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Vulvar cancer comprises 5% of gynecological cancers with squamous cell carcinoma (SCC) being found in 90% of the cases. Vulvar intraepithelial neoplasia is human papilloma virus (HPV)-driven and is the precursor lesion in nearly 40% of all cases of vulvar SCC. Pruritus is reported as the most common initial manifestation of vulvar SCC which may be of a long duration with pain, discharge, and bleeding been less frequently reported which contributes to the delayed initial presentation of the disease. So far, there are no recommended screening strategies for vulvar cancer and HPV vaccination may be the only effective way for prevention. We present a case of advanced vulvar cancer in an immunocompromised host. We will review pertinent topics for the clinicians on HPV infection prevention, clinical course, staging and the need for strong efforts on patient education.

Acute Aortic dissection is relatively uncommon but can lead to fatal outcome due to misdiagnosis and/or delay treatment [ 1 ]. In this report we present a case of a 45-year-old man presenting with chief complaint of substernal chest pain with no remarkable laboratory and echocardiography finding. He was admitted to the cardiology service with clinical suspicion of acute coronary syndrome (ACS). However, further evaluation led to the diagnosed of acute aortic dissection and referral for urgent repair. Aortic dissection could mimic other disorders such as ACS and pulmonary embolism due to variation in the presenting symptoms [ 1 ]. Therefore, high clinical suspicious could lead to timely diagnosis and initiation of life-saving therapeutic interventions.