Vulvar cancer pathophysiology: Difference between revisions

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Revision as of 18:22, 7 October 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]

Development of vulvar cancer is the result of multiple genetic mutations.

Human papillomaviruses subtypes 16 and 18 (High risk) play an essential role in the pathogenesis of vulvar cancer. Once HPV enters an epithelial cell, the virus begins to make the proteins it encodes.
Two of the proteins made by high-risk HPVs (E6 and E7) interfere with cell functions that normally prevent excessive growth, helping the cell to grow in an uncontrolled manner and to avoid cell death. Many times these infected cells are recognized by the immune system and eliminated. Sometimes, however, these infected cells are not destroyed, and a persistent infection results. As the persistently infected cells continue to grow, they may develop mutations in cellular genes that promote even more abnormal cell growth.
HPV- related vulvar carcinoma is most commonly seen in younger women. Vulvar intraepithelial neoplasia (VIN), related to HPV infection, subsequently leads to invasive vulvar cancer.^[1]

Vulvar Carcinomas Subtype	Features on Gross Pathology
Squamous cell carcinoma of vulva	Most lesions originate in the labia, primarily the labia majora. Other areas affected are the clitoris, fourchette, and the local glands Unifocal
Basal cell carcinoma of vulva	Pearly nodule with telangiectasias
Vulvar melanoma	Superficial spreading is the most common type Brown/black color, but may include reddish brown or white Hyperkeratotic, diffused borders with no distinct demarcation Irregular and elevated

Histologic subtypes of vulvar cancer include:^[2]^[3]^[4]^[5]

Vulvar Carcinomas Subtype	Features on Histopathological Microscopic Analysis	Image
Squamous cell carcinoma of vulva	Eosinophilia Extra large nuclei/bizarre nuclei Inflammation (lymphocytes, plasma cells) Long rete ridges Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges	Squamous cell carcinoma of vulva
Basal cell carcinoma of vulva	Basaloid cells - similar in appearance to basal cells: Moderate blue/grey cytoplasm. Dark ovoid/ellipsoid nucleus with uniform chromatin Palisading of cells at the edge of the cell nests Artefactual separation of cells (forming the nests) from the underlying stroma - key feature Surrounded by blue (myxoid) stroma - key feature	Basal cell carcinoma of vulva
Vulvar melanoma	Presence of intraepidermal lateral spread (most characteristic feature) Dermal invasion Desmoplasia Epidermal hyperplasia Appearance of epithelioid cells with occasional spindle cells	Vulvar melanoma

↑ The Histopathology of Vulvar Neoplasia. Glown. http://www.glowm.com/section_view/heading/The%2520Histopathology%2520of%2520Vulvar%2520Neoplasia/item/256#13421 URL Accessed on September 30, 2015
↑ Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.
↑ Malignant melanoma. Libre pathology. http://librepathology.org/wiki/index.php/Malignant_melanoma. URL Accessed on September 30, 2015
↑ Basal cell carcinoma . Libre pathology. http://librepathology.org/wiki/index.php/Basal_cell_carcinoma. URL Accessed on September 30, 2015
↑ Squamous cell carcinoma. Libre pathology. http://librepathology.org/wiki/index.php/Squamous_cell_carcinoma. URL Accessed on September 30, 2015

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 | align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Vulvar Carcinomas Subtype'''}}
 | align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Histopathological Microscopic Analysis'''}}
+| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Image'''}}
+|-
 |-
 | Squamous cell carcinoma of vulva||
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 * Long rete ridges
 * Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges
-[[File:Scc.jpg|thumb|none|300px|Squamous cell carcinoma of vulva]]
+| [[File:Scc.jpg|thumb|none|300px|Squamous cell carcinoma of vulva]]
 |-
@@ Line 68: / Line 70: @@
 * Artefactual separation of cells (forming the nests) from the underlying stroma - key feature
 * Surrounded by blue (myxoid) stroma - key feature
-[[File:BCC.jpg|thumb|none|300px|Basal cell carcinoma of vulva]]
+| [[File:BCC.jpg|thumb|none|300px|Basal cell carcinoma of vulva]]
 |-
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 * Epidermal hyperplasia
 *Appearance of epithelioid cells with occasional spindle cells
-[[File:Melanoma.JPG |thumb|none|300px| Vulvar melanoma]]
+| [[File:Melanoma.JPG |thumb|none|300px| Vulvar melanoma]]
 |-
 |}