Vulvar cancer pathophysiology

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Overview

Pathogenesis of vulvar cancer

  • 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]

Pathology

Table 31-1. Histologic Subtypes of Vulvar Cancer[2][3][4][5]

1. Vulvar carcinomas

  • Squamous cell carcinoma
  • Basal cell carcinoma
  • Vulvar Paget disease
  • Adenocarcinoma
  • Transitional cell carcinoma
  • Verrucous carcinoma
  • Merkel cell tumors
  • Verrucous carcinoma

2. Vulvar malignant melanoma

3. Vulvar sarcoma

  • Leiomyosarcoma
  • Malignant fibrous histiocytoma
  • Epithelial sarcoma
Vulvar carcinomas Subtype Features on Gross Pathology Features on Histopathological Microscopic Analysis
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
  • Pearly nodule with telangiectasias
  • 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
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
  • Presence of intraepidermal lateral spread (most characteristic feature)
  • Dermal invasion
  • Desmoplasia
  • Epidermal hyperplasia
  • Appearance of epithelioid cells with occasional spindle cells

References

  1. The Histopathology of Vulvar Neoplasia. Wilkinson, E, Glob. libr. women's med.http://www.glowm.com/section_view/heading/The%2520Histopathology%2520of%2520Vulvar%2520Neoplasia/item/256#13421 URL Accessed on September 30, 2015
  2. Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.
  3. Malignant melanoma. Libre pathology. http://librepathology.org/wiki/index.php/Malignant_melanoma. URL Accessed on September 30, 2015
  4. Basal cell carcinoma . Libre pathology. http://librepathology.org/wiki/index.php/Basal_cell_carcinoma. URL Accessed on September 30, 2015
  5. Squamous cell carcinoma. Libre pathology. http://librepathology.org/wiki/index.php/Squamous_cell_carcinoma. URL Accessed on September 30, 2015