Vulvar Nonclear Cell Syringoma Associated with Pruritus and Diabetes Mellitus

Background. Syringoma is a benign eccrine sweat gland tumor, characterized by multiple skin colored or slightly yellowish papules. Vulvar syringoma without extragenital involvement is an extremely rare variant of syringoma. Mail Observations. Herein, we report a 40-year-old diabetic female patient who presented with only lichenified plaques on the vulvar region without any extragenital lesions. Diagnosis of vulvar syringoma was made depending on the characteristic double lined cystic enlargements and comma-like tails found in histopathological examination. Immunohistochemical stains for estrogen and progesterone receptors were negative. Conclusion. Vulvar syringoma may present with no obvious papules on lichenified plaques. 1. Introduction Syringoma is a benign eccrine sweat gland tumor, usually presented with multiple skin colored papules on face, neck, and trunk with a female predominance. Syringomas usually involve face, neck, and trunk with a female predominance [1, 2]. However, vulvar syringoma without extragenital involvement is an extremely rare variant of syringoma [1]. Clinical suspicion and histopathological examination provide the true diagnosis of vulvar syringoma. Herein, we describe a 40-year-old diabetic female patient diagnosed as having vulvar syringoma with no obvious papules on lichenified plaques. 2. Case Report A 40-year-old female patient presented with genital pruritus lasting for about 1 year. Pruritus was intense during the menstruation period. She denied oral contraceptive intake, seasonal change, or any contact hypersensitivity. There was no family history of similar complaints or any genital lesions. In the medical history, the patient had only peptic ulcer for about 2 years. Dermatological examination revealed symmetrical lichenified plaques on bilateral labia majora and abrasion and erythema on the edges of the vulvar region (Figure 1). Otherwise body skin was normal, and she had no similar extragenital lesions. Papanicolaou smear of cervix and swabs from the vulvar region did not show any pathological findings and bacterial or fungal elements. Histopathological examination revealed multiple cystic enlargements, lined by two layers of cuboidal epithelium, some of which appeared as tadpole-like ductal epithelial structures including eosinophilic material, embedded in fibrotic stroma (Figure 2). Immunohistochemical stains for receptors of estrogen (ER) and progesterone (PR) were negative. Depending on these clinical and histopathological findings, the patient was diagnosed as having vulvar syringoma. Laboratory tests showed