Vaginal cancer classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]
Overview
Vaginal cancer may be classified according to histopathology into squamous cell carcinoma, adenocarcinoma, vaginal sarcoma and melanoma.
Types of vaginal cancer
Types of vaginal cancer, in order of prevalence, include:
- Vaginal squamous cell carcinoma:
- Squamous cell carcinoma accounts for the majority of vaginal cancers.
- The mean age at diagnosis of squamous cell carcinomas is approximately 60 years.[1]
- These tumors may be nodular, ulcerative, indurated, endophytic, or exophytic.
- Vaginal cancer is also associated with the human papillomavirus (HPV).
- Vaginal epithelium is more stable than cervical epithelium, which undergoes constant metaplasia, and is less susceptible to oncogenic viruses[2].
- Verrucous carcinoma is a less common variant of vaginal squamous cell carcinoma that is well-differentiated and has low malignant potential[3].
- It usually presents as a large, warty, fungating mass that is locally aggressive but rarely metastasizes.
- Vaginal adenocarcinoma:
- Adenocarcinomas represent as primary vaginal cancers in women younger than 20 years old[1].
- Adenocarcinomas arise in areas of vaginal adenosis, Wolffian rest elements, periurethral glands.
- Clear cell variants are the best known type of adenocarcinoma.
- Clear cell carcinoma presents in young women who have been exposed in utero to diethylstilbestrol (DES)[4].
- Clear cell carcinomas of the vagina present as polypoid masses,on the anterior wall of the vagina.
- DES exposure can result in both cervical and vaginal clear cell adenocarcinomas[5].
- The incidence of invasive or in situ squamous cell cancer of the cervix is increased in women exposed to DES in utero[6].
- It is recommended that women exposed to DES in utero have their first gynecologic examination at menarche.
- Vaginal sarcoma:
- Rhabdomyosarcoma in pediatric population, eg. sarcoma botryoides, Leiomyosarcomas, endometrial stromal sarcomas, malignant mixed müllerian tumors.
- Rhabdomyosarcomas are the major types of primary vaginal sarcomas[7].
- The most common of these is the embryonal rhabdomyosarcoma (sarcoma botryoides).
- Sarcoma botryoides is highly malignant tumor that occurs in the vagina during infancy and early childhood.
- This sarcoma generally presents as soft nodules that fill and sometimes protrude from the vagina, resembling a bunch of grapes (botryoides comes from the Greek word botrys, which means "grapes")
Melanoma:
- Melanomas arising on the vaginal mucosa are rare'
- It mostly originate from mucosal melanocytes in areas of melanosis or from atypical melanocytic hyperplasia[8].
- The presenting symptom is most commonly vaginal bleeding.
- They appear as a blue-black or black-brown mass, plaque, or ulceration, most frequently on the distal one-third of the anterior vaginal wall.
- They are often nonpigmented.
- Primary malignant melanomas of the urogenital mucous membranes may have aggressive behavior with a high rate of local failure and metastases[9].
References
- ↑ 1.0 1.1 Creasman WT, Phillips JL, Menck HR (September 1998). "The National Cancer Data Base report on cancer of the vagina". Cancer. 83 (5): 1033–40. PMID 9731908.
- ↑ Ikenberg H, Runge M, Göppinger A, Pfleiderer A (September 1990). "Human papillomavirus DNA in invasive carcinoma of the vagina". Obstet Gynecol. 76 (3 Pt 1): 432–8. PMID 2166263.
- ↑ Isaacs JH (September 1976). "Verrucous carcinoma of the female genital tract". Gynecol. Oncol. 4 (3): 259–69. PMID 964693.
- ↑ Herbst AL, Ulfelder H, Poskanzer DC (April 1971). "Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women". N. Engl. J. Med. 284 (15): 878–81. doi:10.1056/NEJM197104222841604. PMID 5549830.
- ↑ Hanselaar AG, Van Leusen ND, De Wilde PC, Vooijs GP (April 1991). "Clear cell adenocarcinoma of the vagina and cervix. A report of the Central Netherlands Registry with emphasis on early detection and prognosis". Cancer. 67 (7): 1971–8. PMID 2004313.
- ↑ Verloop J, Rookus MA, van Leeuwen FE (June 2000). "Prevalence of gynecologic cancer in women exposed to diethylstilbestrol in utero". N. Engl. J. Med. 342 (24): 1838–9. doi:10.1056/NEJM200006153422415. PMID 10866558.
- ↑ Hilgers RD, Malkasian GD, Soule EH (June 1970). "Embryonal rhabdomyosarcoma (botryoid type) of the vagina. A clinicopathologic review". Am. J. Obstet. Gynecol. 107 (3): 484–502. PMID 4915719.
- ↑ DeMatos P, Tyler D, Seigler HF (July 1998). "Mucosal melanoma of the female genitalia: a clinicopathologic study of forty-three cases at Duke University Medical Center". Surgery. 124 (1): 38–48. PMID 9663250.
- ↑ Frumovitz M, Etchepareborda M, Sun CC, Soliman PT, Eifel PJ, Levenback CF, Ramirez PT (December 2010). "Primary malignant melanoma of the vagina". Obstet Gynecol. 116 (6): 1358–65. doi:10.1097/AOG.0b013e3181fb8045. PMID 21099603.