenting with polypoid growth in the vulvar region. One case was tested HIV positive (Table/Fig 3). Excision biopsy was done to confirm the diagnosis. Lichen Sclerosus (LS) is the most common vulvar lesion, in postmenopausal women and is associated with pruritis. LS has an increased risk of developing vulval carcinomas ranging from VIN to squamous cell carcinoma. Biopsy is advised in these cases to confirm the clinical diagnosis and exclude malignancy (11). The gold standard treatment is ultrapotent topical steroids like clobetasol propionate. Follow-up is required in all these cases. Present study includes 10 cases of LS presented with atrophic plaques and pruritis (12). Epidermal thinning with loss of rete ridges, hydropic degeneration of the basal layer, dermal oedema and fibrosis are seen.

The PG also known as ‘Lobulated capillary haemangioma’, is a benign vascular lesion of the skin and mucous membranes, rare in the vulvar area (13). PGs usually present as small polypoidal lesions and can ulcerate. This study reports six cases of PGs, one case with marked surface ulceration. Microscopically, the lesions comprise of lobular arrangement of capillary sized vessels with loose fibrous stroma and few inflammatory cells with epidermal collarette with surface thinned out epidermis. The proposed mechanism in these lesions is an imbalance between the proangiogenic and antiangiogenic factors causing vascular proliferation. In pregnant women, PGs are hormonal induced. PGs are also seen more in association with use of medications like retinoids, antineoplastic drugs and immunosuppressants (14). FEPs also called as ‘Acrochordons’ are benign lesions of the vulva and vagina in the adult women. They originate from a regressing nevus. The tumours may exhibit hypercellularity, pleomorphism and high mitotic activity mimicking malignancies and biopsy is necessary for a definite diagnosis (15). FEPs are polypoidal or fleshy outgrowths with smooth surfaces, often arise in areas of skin irritation or as a process of skin aging and also due to hormonal changes (high levels of oestrogen and progesterone). 12 cases of FEPs ranging from size 2×1×1 cm to 5×4×3 cm were reported in the present study. Microscopically, the lesions are polypoidal and are lined by stratified squamous epithelium with fibrocollagenous tissue and few scattered inflammatory cells. One lesion showed surface ulceration, as larger lesions are more prone for secondary inflammation and ulceration (16).

The AA is a rare tumour, locally aggressive in the pelvic perineal regions. In 1983, Steeper and Rosai named this lesion as AA because of its local recurrence and infiltrative nature- WHO categorises this under ‘tumour of uncertain differentiation’. Clinically, it presents as a painless slow growing mass and most of the times misdiagnosed as vaginal cyst such as Bartholin gland cyst or Gartner duct cyst. Due to its high potential for recurrence, a regular follow-up is essential. These can attain larger sizes upto 10 cm (17). The present study revealed four cases of AA with sizes of 5×4 cm and 7×6 cm. One of the lesions was diagnosed clinically as a recurrent sebaceous cyst. On gross examination, the tumours were lobulated, tan grey with gelatinous to myxoid cut surface. Microscopically, these are hypocellular tumours composed of oval to spindle stellate cells without atypia embedded in myxoid stroma with delicate vasculature (Table/Fig 4). These tumours are usually treated by excision with 1cm wide margin. They have a 30% chance of recurrence and usually have only one recurrence (18). As most of these lesions exhibit Estrogen Receptor (ER) and Progesterone Receptor (PR) positivity, Gonadotropin Releasing Hormone (GnRH) analogues are highly useful in reducing the sizes in case of larger lesions, making complete excision feasible (19). Leiomyomas of the vulva are rare tumours, benign in nature and are confused with Bartholin cyst clinically. In the present study, a case presenting as left vulvar mass of size 4×3 cm at the vaginal introitus. Fine Needle Aspiration Cytology (FNAC) was done initially and cytology showed few spindle shaped cells in a marked haemorrhagic background. As excision was advised, the excised tumour and histopathological evaluation showed a circumscribed tumour with spindle shaped cells arranged in intersecting fascicles and whorls with bland looking cigar shaped nuclei (Table/Fig 5). Surgical excision is the treatment of choice and most of the times diagnosis is done postoperatively by histopathology (20).

