Stage IA Vulvar Squamous Cell Carcinoma

Yoder, Brian J.; Rufforny, Irina; Massoll, Nicole A.; Wilkinson, Edward J.

doi:10.1097/pas.0b013e318159a2cb

Cited by 49 publications

(11 citation statements)

References 20 publications

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“…This study together with several previous examinations has demonstrated that differentiation grade plays an important role in the aggressiveness of a tumor and has a considerable impact on survival [9, 10, 13, 14, 17, 27]. …”

Section: Discussionsupporting

confidence: 56%

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Prognostic factors and a value of 2009 FIGO staging system in vulvar cancer

Sznurkowski

Milczek

Emerich

2012

Arch Gynecol Obstet

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ObjectiveIn 2009, International Federation of Gynecology and Obstetrics (FIGO) modified staging of vulvar cancer—the prognostic significance of the new classification relative to the prior system as well as to the commonly recognized prognostic factors has not been assessed. The aim of this study was to test prognostic ability of 2009 staging in a cohort of uniformly treated and staged cases with long-term follow-up.MethodsPathologic characteristics were obtained by blind review of the original tissue samples. 76 patients who qualified for surgery on the basis of the same criteria, with full clinical history, were included in the study. The histological analyses were performed on 76 and 35 paraffin-embedded tissue samples from primary tumors and lymph nodes, respectively. Survival analyses included the Kaplan–Meier method, log-rank test and Cox proportional hazards model.ResultsUnivariate analysis has demonstrated that age (p = 0.0170), lymph node metastasis (p = 0.0393), tumor grade (p = 0.0086) and FIGO1994 stage (p = 0.001) were the significant prognostic factors for overall survival. Multivariate analysis has demonstrated that growing age (HR 2.25, 95 % CI 0.79–3.71, p = 0.0321), tumor grade (G1 vs. G2 and G3) (HR 1–3.11, 95 % CI 1.6–4.62, p = 0.0057) and FIGO1994 stage (HR 1.78, 95 % CI 0.55–3.01, p = 0.0061) are independent prognostic factors with respect to overall survival.ConclusionsThe results indicate the prognostic advantage of the 1994 FIGO staging as it has become an independent prognostic factor in contrast to the new FIGO system. This should be tested in future larger cohort studies. Differentiation grade turned out to be a very valuable independent prognostic factor and should be incorporated as a routine component of the histopathologic reports in vulvar cancer.

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Section: Discussionsupporting

confidence: 56%

“…differentiation grade, size and number of lymph node metastasis, presence of extracapsular spread), and depth of invasion was previously assessed using diverse criteria. The importance of proper measurement of the depth of invasion in vSCC was recently indicated by Yoder et al [17]. …”

Section: Discussionmentioning

confidence: 99%

Prognostic factors and a value of 2009 FIGO staging system in vulvar cancer

Sznurkowski

Milczek

Emerich

2012

Arch Gynecol Obstet

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“…Additional research has shown that the infiltrative pattern of invasion is associated with a higher likelihood of lymph node involvement and decreased overall survival; however, stromal responses to vSCC have been relatively understudied. 12–15 …”

Section: Discussionmentioning

confidence: 99%

“…Although an infiltrative pattern of invasion in vSCC has been frequently cited as an adverse prognostic factor, 11–15 the literature is particularly sparse in regards to the importance of stromal responses to vSCC. In a review of 51 cases of vSCC, Ambros and colleagues reported that a subset of vSCCs showed a prominent fibromyxoid stromal response, and that these tumors were more likely to be associated with women of older age, clitoral involvement, nodal metastasis and overall poorer survival rates compared to tumors without a prominent fibromyxoid stromal response.…”

Section: Introductionmentioning

confidence: 99%

A Fibromyxoid Stromal Response Is Associated With an Infiltrative Tumor Morphology, Perineural Invasion, and Lymph Node Metastasis in Squamous Cell Carcinoma of the Vulva

