Neoplastic Disease of the Vulva and Vagina Flashcards
What are the 2 categories of preinvasive neoplastic disease of the vulva?
Squamous -Vulvar intraepithelial neoplasia (VIN) Nonsquamous intraepithelial neoplasias - Paget disease - Melanoma in situ
What is used to assist in the diagnosis of neoplastic vulva disease?
Immunohistochemical staining
How is VIN defined?
Cellular atypia contained within the epithelium
What is the danger of VIN?
20% have coexistent invasive carcinoma
60% have cervical neoplasia as well (HPV correlates)
100% progression to invasive vulvar cancer if untreated in patients over 40
What are the two distinct forms of VIN?
Younger, premenopausal = aggressive multifocal lesions (high association with HPV)
Older, postmenopausal = slow, focal lesions not associated with HPV
How is VIN treated?
Depends on degree of disease
If no evidence of invasion, wide local excision with disease free margin of 5-10 mm
If multifocal, then vulvectomy or skinning vulvectomy, with split-thickness skin grafts
-Laser vaporization can also be used
In younger patients, 5-FU and imiquimod
How does extramammary Paget’s disease (of the vulva) present?
chronic inflammatory changes - hyperemic, sharply demarcated, thickened
Long standing pruritis with velvety red lesions that scar into white plaques
In which age group is paget’s disease of the vulva most common?
> 60 years old
What is the treatment for Paget’s disease?
Wide local excision with wide margins
rule out adenocarcinoma
invariably fatal if it spreads to lymph nodes*
What is the most common type of vulvar cancer?
Squamous cell carcinoma (87%)
malignant melanoma
bartholins adenocarcinoma
basal cell
What is the treatment for SCC of the vulva?
Wide radical local excision with inguinal lymph node dissection
If stage I, only ipsilateral lymphadenectomy needed
if stage II, modified radical vulvectomy with separate ingiunal resection
stage III and IV = radical vulvectomy and bilateral inguino-femoral lymph nod dissection
What is needed if lymphadenectomy reveals mets?
pelvic radiation
Is lymphadenectomy for melanoma performed?
No because depth of invasion is prognostic factor and mets are 100% mortality
What is the prognostic factor for SCC of vulva?
number of positive inguinal lymph nodes
1 >90% 5 year
2, 50-80%
3,
Where does vaginal intraepithelial neoplasia present?
Multifocal lesions in the vaginal apex
