Field Cancerization of the Cervix and Vulva in a Young HIV-Positive Woman: Diagnostic Challenges in Multifocal HPV Disease – A Case Report and Literature Review

INTRODUCTION: Human Papillomavirus (HPV) is a well-established cause of cancers of the cervix, vulva, and vagina, particularly high-risk types such as HPV-16 and 18. In women living with HIV, impaired immune function reduces viral clearance, leading to persistent infection, faster progression of precancerous lesions, and involvement of multiple sites within the lower genital tract. This phenomenon is often explained by the concept of "field cancerization", where widespread HPV exposure results in synchronous neoplastic changes in adjacent mucosal tissues. CASE PRESENTATION: A 36-year-old HIV-positive woman presented with abnormal vaginal bleeding and post-coital bleeding. Testing revealed infection with multiple high-risk HPV genotypes, including HPV-16, and cervical cytology showed High-grade Squamous Intraepithelial Lesion (HSIL). Histopathological evaluation confirmed two concurrent HPV-related lesions: invasive squamous cell carcinoma of the cervix (FIGO stage IB1) and vulvar HSIL (VIN 3). She underwent a radical hysterectomy with pelvic lymph-node dissection along with wide local excision of the vulvar lesion, followed by adjuvant pelvic radiotherapy. CONCLUSION: This case illustrates the uncommon coexistence of cervical squamous cell carcinoma and vulvar HSIL in an HIV-positive woman, emphasizing the role of immunosuppression in persistent HPV infection and multifocal disease. Thorough evaluation of the entire lower genital tract, along with vigilant follow-up, is crucial for early detection and improved outcomes in this high-risk population.