How Can We Treat Vulvar Carcinoma in Pregnancy? A Systematic Review of the Literature

Abstract

According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17–41 years). The tumor size range was 0.3–15 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before-and-after delivery (11/37, 30%). We found that 21/37 (57%) cases were stage I, 2 II (5%), 11 III (30%), and 3 IVB (8%). HPV-related features (condylomas/warts; HPV infection; high-grade squamous intraepithelial lesion) were reported in 11/37 (30%) cases. We also found that 9/37 (24%) patients had inflammatory conditions (lichen sclerosus/planus, psoriasis, chronic dermatitis). The time-to-recurrence/progression (12/37, 32%) ranged from 0 to 36 (mean 9) months. Eight women died of disease (22%) 2.5–48 months after diagnosis, 2 (5%) were alive with disease, and 23 (62%) were disease-free at the end of follow-up. Pregnant patients must be followed-up. Even if they are small, newly arising vulvar lesions should be biopsied, especially in women with risk factors (HPV, dermatosis, etc.). The treatment of VSCCs diagnosed in late third trimester might be delayed until postpartum. Elective cesarean section may prevent vulvar wound dehiscence. In the few reported cases, pregnancy/fetal outcomes seemed to not be affected by invasive treatments during pregnancy. However, clinicians must be careful; larger cohorts should define the best treatment. Definite guidelines are lacking, so a multidisciplinary approach and discussion with patients are mandatory.

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review (Part 6): Correlation of PD-L1 Expression with the Status of Mismatch Repair System, BRCA, PTEN, and Other Genes

“…Systematic literature reviews and metanalyses (SLRs) conducted according to the PRISMA guidelines (including an evidence-based minimum set of items for reporting) ( , accessed on 8 May 2021) are increasingly important in health care, keeping medical doctors up to date, and also representing the background for developing clinical guidelines/trials, as well as the justification for financial supports of research projects. Usually conducted by multidisciplinary teams, SLRs performed according to these guidelines could be applicable in various topics/contexts, improving the research quality not only of pure meta-analyses but also of SLRs applied to case report/series [ 215 , 216 , 217 , 218 , 219 , 220 , 221 , 222 , 223 , 224 , 225 , 226 , 227 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 , 255 , 256 , …”

Postpartum regression of human papillomavirus‐related vulvar cancer: A case report

“…Vaginal delivery can be considered if the wound is well-healed after vulvar cancer treatment or if the vulvar mass is small. 7 Although no evidence exists that pregnancy affects the prognosis of vulvar cancer, 5,7 it is possible that mechanical dilatation and vulvar laceration during labor may promote metastasis.…”

“…However, HPV test, immunohistological test, and molecular analysis were not performed in 35 cases; hence, it was impossible to determine whether they were HPV‐related 7 . Additionally, condyloma was diagnosed in a case 6 months before pregnancy, but subsequent biopsy at 29 weeks of gestation revealed vulvar cancer, suggesting a pre‐pregnancy misdiagnosis and malignant transformation of the condyloma 7,8 . Lichen sclerosus‐like lesions appearing to be HPV‐independent but were HPV‐dependent vulvar cancer 9 and HPV‐negative vulvar intraepithelial neoplasia (VIN) showing a histological pattern similar to that of HPV‐related HSIL were reported 10 .…”

“…Lichen sclerosus‐like lesions appearing to be HPV‐independent but were HPV‐dependent vulvar cancer 9 and HPV‐negative vulvar intraepithelial neoplasia (VIN) showing a histological pattern similar to that of HPV‐related HSIL were reported 10 . Therefore, there is a limit to morphologically assessing whether it is HPV‐dependent or independent, and immunohistological assessment is required 7 . HPV‐related vulvar SCC found in younger patients is associated with smoking, a compromised immune status, and multiple sexual partners 3 .…”

“…One of the 37 reported cases, consulted various doctors for an itchy ulcer on the left labia minora during pregnancy, but no biopsy was performed; instead, ointment and antibiotics were prescribed. Two weeks after puerperium, she visited the gynecological oncology department, underwent a biopsy, and was diagnosed with vulvar cancer 7 . Hesitation to take a biopsy during pregnancy owing to post‐biopsy bleeding, and rarity of vulvar cancer, might have led to underestimation of the tumor and consequent follow‐up until after delivery.…”