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NBME Form 13 Practice Test

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An 82-year-old with a cauliflower-like lesion between the vagina and rectum; likely diagnosis?
Correct Answer:
Vulvar Carcinoma (Squamous Cell)
Explanation:
A cauliflower-like, exophytic mass arising from the external genital area in an elderly woman points to vulvar squamous cell carcinoma. The space between the vagina and rectum is the vulvar region, and vulvar cancers classically present as raised, warty (cauliflower-like) lesions that may be pruritic or bleed. This differentiates it from anal cancer (which involves the anal canal itself), cervical cancer (arises from the cervix inside the uterus), or vaginal sarcoma (originating in the vaginal wall). Among vulvar malignancies, squamous cell carcinoma is by far the most common in postmenopausal women, often linked to HPV or chronic inflammatory dermatoses. Diagnosis is confirmed by biopsy.

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