HPV-associated Vulvar Trichoblastoma: A Diagnostic Pitfall

We report a rare case of a vulvar trichoblastoma arising synchronously with HPV-associated high-grade vulvar intraepithelial neoplasia (VIN3) in a 35-yr-old woman. Histology showed a deep dermal tumor with basaloid nests demonstrating peripheral palisading, folliculo-sebaceous differentiation, and increased mitotic activity. The tumor was diffusely positive for p16 by immunohistochemistry and high-risk HPV by RNA in situ hybridization, demonstrating similar positivity to the superficial VIN3. This overlap of morphologic and immunophenotypic features created a diagnostic pitfall, emphasizing the importance of distinguishing trichoblastoma from invasive squamous cell carcinoma using a judicious panel of immunohistochemical markers along with careful histologic assessment. Awareness of this rare mimic is essential to avoid misdiagnosis of invasive carcinoma and prevent overtreatment.