Invasive Vulvar Cancer in Pregnancy

Parva, Mehdi; Miroshnichenko, Gennady; Holtz, David O.; Dunton, Charles J.

doi:10.1097/lgt.0b013e31819d8059

Cited by 2 publications

(46 citation statements)

References 33 publications

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“…The patients’ age range at presentation was 17–41 years (mean 30 years) [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] ( Table 1 ). The majority of cases was diagnosed in the United States (15 cases) [ 18 , 23 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 40 , 41 ], 12 in Europe (5 United Kingdom, 3 France, 2 Germany, 1 Belgium, 1 Holland) [ 11 , 12 , 13 , 17 , 20 , 22 , 24 , 26 , 33 , 38 ...…”

Section: Resultsmentioning

confidence: 99%

“…Globally, the anterior/upper part of the vulva was involved in 22/37 (60%) cases [ 13 , 14 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 36 , 38 , 39 ], and the posterior/lower portion in 10/37 (27%) cases [ 18 , 20 , 25 , 28 , 31 , 35 , 36 , 41 ] ( Table 1 , Table S1 ). Nine lesions were centered in the median anterior/upper (6 cases) [ 21 , 26 , 30 , 32 , 38 ] or median posterior/lower (3 cases) [ 18 , 35 ] part of the vulva, extending bilaterally. One case seemed confined to the mid vulvar part [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…One case seemed confined to the mid vulvar part [ 36 ]. The clitoris/periclitoral area was infiltrated in 14/37 (38%) cases [ 13 , 19 , 21 , 23 , 24 , 26 , 28 , 30 , 31 , 32 , 34 , 38 , 39 ], labium majus in 18/37 (49%) cases [ 13 , 15 , 19 , 20 , 21 , 22 , 23 , 29 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 41 ], labium minus in 11/37 (30%) cases [ 13 , 14 , 17 , 20 , 21 , 24 , 27 , 28 , 36 ], the posterior fourchette in 3 (8%) cases [ 18 , 20 , 28 ]. Unilateral [ 14 , 15 , 17 , 19 , 20 , 22 , 23 , 24 , 27 , 29 , …”

Section: Resultsmentioning

confidence: 99%

“… Discovery during pregnancy without pre-conceptional evidence of vulvar lesions (25/37 cases, 68%) . The VSCCs were identified during the 1st (2/25 cases, 8%) [ 14 , 35 ], 2nd (14/25 cases, 56%) [ 13 , 16 , 18 , 23 , 24 , 28 , 29 , 31 , 32 , 33 , 36 , 37 , 38 , 39 ], or 3rd trimester of pregnancy (9/25 cases, 36%) [ 11 , 12 , 19 , 21 , 26 , 30 , 31 , 36 , 41 ]. Peri-conceptional evidence of a vulvar lesion (3/37 cases, 8%).…”

Section: Resultsmentioning

confidence: 99%

“…A smoking history was evident in 3/37 (8%) cases [ 18 , 20 , 22 ] (1 heavy-smoker [ 20 ]; 1 moderate-smoker for 2 years [ 22 ]; 1 smoker not otherwise specified, NOS), being excluded in 3 additional cases [ 17 , 28 ].…”

Section: Resultsmentioning

confidence: 99%

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

Palicelli

Giaccherini

Zanelli

et al. 2021

Cancers

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

Palicelli

Giaccherini

Zanelli

et al. 2021

Cancers

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Diagnostic Criteria for Differentiated Vulvar Intraepithelial Neoplasia and Vulvar Aberrant Maturation

Heller

Day

Allbritton

et al. 2020

J Low Genit Tract Dis

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Objective The aim of the study was to describe the features required for diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM). Materials and Methods The International Society of the Study of Vulvovaginal Diseases tasked the difficult pathologic diagnoses committee to develop consensus recommendations for clinicopathologic diagnosis of vulvar lichen planus, lichen sclerosus, and dVIN. The dVIN subgroup reviewed the literature and formulated diagnostic criteria that were reviewed by the committee and then approved by the International Society of the Study of Vulvovaginal Diseases membership. Results Differentiated vulvar intraepithelial neoplasia is the immediate precursor of human papillomavirus (HPV)–independent vulvar squamous cell carcinoma and shows a spectrum of clinical and microscopic appearances, some overlapping with HPV-related neoplasia. The histopathologic definition of dVIN is basal atypia combined with negative or nonblock-positive p16 and basal overexpressed, aberrant negative, or wild-type p53. The most common pattern of dVIN is keratinizing with acanthosis, aberrant rete ridge pattern, and premature maturation. The morphologic spectrum of keratinizing dVIN includes hypertrophic, atrophic, acantholytic, and subtle forms. A few dVIN cases are nonkeratinizing, with basaloid cells replacing more than 60% of epithelium. Vulvar aberrant maturation is an umbrella term for lesions with aberrant maturation that arise out of lichenoid dermatitis and lack the basal atypia required for dVIN. Conclusions Evaluation of women at risk for dVIN and VAM requires a collaborative approach by clinicians and pathologists experienced in vulvar disorders. Close surveillance of women with lichen sclerosus and use of these recommendations may assist in prevention of HPV-independent squamous cell carcinoma through detection and treatment of dVIN and VAM.

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Invasive Vulvar Cancer in Pregnancy

Cited by 2 publications

References 33 publications

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

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

Diagnostic Criteria for Differentiated Vulvar Intraepithelial Neoplasia and Vulvar Aberrant Maturation

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