Case report: an unusual vulval lesion resembling Granuloma inguinale

Abstract

Introduction: Granuloma inguinale is a sexually transmitted infection that frequently presents as a genital ulcer. It has however been known to present in unusual forms such as mass lesions and pseudoepitheliomatous hyperplasia. Pseudoepitheliomatous hyperplasia can mimic squamous cell carcinoma or adenocarcinoma. Diagnosis of granuloma inguinale can be made using cytological or Histopathologic examination and is based on demonstration of Donovan bodies. Case reports have been published in South African journals, and none from the rest of sub-Saharan Africa. Case Report: A 40 year old lady presented to the Gynaecology Outpatient Clinic with history of a vulval lesion, excision biopsy done. Staining by H & E revealed an encapsulated granulomatous lesion composed of lymphoid cells and histiocytes surrounding a necrotic lesion with a focal neutrophil infiltrate.The histiocytes have red-golden cytoplasmic bodies which stain deeply basophilic on Giemsa staining. These had a slight PAS positivity, stained negative with Zeil-Nielsen and Pearl’s stains. Conclution: The diagnosis of granuloma inguinale requires a high index of suspicion. Any lesion characterised by a granulomatous inflammatory process attended by necrosis, focal neutrophil infiltration, lymphocytosis, fibrosis and the presence of histiocytes with intracytoplasmic inclusions should raise an index of suspicion. A distinction may need to be made from chlamydia, Mycobacterium tuberculosis, and cat scratch disease.