Female Genital Schistosomiasis (FGS) Associated with Well-Differentiated Squamous Cell Carcinoma of the Vulva: A Case Report.

Abstract

Introduction: Female genital schistosomiasis (FGS) is emerging neglected gynecological disease was mostly due Schistosoma haematobium infection. It results from egg deposition in the female genital tract. Despite the fact that this condition has been reported in the early days of the discovery of S. haematobium in Egypt, its existence has been grossly neglected. Thus, causing many women and girls in schistosomiasis-endemic areas to go through a preventable, debilitating, and stigmatizing presentation of FGS. To prevent this, increasing awareness of FGS is necessary for all, especially healthcare providers, to improve the diagnosis, management, and treatment.

Case Presentation: This paper describes the case of a 76-year-old widow who presented with a 10-year history of vulval soreness, multiple warty lesions on the vulva with surrounding areas of leukoplakia and ulceration, and ulcerative inguinal lymph nodes without haematuria. She has been a resident of Talasse, a rural community in the Balanga Local Government Area of Gombe State. A non-cigarette smoker, no evidence of HPV infection, and other precursor lesions with no previous history of any medical or surgical problems. Initially diagnosed with a vulvar tumor, histological tissue showed invasive nests of squamous cells with keratin pearl formation and  calcified ova of Schistosoma within the stroma with surrounding inflammatory cell infiltrates. This is line with FGS with a well differentiated squamous cell carcinoma of the vulvar. Though the patient died while being investigated she received praziquantel treatment at a dose 40mg/kg.

Conclusion: Female genital schistosomiasis has continued to evade diagnosis even in endemic areas. Thus, in managing girls and women who reside in or have traveled to endemic areas, clinicians should maintain a high index of suspicion for schistosomiasis even in the presence of other diseases or negative urine microscopic examination for Schistosoma eggs