Epidermolytic hyperkeratosis in the lower female genital tract: an uncommon simulant of mucocutaneous papillomavirus infection--a report of two cases.

Two examples of epidermolytic hyperkeratosis (EH) involving the female genital tract are described. The first case, an isolated epidermolytic acanthoma, involved the vulva of a 75-year-old woman. The second case involved the vaginal wall of a 40-year-old woman who had similar lesions of the oral mucosa. EH is characterized by epidermal acanthosis, compact papillomatous hyperkeratosis, and dissolution of the suprabasilar epithelium, resulting in perinuclear clear zones. Granular keratohyalin clumping, hypergranulosis, and dyskeratosis resulting in intracellular eosinophilic globules ("cells within a cell" appearance) are additional distinctive findings. Because of the rarity of the lesion in the female genital tract, it may be confused with other lesions that more commonly affect this region. Correct recognition of EH may have significant clinical implications.