Jeffus

Gehlot

Holthoff

et al. 2015

American Journal of Surgical Pathology

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Patterns of invasion and stromal response are understudied in vulvar squamous cell carcinoma (vSCC). The aim of this study was to explore whether histologic features such as an infiltrative pattern of invasion and fibromyxoid stromal response (FMX-SR) are meaningful prognostic factors. We reviewed 143 vSCC resections and correlated patterns of invasion and stromal response with patient age, ethnicity, depth of invasion (DOI), tumor size, perineural invasion (PNI) (S100/AE1/3 stain), lymph node involvement (LNI), extranodal extension, margin status, pathologic stage, and recurrence. Univariate analyses of continuous variables were performed using t-tests, while Pearson’s χ2 tests were used for categorical variables. Logistic regression analyses examined the relationship between histopathologic characteristics and clinical outcomes. There was a statistically significant association between infiltrative tumors and a FMX-SR in comparison to non-infiltrative tumors (p < 0.001). Tumors with FMX-SR were significantly more deeply invasive (p=0.0025) and more likely to have LNI (p=0.0364), extranodal extension (p=0.0227) and PNI (p=0.0011) compared to tumors without FMX-SR. For cases with negative surgical margins, the association between tumors with FMX-SR and LNI was significantly strengthened (OR=4.73, p=0.0042), even after adjustments for age, race and DOI (OR=4.34, p=0.0154). Presence of both FMX-SR and infiltrative pattern of invasion in tumors with negative margins was significantly associated with LNI (p=0.0235) and recurrence (p=0.0124). These results suggest that interactions between nerve, tumor, and stromal cells play a role in tumor progression and represent additional prognostic factors that help stratify those patients at highest risk for LNI, extranodal extension and recurrence.

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“…A stage IA tumour has <1% risk of lymph node metastases, compared to tumours invading 1.1–5.0 mm having lymph node metastasis in up to 20%. 93 Lymphadenectomy is recommended for any tumour beyond stage IA in most institutions and hence accurate assessment of invasion is critically important for guiding patient care. Caution should be exercised when assessing invasion in hair-bearing skin, as one-third of cases can involve the skin appendages as deep as 2.7 mm.…”

Section: Diagnostic Challenges and Differential Diagnosismentioning

confidence: 99%

Squamous precursor lesions of the vulva: current classification and diagnostic challenges

et al. 2016

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Summary Growing evidence has established two major types of vulvar intraepithelial neoplasia (VIN), which correspond to two distinct oncogenic pathways to vulvar squamous cell carcinoma (VSCC). While the incidence of VSCC has remained relatively stable over the last three decades, the incidence of VIN has increased. VIN of usual type (uVIN) is human papillomavirus (HPV)-driven, affects younger women and is a multicentric disease. In contrast, VIN of differentiated type (dVIN) occurs in post-menopausal women and develops independent of HPV infection. dVIN often arises in a background of lichen sclerosus and chronic inflammatory dermatoses. Although isolated dVIN is significantly less common than uVIN, dVIN bears a greater risk for malignant transformation to VSCC and progresses over a shorter time interval. On histological examination, uVIN displays conspicuous architectural and cytological abnormalities, while the morphological features that characterise dVIN are much more subtle and raise a wide differential diagnosis. On the molecular level, dVIN is characterised by a higher number of somatic mutations, particularly in TP53. Here we review the classification, epidemiology, clinical features, histomorphology, ancillary markers and molecular genetics of both types of VIN, and discuss the morphological challenges faced by pathologists in interpreting these lesions.

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Stage IA Vulvar Squamous Cell Carcinoma

Cited by 49 publications

References 20 publications

Prognostic factors and a value of 2009 FIGO staging system in vulvar cancer

Prognostic factors and a value of 2009 FIGO staging system in vulvar cancer

A Fibromyxoid Stromal Response Is Associated With an Infiltrative Tumor Morphology, Perineural Invasion, and Lymph Node Metastasis in Squamous Cell Carcinoma of the Vulva

Squamous precursor lesions of the vulva: current classification and diagnostic challenges

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