Vulvar Mycosis Fungoides: A Rare Non-Hodgkin’s Cutaneous Lymphoma

Objective: Should one evaluate the asymptomatic nonspecific hypopigmented interlabial area in a menopausal woman attending a corporate health check clinic? Case Report: A menopausal woman aged 66 years, a para 2, reported for a voluntary routine health check including gynaecological evaluation. Examination revealed a hypopigmented interlabial area without any itching, itch marks, redness or thickened skin. There was no altered sensation. There were no skin lesions elsewhere on the body nor was any significant lymphadenopathy. Toluidine blue-directed vulvar biopsy was consistent with mycosis fungoides. Gene rearrangement of T cell receptor by PCR and gel electrophoresis suggested clonal nature of T cell lymphoproliferative disorder. Immunohistochemistry markers CD3 and CD4 were positive. Conclusion: Cutaneous T cell lymphomas are aggressive and prone to delayed or misdiagnosis and have a high mortality rate. Malignant lymphomas in the pelvis are rare, and the vulvar primary involvement is only 4% of pelvic lymphomas. Therefore, any vulvar hypopigmented or hypertrophied areas need to be subjected to histopathological evaluation.