VULVA NEOPLASM

IRAWAN
SASTRADINATA

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 Benign vulvar disease
Benign Epithelial Vulvar Disease

Benign Vulvar Tumor

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 Vulvar tumor is not always a
neoplasia
Bartholin cyst, Skene duct cyst

Vulvar neoplasia is not always a

tumor
VIN
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 EPITHELIAL VULVAR
DISEASE
Nonneoplastic epithelial disorder of skin and mucosa
Mixed nonneoplastic and neoplastic epithelial disorders
Intraepithelial neoplasia
Squqmous intraepithelial neoplasia VIN
Nonsquqmous intraepithelial neoplasia
Invasive tumor

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 INTRA EPITHELIAL DISEASE

Most frequent vular disease

Can be detect by direct visual

examination with or without acetic acid
application

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 BENIGN VULVAR TUMOR;

BARTHOLIN CYST

SKENE

INCLUSION CYST

VULVAR INTRAEPITELIAL LESSION

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 Squamous
Intraepithelial
Neoplasia

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 Non squqmous intraepithelial
neoplasia

Peget Disease
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 VIN II VIN II
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 MANAGEMENT

BIOPSY EXCISSION

at least if there are not responsive to a given treatment

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 CONDYLOMA ACCUMINATA

TCA 4 weeks later

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 Benign Vulvar Tumor
1. Bartholin cyst

Infection (-) extipation

Infection (+) Antibiotic

Incission

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 SKENE DUCT CYST

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 Inclusion cyst
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 MANAGEMENT
Vulvar tumor

extirpation

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 BARTHOLIN CYST

EXTIRPATION

INCISSION, MARSUPIALIZATION

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 SKENE DUCT CYST

EXTIRPATION
BE CAREFUL OF ADJESCENCE STRUCTURE

URETHRA AND ITS EXTERNAL SPHINCTER

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 MALIGNAT VULVA
DISEASE

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 Introduction
Vulvar cancer is a malignant invasive
growth in the vulva,
4% of all gynecological cancers
affects women in later life.
Incidence in US : 3,740 new cases
will be diagnosed in 2006
about 880 women will die as a result
of vulvar cancer

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 Introduction
Most common : Squamous cell
carcinoma
Other common malignancy :
- malignant melanoma
- Basal cell carcinoma
- verrucous carcinoma

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 Squamous cell carcinoma
Definition : invasive carcinoma
composed of squamous cell of
varying degrees of differentiation
Frequently in older age group
1 : 100.000 in younger women
20 : 100.000 in the elderly

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Squamous cell carcinoma
Etiology: Unknown
Risk factor :
- Human papilloma virus (HPV)
HPV 6 or 11 verrucous ca
- Cigarette smoking
Precursor lesion :
- VIN (vulvar intraepithelial neoplasia)
- Lichen sclerosus

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 Two Major Pathogenetic
Routes
I. Linked to HPV infection, associates
with 40% of vulvar cancer includes:
1. Association with HPV exposure or history of
STD
2. Slightly younger group than HPV negative
3. Multifocality or association with cervical
neoplasia
4. Amplification at 3p25-27
5. Association with smoking
6. Preceded by VIN ( Bowens disease)

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 Two major

II. Linked to inflammatory dermatoses,

associates with 60% of vulvar
cancers, includes:
1. Pre-existing lichen simplex chronicus, lichen
sclerosus
and other acanthoses
2. Slightly older mean age ( eight decade)
3. Lower risk of other genital tract primary
neoplasm
4. Association with p53 positivity,
5. Lack of association with HPV
6. Preceded in many cases by atypias involving
the
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Vulvar intraepithelial neoplasia
(VIN)

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 Lichen sclerosus

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 Squamous cell carcinoma
Clinical feature :
- ulcer, nodule, macule or
pedunculated mass - often
associated with itching, irritation
- sometimes local bleeding and
discharge
Location:
- solitary
- labia minora or majora
- clitoris : 10%

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 Invasive squamous cell
carcinoma

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 Invasive squamous cell carcinoma

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Squamous cell carcinoma
Differential diagnosis:
- Pagets disease
- VIN
- Condyloma acuminatum

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 Pagets Disease

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 Condyloma acuminatum

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 Condyloma acuminatum

koilocytosis

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 Other common
malignancy
- malignant melanoma
- Basal cell carcinoma
- verrucous carcinoma

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 Malignant melanoma

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 Basal cell
carcinoma

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 Verrucous carcinoma

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 Microinvasive carcinoma

Has been applied to vulvar

cancer in which the depth of
penetration is less than 5 mm.
If less than 3mm and well
differentiated -> conservative
surgery is indicated
The presence of eosinophils in
VIN is a clue to the presence of
early invasion

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 Spread and Metastases

Regional metastases occur 20% of

cases
Tumor of the labia spread to
inguinal lymph node
->clitoris deep nodes
!!! Inflammatory and ulceration
often lead to enlargement of
inguinal lymph node.

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 Prognosis

5 year survival rate in patient

treated for vulvar squamous cell
carcinoma ->
50-75%.
Prognostic factors :
- Staging-> Tumor diameter, depth
of invasion, lymph node status.
- Infiltrative margin, vascular
invasion.
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