Chronic vulvar fissure--a rare manifestation of mycosis fungoides.
BACKGROUND
Vulvar fissures are a common cause of vulvar pain and discomfort. The differential diagnosis of the underlying process is broad, and some cases remain undiagnosed. Mycosis fungoides, the dominant component of cutaneous T-cell lymphoma, rarely present as fissures. We report a case of a chronic vulvar fissure due to mycosis fungoides.


METHODS
A 55-year-old woman was referred to the vaginitis clinic for evaluation of a chronic vulvar fissure, 6 cm in length, located at the left interlabial sulcus. A detailed history and examination for other skin lesions revealed an erythematous pruritic patch on left breast that had been present for years. Repeat biopsies from both sites showed a dense dermal lymphocytic infiltrate composed predominantly of CD3- and CD4-positive T cell with minimal epidermotropism. A T-gamma polymerase chain reaction analysis demonstrated a clonal T-cell rearrangement. Based on a diagnostic algorithm that combines clinical features, histopathology, and molecular biology, a diagnosis of mycosis fungoides was confirmed.


CONCLUSIONS
Patients presenting with vulvar lesions should always be suspected of having an underlying dermatosis, and a detailed examination for other skin lesions should be performed. In the presented case, once both skin lesions were linked clinically, repeat biopsies of both sites led to a confirmed diagnosis of mycosis fungoides.
Reichman
Orna
O
Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI, USA. Orna.reich@gmail.com
Sobel
Jack D
JD
Bentley
Gail
G
D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology; D017252:CD3 Complex / Q000032:analysis; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000175:diagnosis* / Q000473:pathology*; D016133:Polymerase Chain Reaction / Q000379:methods; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000235:genetics; D014846:Vulvar Neoplasms / Q000175:diagnosis* / Q000473:pathology*
D017252:CD3 Complex; D016692:Receptors, Antigen, T-Cell, gamma-delta