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HPV-associated Vulvar Trichoblastoma: A Diagnostic Pitfall
Yaping Ju1,2, Brittney K DeClerck1,2, Saloni Walia1,2
1Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles.
Summary
A rare vulvar trichoblastoma co-occurred with high-grade vulvar intraepithelial neoplasia (VIN3) in a woman. Similar p16 and HPV positivity mimicked invasive carcinoma, highlighting diagnostic challenges.
Area of Science:
- Dermatopathology
- Gynecologic Oncology
Background:
- Vulvar trichoblastoma is a rare benign adnexal neoplasm.
- High-grade vulvar intraepithelial neoplasia (VIN3) is a premalignant lesion associated with HPV.
- Synchronous occurrence of these entities is exceptionally rare.
Purpose of the Study:
- To report a rare case of synchronous vulvar trichoblastoma and VIN3.
- To highlight the diagnostic challenges posed by overlapping features.
- To emphasize the importance of accurate differentiation from invasive squamous cell carcinoma.
Main Methods:
- Histopathological examination of a vulvar tumor.
- Immunohistochemical staining for p16.
- RNA in situ hybridization for high-risk HPV detection.
Main Results:
- A 35-year-old woman presented with a deep dermal tumor and superficial VIN3.
- The trichoblastoma exhibited basaloid nests with folliculo-sebaceous differentiation and increased mitoses.
- Both lesions showed diffuse p16 positivity and high-risk HPV detection, creating a diagnostic pitfall.
Conclusions:
- The morphologic and immunophenotypic overlap between vulvar trichoblastoma and VIN3 can mimic invasive squamous cell carcinoma.
- Careful histological assessment and a panel of immunohistochemical markers are crucial for accurate diagnosis.
- Distinguishing trichoblastoma from invasive carcinoma is essential to prevent overtreatment.
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