Ischemic fasciitis: an unusual vulvovaginal spindle cell lesion

Ischemic fasciitis is a benign reactive lesion that most commonly occurs in elderly, immobile patients in weight-bearing areas that are subject to intermittent ischemia with subsequent tissue breakdown and regenerative changes. The lesion can be clinically and pathologically mistaken for malignancy. Here we describe the first reported case of ischemic fasciitis of the vulvovaginal region in a 20-year-old paraplegic woman who presented with a clinically suspicious vulvar swelling. Histologic examination showed surface ulceration and underlying fibrinoid necrosis with surrounding reactive atypical fibroblast-like cells and small blood vessels, the characteristic histologic features of ischemic fasciitis.