A 60-year-old married female patient presented to us with asymptomatic gradually increasing skin lesion on vulva since 2 years. There was no history of risk of exposure to sexually transmitted diseases. There was no history of discharge from the lesion. No history of white discharge per vaginum or burning micturition. She had not taken any treatment in the past for the same. No past history of tuberculosis.
Examination revealed a firm, nontender, nodular plaque of 3.5 cm x 2.5 cm along with a few shiny papules along the right labia majora [Figure 1a]. The left labia majora, labia mijora, clitoris, and perianal areas were not involved. Oral mucosa was normal. There was no regional lymphadenopathy. Differential diagnoses considered were fibrosis lymphangioma circumscriptum, giant trichoepithelioma, sarcoidosis, lupus vulgaris, and deep fungal infection.
Histopathology from the lesion showed numerous horn cysts present throughout the dermis surrounded by eosinophilic cells [Figure 2a]. Few of the cyst walls were lined by eosinophilic epidermal cells and contained keratin [Figure 2b]; thereby leading to a diagnosis of a less known adnexal tumor trichoadenoma.