Vulval Dystrophies

Abstract

The multitude of terminology used for white patch or leukoplakia of the vulva is confusing. The International Society for the study of Vulval disease adopted the term vulval dystrophy as originally suggested by Jeffcoate (1966) to replace all other previously used terms such as kraurosis vulvae, atrophic dystrophy, leuko-plakic vulvitis, leukoplakia, hyperplastic vulvitis, etc. The vulval dystrophies have been classified into:

• (i) Hyperplastic dystrophy with or without atypia — In this there is acanthosis, elongation or blunting of the rete pegs and a varying degree of hyperkeratosis (Fig. 18.1). The granular layer may or may not be prominent. When atypia is present, it may be mild, moderate or severe. Chronic inflammatory cell infiltrates in the dermis, in varying numbers, are always seen.

• (ii) Lichen sclerosus — Thinning of the squamous epithelium is the dominant feature. Hyperkeratosis is also present. A characteristic, acellular, homogeneous, eosinophilic layer of the dermis associated with variable oedema is seen just beneath the epidermis (Fig. 18.2). According to Hewitt (1986), this superficial hyalinisation, even if it is very thin and limited to the basement membrane or papillae, should be considered a significant point for the diagnosis of lichen sclerosus. There is a zone of lymphocyte and plasma cell infiltration below this acellular layer.

• (iii) Mixed dystrophy with or without atypia — This shows areas of hyperplastic dystrophy as well as lichen sclerosus (Fig. 18.3). When atypia of the epithelial cells is present, it may be mild, moderate or severe.