外阴硬化性苔癣合并外阴鳞状细胞癌一例

外阴硬化性苔藓（vulva lichen sclerosis，VLS）是女性慢性难治性皮肤病。主要发生于外阴及肛周皮肤，以外阴皮肤变白、瘙痒为主要特征，若伴有外阴疼痛及硬结明显者应警惕发展为外阴鳞状细胞癌（vulva squamous cell carcinoma，VSCC）。本文介绍了一例有40余年VLS病史的56岁女性，于大阴唇部位取材，组织病理示“外阴硬化性苔藓，轻度”，后因阴蒂部位粘连，且疼痛明显，行外阴粘连分离术，见阴蒂色暗红，呈小菜花状，并分别用活检钳及冷刀两次病理取材后组织病理证实为VSCC，遂行扩大性外阴切除术+双侧腹股沟淋巴结切除术。术后进一步给予放疗+化疗。本例提示了对于VLS病史较长，且局部硬结，疼痛明显者，应警惕癌变，若阴蒂处疼痛且粘连者，应行粘连分解，暴露阴蒂，必要时重复取材，以免漏诊误诊。

A Case of Vulva Lichen Sclerosis Combined with Vulva Squamous Cell Carcinoma

Vulva Lichen Sclerois(VLS) is a chronic refractory skin disease in women. It mainly occurs in vulval and perianal skin. It mainly occurs in Vulvar and perianal skin and is characterized by whitening and pruritus of vulvar skin. Patients with obvious vulvar pain and induration should be alert to develop Vulvar squamous-cell Carcinoma (VSCC). This article introduces a 56-year-old woman with a history of VLS for more than 40 years. Taking the material from the Labia Majoris, the histopathology showed "VLS, mild". Later the separation of vulva adhesion was performed for the adhesion of the clitoris and obvious pain, showing that the clit was dark red and cauliflower-shaped. After two biopsies with biopsy forceps and cold knife, VSCC was confirmed by histopathology, then extensive eulvectomy plus bilateral inguinal lymphadenectomy was performed. Further radiotherapy and chemotherapy were given after the operation. It is suggested that VLS with a long history of local induration and obvious pain should be alert for canceration. If the clitoris is painful and sticky, it should undergo adhesion separation, expose the clitoris, and repeat the material when necessary, so as to avoid misdiagnosis.