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Pruritic lichenoid lesions on the vulva of an 11-year-old girl
Chia-Chi Hsu , Chao-Kai Hsu , Hung-Chien Lin , Chien Hun Huang , Julia Yu-Yun Lee
DERMATOLOGICA SINICA 29 (2011) 111–112

An 11-year-old premenarcheal Taiwanese girl presented with a 2-year history of itchy papules on the external genitalia. The itching was generally mild and intermittent but was aggravated by heat or during hot weather. These lesions increased gradually and had poor response to topical corticosteroid, antibiotic, or antifungal therapy. Examination revealed numerous, coalescing, 1-mm to 2-mm, slightly erythematous lichenoid papules on the labia majora. Many papules were surmounted by tiny white milia (Figure 1). There was no extragenital lesion. She denied family history, prior local trauma, or vesiculobullous disease. A skin biopsy specimen was obtained from yellow-white papules on the left labia majora. The histopathological evaluation showed numerous short cords or coma-shaped cords and ductal structures lined by cuboidal epithelial cells embedded in a sclerotic stroma in the upper and mid-dermis. In addition, many keratinous cysts were present in the superficial portion of the tumor (Figure 2). Serial sectioning revealed focal connection between the cysts and some of the underlying epithelial cords or ductal structures (arrows in Figure 2). Fontana-Masson stain failed to stain the cystic walls. Immunostaining for carcinoembryonic antigen (CEA) was positive in the epithelial cords, ductal structures, and part of the contents as well as the luminal aspect of the lower part of the larger keratinous cysts where the wall consisted of a thin layer of squamous epithelium without a granular layer (Figure 3). No CEA expression was found in the upper part of the cyst wall where the squamous epithelium was thicker with granular layer. Immunostaining for estrogen receptors (ERs) and progesterone receptor (PRs) showed negative results.

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