Queratosis seborreica en el fondo de saco de Douglas: reporte de un caso

BACKGROUND: Thera are few repots of intraepithelial neoplasms with origins in the cervix or vagina with squamous appearance. This kind of lesions have been classified because of their morphologic similarities, in the category of “seborrheic keratoses like”. When seborrheic keratoses appears in the vaginal or vulvar mucosa, it has to be differentiated from low and high grade intraepithelial squamous lesions. OBJECTIVE: To describe a case of seborrheic keratoses in the recto-uterine pouch. CLINICAL CASE: 70 years old patient, who underwent surgery for stress urinary incontinence with a sub-urethral sling. During the procedure, a lesion in the vaginal mucosa was detected, specifically in the recto-uterine pouch, of 1.2 x 1 cm length, with a light brown color and soft consistency. A specimen was taken from the lesion during the procedure for histopathological study, which reported: hyperkeratosis in the epidermis, regular acanthosis, thickening and anastomosis of the crests with formation of corneal pearls, dermis with inflammatory, chronic, perivascular infiltration, with no signs of malignancy. The diagnosis was hypertrophic seborrheic keratoses, positive for P16 stain which orients to HPV infection. The lesion was removed and the patient continued follow up with her primary care provider. CONCLUSIONS: Seborrheic keratoses in this location is uncommon, with few reports in literature. These lesions are usually benign and are associated to HPV of low risk.