27: Vulvar/vaginal neoplasm Flashcards
VIN is ?
Histologic grades include ?
presentation?
a premalignant disease confined to the vulvar epithelium. VIN I, II, and III based on depth of epithelial involvement
-often asymptomatic but can present with vulvar pruritus and irritation unresponsive to treatment with antifungals or steroids
VIN risk factors
HPV 16 and 18, cigarette smoking, immunodeficiency, and immunosuppression.
VIN diagnosis and treatment
diagnose with vulvar biopsy
- treat with wide local excision, simple or skinning vulvectomy, or laser vaporization of tissue with close colposcopic follow-up
- conservative tx with topical 5-FU or imiquimod
Extra Mammary Paget disease (EMPD)
a preinvasive intraepithelial neoplasia of the vulva; rare but is associated with adenocarcinoma 20% of the time
EMPD appearance
how to diagnose and treat?
- chronic inflammatory changes; pruritic, velvety red in appearance and can eventually scar into white plaques
- biopsy to diagnose
- wide local excision; there is a high recurrence rate and close f/u is important.
- almost always fatal if spread to LNs
is vulvar carcinoma common?
how to stage
risk factors
less than 5% of gyne cancers
- staged surgically
- risk factors: HPV, HIV, and history of cervical cancer
vulvar cancer presentation
how to diagnose?
90% of vulvar carcinoma is this histological type
vulvar itching, pain, and bleeding, and the diagnosis is made by vulvar biopsy.
SCC (squamous cell carcinoma)
treatment of vulvar cancer
radical local excision (stage I) or radical vulvectomy (stages II, III, IV), and regional (inguino-femoral) lymphadenectomy; pelvic exenteration or preoperative chemoradiation may also be used for advanced disease.
Five-year survival rates for vulvar cancer are excellent for ?, but drops to 15% for ?
two or fewer positive nodes
three or more positive node
VAIN lesions presentation
how to pick up?
often asymptomatic but may present with vaginal discharge or postcoital spotting. They can also be picked up on cervical cytology (persistently abnormal paps but no cervical neoplasia)
is VAIN more or less common than CIN or VIN?
where are lesions and how to diagnose?
VAIN is much less common than CIN or VIN.
- Most lesions are multifocal and located in the vaginal apex.
- Diagnosis is made by colposcopically directed vaginal biopsy (with acetic acid and Lugol’s solution)
At least 50% to 90% of patients with VAIN have what coexistent neoplasm ?
intraepithelial lesion or invasive lesion of the cervix or vulva.
common therapies for VAIN
Local excision, laser ablation/vaporization, and topical 5-FU
-require close follow-up with colposcopy to rule out recurrence
Prior to treating VAIN, patients should undergo ? to assess for ?
chest imaging, cystoscopy, proctosigmoidoscopy, and IVP to assess for the extent disease.
Small stage I malignancies of the upper vagina can be treated with ?; all other lesions are treated with ? for an overall 5-year survival rate between ?
- surgical excision
- internal and external radiation therapy
- 45% and 55%.
