26 - Neoplastic Diseases of the Vulva and Vagina

HPV 16, 18, 31, 33, and 35

HPV serotypes implicated in vulvar neoplasia or carcinoma

HPV 6, 11

HPV serotypes implicated in benign vulvar warts

Lichen sclerosus

Vulvar lesion characterized by change in the vulvar skin that often appears whitish; microscopically the epithelium becomes markedly thinned (cigarette paper in appearance), with a loss or blunting of the rete ridges

Squamous cell hyperplasia

Vulvar lesion characterized by elongation & widening of rete ridges, which may be confluent

Vulvar intraepithelial neoplasia

Vulvar lesion correlated with HPV infection

Paget disease

Uncommon apocrine gland neoplasia most often affecting the anogenital areas of both women and men

Squamous cell carcinoma

Comprise approximately 90% of primary vulvar malignancies

Melanoma

Most common non-squamous cell malignancy of the vulva

Tumor of any size with extension to adjacent perineal structures (one-third lower urethra, one-third lower vagina, anus) with negative nodes

FIGO Stage II for vulvar cancer

Tumor of any size with or without extension to adjacent perineal structures (one-third lower urethra, one-third lower vagina, anus), with positive inguinofemoral lymph nodes

FIGO Stage III for vulvar cancer

Tumor invades other regional (two-thirds upper urethra, two-thirds upper vagina) or distant structures

FIGO Stage IV for vulvar cancer

AJCC TNM staging system for cutaneous melanoma

Staging of vulvar melanoma follows which staging system?

• High-risk strains of HPV

• VAIN-3

• Cigarette smokers

• Immunocompromised

Populations with highest risk of progression to vaginal carcinoma

• CO2 laser vaporization

• Topical 5-FU cream

• Wide local excision (upper vaginectomy): treatment of choice for VIN 3

Treatment options for VAIN

Squamous cell carcinoma

Most common vaginal malignancy and accounts for 90% of primary vaginal cancers

Clear cell adenocarcinoma

Vaginal malignancy due to exposure to Diethylstilbestrol (DES)

Malignant melanoma

Highly malignant vaginal cancer, with common presenting symptoms of vaginal discharge, bleeding, and a palpable mass

Limited to vaginal wall

FIGO Stage I for vaginal cancer

Involves subvaginal tissue but has not extended to pelvic wall

FIGO Stage II for vaginal cancer

Extends to pelvic wall or to pelvic lymph nodes and/or causing hydronephrosis or nonfunctioning kidney

FIGO Stage III for vaginal cancer

• IVA: extends to the bladder, rectum, or beyond the pelvis

• IVB: distant part of the body

FIGO Stage IV for vaginal cancer