According to histopathology, benign tumours of the vulvar region, considered as adenomas of the mammary like anogenital glands based on their histogenesis (21). This study includes four cases of HP presenting as a flesh coloured solid to cystic nodule. Microscopic examination showed circumscribed tumours with papillary fronds, tubules and glandular structures lined by cuboidal epithelium with focal apocrine type of cells with intact myoepithelial layer and areas of cystic change (22). Similar microscopic findings were observed in the present study (Table/Fig 6).

About 90% of all the vulvar cancers are squamous cell carcinomas, the others include Melanoma, Paget’s disease, Bartholin’s gland tumour, Adenocarcinoma and Basal cell carcinoma (2). Invasive squamous cell carcinoma takes a major share in the malignant lesions of the vulva. It is a very rare cancer to occur in the vulvar region, but can have significant morbidity and mortality. Vulvar Squamous Cell Carcinoma (VSCC) and VIN can be HPV-associated or HPV-independent. They have different clinical and histopathological findings. HPV-independent VSCC occurs in old-age and histologically has well-differentiated keratinising carcinomas, and the precursor lesions are differentiated VIN (dVIN). HPV-associated VSCC occur in younger age individuals and histologically had basaloid or warty carcinomas and usual Vulvar Intraepithelial Neoplasia (uVIL), sometimes associated with LS as a precursor lesion (23). HPV16 is the most common type identified in these lesions. Other reported HPV types reported include HPV 18, 31, 33, and 45. Immunostaining with p53 and p16 (INK4a) can aid in detecting HPV association with VSCC. HPV associated VSCC stain positively for p16, whereas HPV-independent VSCC stains positively with p53. The most common histological type of VSCC is keratinising type, followed by basaloid and warty types. Although the pathways for development of HPV-associated and HPV-independent are different, not much difference has been observed in the prognosis of the tumours (24). In the present study, 14 patients diagnosed as VSCC with a mean age of 56±11.24 years. Eight were postmenopausal and six were premenopausal. Nine of them presented with nodular growth in the vulvar region whereas, the other five presented with ulcerative growth over the vulva. Punch biopsy specimens were received in 13 patients and wide local excision of the growth with nodes from bilateral inguinal lymph nodal dissection was obtained from one patient. Keratinising pattern was observed histologically in eight of the cases and basaloid pattern was observed in six cases. Six patients from the premenopausal group tested positive for HPV and the remaining eight patients from the postmenopausal group tested negative for HPV.

Extra Mammary Paget’s Disease (EMPD) is a relatively rare condition. It is more common in the apocrine gland predominant regions like penis, perineum and vulva. Its incidence is as low as 1-2% of all the vulvar malignancies and is slowly raising in the Asian population (25). The most common presenting symptoms include pruritis, pain and oedema, leukoplakia, hyperkeratosis, ulceration and bleeding in high apocrine gland areas. It is often misdiagnosed pertaining to the multiple differential diagnoses for EMPD including LS, dermatitis, Tinea, vulvovaginitis, and intertrigo (26). Histologically, Paget’s disease has been classified into primary and secondary. Various theories have been established for the development of primary EMPD, which include (27),(28):

a. From the apocrine glands which are intra-epidermal, and from the basal layer.
b. From the inter-labial fold has mammary-like glands, which can give rise to paget’s disease.
c. From the Toker cells, alleged to be the precursors of Paget cells.

Secondary paget’s occurs due to epidermotropic metastases from underlying genitourinary or gastrointestinal malignancies (29). The diagnosis of EMPD is confirmed by skin biopsy, which shows large cells with abundant amphophilic cytoplasm with buckshot distribution. Mucin Core Protein MUC5AC and gross cystic disease fluid protein-15 are usually positive in primary EMPD (30). Both surgical and non surgical techniques have been established for the management of EMPD. Surgical procedures include a myriad of techniques ranging from a simple wide local excision to more radical techniques like partial and total vulvectomy. Mohs micrographic surgery and liner strip skin biopsy have also been reported useful for EMPD. Non surgical techniques include photodynamic therapy, radiation therapy, laser therapy and application of topical creams like Imiquimod, Bleomycin, and 5-fluorouracil (5-FU). These non surgical techniques are mostly as adjunct to surgical treatment (26). The prognosis depends upon the invasion of the dermis. The more invasive the tumour is, the worse is the prognosis (30).

