A 70-year-old female presents with intense itching and a white plaque in the genital region. Histopathological examination shows loss of rete ridges, abundant collagen, and thinned epithelium. What is the most likely diagnosis?

1. A

   Lichen planus

2. B

   Lichen sclerosis

3. C

   Candidiasis

4. D

   Vulvar leukoplakia

Appeared in: INI-CET EXAM -2025

Explanation

• Lichen sclerosis is the correct diagnosis as it is a chronic inflammatory condition that classically presents in postmenopausal women.
• The clinical signs of intense itching (pruritus) and porcelain-white plaques in the anogenital region are hallmark features of this condition.
• The histopathological findings are definitive: a thinned epidermis, effacement (loss) of the rete ridges, and a band of hyalinized (sclerotic) collagen in the papillary dermis are pathognomonic for Lichen Sclerosus.

Why Other Options Were Wrong

• Option A: Lichen planus typically presents with violaceous (purple), polygonal papules, often with lacy white lines called Wickham's striae. Its histology is different, showing a 'saw-tooth' pattern of rete ridges and a dense, band-like inflammatory infiltrate, not a loss of ridges.
• Option C: Candidiasis is a fungal infection. While it causes itching and can form white plaques, the histopathology would reveal yeast and pseudohyphae, not the specific epithelial and dermal changes described in the question.
• Option D: Leukoplakia is a clinical descriptive term meaning 'white patch.' It is not a specific histopathological diagnosis. Lichen sclerosus is a common underlying cause of vulvar leukoplakia, so 'leukoplakia' describes the sign, while 'Lichen sclerosis' is the actual disease.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Diagnosis of vulvar dermatoses based on clinical and histopathological findings to guide bedside assessment, documentation, and the next nursing action.
• The primary nursing role involves patient education about the chronic nature of Lichen Sclerosus, the correct application of potent topical corticosteroids, and the importance of vulvar hygiene to minimize irritation.
• Nurses must emphasize the need for long-term follow-up and regular self-examination. Patients should be taught to report any new nodules, sores, or persistent lesions, as there is a 3-5% risk of malignant transformation to squamous cell carcinoma.
• What if? If the biopsy showed atypical cells in addition to the features of Lichen Sclerosus, the diagnosis would be vulvar intraepithelial neoplasia (VIN) arising in a background of Lichen Sclerosus, which requires more aggressive management and closer surveillance to prevent progression to invasive cancer.

How to Approach the Question

• First, identify the key patient demographics and clinical symptoms: a 70-year-old female with intense itching and a white genital plaque. This points towards a postmenopausal vulvar dermatosis.
• Next, focus on the histopathological keywords provided in the stem: 'loss of rete ridges,' 'abundant collagen,' and 'thinned epithelium.' These are highly specific findings.
• Systematically evaluate each option against the clinical and histological data.
• Eliminate 'Candidiasis' because its histology (yeast/pseudohyphae) does not match.
• Eliminate 'Vulvar leukoplakia' as it is a clinical description, not a definitive diagnosis.
• Differentiate between 'Lichen sclerosis' and 'Lichen planus.' Recall or look up the classic histology for each. The described findings (thinned epithelium, lost ridges, collagen band) are pathognomonic for Lichen Sclerosus, whereas Lichen Planus has 'saw-tooth' ridges and a band-like infiltrate.

Concept Tested & Keywords

• Concept Tested: Diagnosis of vulvar dermatoses based on clinical and histopathological findings.
• Stem keywords: 70-year-old female, intense itching, white plaque, genital region, histopathological examination, loss of rete ridges, abundant collagen, thinned epithelium
• Lead-in keywords: most likely diagnosis
• Clinical cues: The patient's age (70-year-old female) points towards conditions common in postmenopausal women.
• Clinical cues: The combination of a clinical sign (white plaque) with specific histopathology (loss of rete ridges, thinned epithelium) is the key to the diagnosis.

Question ID

QOfe4xIFdzWvi7F98vvmbt

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Reference Book

E6 Gynecology Williams pp. 93-122, 94-126