Invasive Neoplasms Of The Vulva Squamous Cell Carcinoma

It is now recognized that there are two types of squamous cell carcinoma (SCC) of the vulva: the human papilloma virus (HPV)-related lesions seen in younger women and those unrelated to HPV seen in older women (Fig. 32A-D). The HPV-related lesions

Squamous Cell Carcinoma Vulva

Figure 30 Differentiated vulvar intraepithelial neoplasia (VIN). (A) The atypia of differentiated VIN is often subtle, with a few basal atypical cells, and dyskeratosis. (B) (See color insert) The cells show glassy eosinophilic cytoplasm, pronounced cell borders, and prominent nucleoli. There is a keratin pearl in the left upper portion of the field.

Figure 30 Differentiated vulvar intraepithelial neoplasia (VIN). (A) The atypia of differentiated VIN is often subtle, with a few basal atypical cells, and dyskeratosis. (B) (See color insert) The cells show glassy eosinophilic cytoplasm, pronounced cell borders, and prominent nucleoli. There is a keratin pearl in the left upper portion of the field.

Table 30 Differentiated Vulvar Intraepithelial Neoplasia

Clinical

Differential

Diagnosis

Symptoms

appearance

diagnosis

Therapy

Differentiated vulvar

Usually

Pale plaque(s)

Squamous cell

Excision

intraepithelial neoplasia

none

or nodules

hyperplasia

often have a basaloid, warty, or mixed histology (see description in VIN, usual type), while the HPV-unrelated lesions are well-differentiated carcinomas with abundant ker-atinization and pearl formation (57). HPV-negative carcinomas may be associated with lichen sclerosus and squamous cell hyperplasia, and whether or not these lesions pose a risk of developing carcinoma is still controversial although Fox and Wells (57) have stated that women with lichen sclerosus, while they do not usually develop carcinoma, are clearly at increased risk (57). Because this is the most common malignant vulvar neoplasm, it is often suspected in a wide variety of lesions, and clinicians are trained to be liberal in their biopsy practices. Squamous cell carcinomas may be endo-phytic or exophytic lesions and may be pale or red most often. Histologically, the inva-siveness of the lesion can be confirmed by the stromal response, desmoplastic or inflammatory, to the invasive nests of squamous epithelium. Lesions associated with HPV are often warty, basaloid, or mixed, as in the HPV-related VIN lesions. Similarly, the non-HPV-related invasive carcinomas have some of the features of differentiated VIN and are usually well differentiated with abundant keratinization and keratin pearls (Table 32).

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