One case was diagnosed as EMPD in the present study. The patient was a postmenopausal woman with pruritis and whitish lesions over the vulvar region. Punch biopsy specimen was received for histopathological examination. Microscopically, amphophilic cytoplasm in large cells with buckshot distribution was seen and stained positive for MUC5AC. This is a table comparing the present study with various other studies published in the literature (Table/Fig 7) (1),(2),(5).

The mean age of patients in the present study was in the 3rd decade, similar to all the studies except for the study by Ozdemir O et al., (4th decade) (1). Most common site of involvement was labia majora in all the studies. Itching has been reported to be the most common patients. Non neoplastic lesions were the most common lesions in all the studies. Bhat DM et al., reported an equal incidence of both neoplastic and non neoplastic lesions (2). Lichen sclerosis et atrophicus was the most common non neoplastic lesion, whereas Squamous cell carcinoma is the most common malignant neoplastic lesion in all the studies (1),(2),(5).


Biopsy was not done in three cases of MC but has been diagnosed based on clinical findings. Since, the cases presented only in the past two years have been taken into consideration there might a change in the proportion of the cases over a long period of time. Some cases which did not require biopsy were not included in the clinical spectrum.


Vulvar lesions cause apprehension to women in terms of both personal and sexual concerns. Along with the clinical history and physical examination, a biopsy of the lesion plays a very important role in proper diagnosis and treatment and in decreasing the patients’ apprehension. The aetiology of vulvar lesions ranges from infective, inflammatory conditions to benign and malignant neoplasms. These could be due to sexually transmitted infections or due to sporadic or genetically-linked neoplasms.


