Squamous cell carcinoma
-Superficially invasive :
-Invasive :
-With tumour giant cells
-Spindle cell variant
-Acantholytic variant
-Basaloid carcinoma
-Verrucous carcinoma
-Warty carcinoma
-Basal cell carcinoma
Definition:
Depth of tumour invasion is less than 1mm
Diameter is less than 2cm.
Gross features:
Macroscopically cannot differentiate from VIN.
Lesion presents as an ulcer, red macule or papule.
White plaque or brown or black area within area of VIN.
-Isolated squamous cells or irregular nests in the stroma with loss of peripheral palisade.
-Increased eosinophilic cytoplasm
-Dyskeratosis and pearls
-Dermal stromal reaction. There is fibrosis and oedema
- Discontinuous basement membrane
Assess with laminin immunohistochemistry.
Behaviour & treatment
-No risk of lymph node metastasis.
- Wide local excision with or without ipsilateral lymph node dissection.
Presence of eosinophils in VIN is highly suggestive of early invasion.
-95% of malignancies of the vulva.
-3.5-8% of female genital tract malignancies.
-Mean age 60-74 years.
-Risk factors:
Age, smoking, immunodeficiency, condylomas, multiple partners, genital granulomatous disease. HPV in younger women
-Clinical features:
Pruritis, pain, discharge, bleeding,dysuria.
Site- labia majora , minora & clitoris
90% case are solitary.
More than 2cm in diameter in 60% cases
-Gross ;
Exophytic ; Papillomatous ; Ulcer.
-Histology :
Depth of invasion more than 1mm.
Pushing or infiltrative margins.
Grading
Usual- well, moderate, poor
Alternatively -Percentage of undifferentiated cells.
Pathological & clinical measurements:
- Tumour diameter (clinical)
- FIGO staging click
Histological appearances: click
- With tumour giant cells
May resemble melanoma
Non-keratinising
- Spindle cell type:
May mimic sarcoma or carcinosarcoma.
Immunoreactive for cytokeratin
-Acantholytic type:
Pseudoglandular architecture.
Glycogen-laden acantholytic cells
High hyaluronic acid content but no mucin.
These are more aggressive than the non-acantholytic type.
Differential diagnosis:
Amelanotic melanoma
Metastatic squamous carcinoma
Epithelioid sarcoma click
Pseudo-epitheliomatous hyperplasia
Keratoacanthoma click
Skin appendage involvement by VIN
? Carcinoma. CLICK
-Local spread - Vagina ; Distal urethra ; Base of bladder; Pelvic bones; Peri rectal tissues
- Lymphatics and blood vessels-
-Inguinal & femoral nodes (ipsilateral).
-Contra-lateral lymphnodes.
-Deep pelvic nodes involved in 25% of patients with superficial lymphnode involvement.
-Cloquet's node is frequently sampled.
-Paraaortic lymph nodes -thoracic duct- venous circulation.
Treatment:
-Radical vulvectomy with superficial lymph node dissection (local recurrence 6-7%)
- Tumours less than 2cm- wide local excision with ipsilateral lymphnode dissection is sufficient.
-Pelvic irradiation if superficial or Cloquet's nodes are involved.
-Possibly superior results if deep pelvic lymph nodes are also dissected.
- Chemotherapy with 5 FU an option for unresectable disease or those requiring exenteration ( 3yr survival 47-84%)