Ozdemir O, Sari M, Ertugrul F, Sen E, Ilgin B, Atalay C. Spectrum of vulvar lesions in an obstetrics and gynecology outpatient clinic. Med Sci Int Med J. 2015;4(1):1876. [crossref]
Bhat DM, Mahajan VA, Kumbhalkar DT, Raut WK. Spectrum of vulvar lesions: Patient’s anxiety, clinician’s concern and pathologist’s diagnostic challenge. Int J Reprod Contracept Obstet Gynecol. 2019;8(6):2506-14. [crossref]
Vlastos AT, Charvet I, Dellacasa I, Capanna F, Pelte MF, Thueler P, et al. Diagnosis of vulvar lesions by non invasive optical analysis: A pilot study. Rare Tumours. 2009;1(1):e8. [crossref] [PubMed]
Hanprasertpong J, Chichareon S, Wootipoom V, Buhachat R, Tocharoenvanich S, Geater A. Clinico-pathological profile of vulva cancer in southern Thailand: analysis of 66 cases. J Med Assoc Thail Chotmaihet Thangphaet. 2005;88(5):575-81.
Mohan H, Kundu R, Arora K, Punia RS, Huria A, Mohan H, et al. Spectrum of vulvar lesions: A clinicopathologic study of 170 cases. Int J Reprod Contracept Obstet Gynecol. 2014;3:175-80. [crossref]
Tyring SK. Vulvar squamous cell carcinoma: guidelines for early diagnosis and treatment. Am J Obstet Gynecol. 2003;189(3 Suppl):S17-23. [crossref] [PubMed]
Singla C, Mahajan BB, Kaur T, Malhotra SK, Sharma N. Genital molluscum contagiosum in females-therapeutic efficacy and comparative evaluation of topical 10% and 20% potassium hydroxide. Indian J Sex Transm Dis AIDS. 2018;39(2):102. [crossref] [PubMed]
Badri T, Gandhi GR. Molluscum Contagiosum. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Sep 15]. Available from:
Sen S, Goswami BK, Karjyi N, Bhaumik P. Disfiguring molluscum contagiosum in a HIV-positive patient responding to antiretroviral therapy. Indian J Dermatol. 2009;54(2):180. [crossref] [PubMed]
Gormley RH, Kovarik CL. Dermatologic manifestations of HPV in HIV-infected individuals. Curr HIV/AIDS Rep. 2009;6(3):130-38. [crossref] [PubMed]
O’Keefe RJ, Scurry JP, Dennerstein G, Sfameni S, Brenan J. Audit of 114 non neoplastic vulvar biopsies. Br J Obstet Gynaecol. 1995;102(10):780-86. [crossref] [PubMed]
Pérez-López FR, Vieira-Baptista P. Lichen sclerosus in women: A review. Climacteric J Int Menopause Soc. 2017;20(4):339-47. [crossref] [PubMed]
Abreu-Dos-Santos F, Câmara S, Reis F, Freitas T, Gaspar H, Cordeiro M. Vulvar lobular capillary hemangioma: A rare location for a frequent entity. Case Rep Obstet Gynecol. 2016;2016:3435270. [crossref] [PubMed]
Sarwal P, Lapumnuaypol K. Pyogenic Granuloma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Sep 15]. Available from:
Nucci MR, Young RH, Fletcher CD. Cellular pseudosarcomatous fibroepithelial stromal polyps of the lower female genital tract: An under recognized lesion often misdiagnosed as sarcoma. Am J Surg Pathol. 2000;24(2):231-40. [crossref] [PubMed]
Navada MH, Bhat PRB, Rao SV, Nagarathna G. Large fibroepithelial polyp of vulva. Case Rep Dermatol Med. 2011;2011:e273181. [crossref] [PubMed]
Djusad S, Sari YM, Tjahjadi H. Deep (aggressive) angiomyxoma of the vagina misdiagnosed as Gartner cyst: A case report. Int J Surg Case Rep. 2021;83:105948. [crossref] [PubMed]
Kura MM, Jindal SR, Khemani UN. Aggressive angiomyxoma of the vulva: An uncommon entity. Indian Dermatol Online J. 2012;3(2):128-30. [crossref] [PubMed]
McCluggage WG, Jamieson T, Dobbs SP, Grey A. Aggressive angiomyxoma of the vulva: Dramatic response to gonadotropin-releasing hormone agonist therapy. Gynecol Oncol. 2006;100(3):623-25. [crossref] [PubMed]
Ammouri S, Elkarkri C, Zeraidi N, Lakhdar A, Baydada A. Vulvar leiomyoma: A case report. Pan Afr Med J [Internet]. 2019 Apr 29 [cited 2022 Aug 25];32(208). Available from: [crossref] [PubMed]
El-Khoury J, Renald MH, Plantier F, Avril MF, Moyal-Barracco M. Vulvar hidradenoma papilliferum (HP) is located on the sites of mammary-like anogenital glands (MLAGs): Analysis of the photographs of 52 tumors. J Am Acad Dermatol. 2016;75(2):380-84. [crossref] [PubMed]
Kambil SM, Bhat RM, D’Souza DC. Hidradenoma papilliferum of the vulva. Indian Dermatol Online J. 2014;5(4):523-24. [crossref] [PubMed]
Singh N, Gilks CB. Vulval squamous cell carcinoma and its precursors. Histopathology. 2020;76(1):128-38. [crossref] [PubMed]
Del Pino M, Rodriguez-Carunchio L, Ordi J. Pathways of vulvar intraepithelial neoplasia and squamous cell carcinoma. Histopathology. 2013;62(1):161-75.[crossref] [PubMed]
Delport ES. Extramammary Paget’s disease of the vulva: An annotated review of the current literature. Australas J Dermatol. 2013;54(1):09-21. [crossref] [PubMed]
Kosmidis CS, Sevva C, Roulia P, Koulouris C, Varsamis N, Koimtzis G, et al. Extramammary Paget’s disease of the vulva: Report of two cases. Med Kaunas Lith. 2021;57(10):1029. [crossref] [PubMed]
Morris CR, Hurst EA. Extramammary Paget disease: A review of the literature-Part I: History, epidemiology, pathogenesis, presentation, histopathology, and diagnostic work-up. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2020;46(2):151-58. [crossref] [PubMed]
McDaniel B, Brown F, Crane JS. Extramammary Paget Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Dec 8]. Available from:
Carton I, Lebreton M, Tesson C, Henno S, Lavoué V, Levêque J, et al. Paget’s disease of the vulva: A challenge for the gynaecologist. J Gynecol Obstet Hum Reprod. 2021;50(1):101896. [crossref] [PubMed]
Asel M, LeBoeuf NR. Extramammary Paget’s Disease. Hematol Oncol Clin North Am. 2019;33(1):73-85.[crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/60277.17575

Date of Submission: Sep 16, 2022
Date of Peer Review: Oct 17, 2022
Date of Acceptance: Dec 10, 2022
Date of Publishing: Mar 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Sep 22, 2022
• Manual Googling: Nov 29, 2022
• iThenticate Software: Dec 05, 2022 (6%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)