Vulvar Carcinoma in Pregnancy: A Case Report and Literature Review

Regan, Michael J.; Rosenzweig, Bruce A.

doi:10.1055/s-2007-994755

Cited by 13 publications

(35 citation statements)

References 3 publications

(3 reference statements)

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“…27,43 The surgical complication rate for the 11 women operated on in the antenatal period was 36%, with two women having significant haemorrhage 37,44 and two incurring groin seromas. 45,46 The surgical complication rate for those operated on in the post-natal period was also 36% (one wound infection, 37 one wound breakdown, 38 one septicaemia 39 and one groin haematoma). 9 The majority of tumours were early stage (47% weeks' gestation; 6 and one pre-term labour and delivery at 29 weeks' gestation.…”

Section: Vulval Carcinoma In Pregnancymentioning

confidence: 98%

Squamous Cell Vulval Carcinoma and Pregnancy — A Review

Palmer¹,

Vatish²,

Tidy³

2010

European Oncology &Amp; Haematology

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Carcinoma of the vulva accounts for 4% of all female genital tract malignancies. 1 The incidence in the UK is two per 100,000 female population. 2 Vulval cancer is rare in young women with rates of more than one per 100,000 among women aged 25-44 years in the UK. 2 In the US, 15% of vulval cancers are reported to occur in women <50 years of age. 3,4 Prior studies have reported an incidence of 3.3% in women <35 years old, 5 2.3% in women <40 years old and 6.1%in women <45 years old. 6In recent years, an increased incidence of vulval cancer in younger women has been observed. Reports of either vulval carcinoma presenting during pregnancy, 25,[27][28][29] or of pregnancy following treatment for vulval cancer, are rare [29][30][31] because the majority of women with the condition are perimenopausal with completed families, post-menopausal or rendered infertile or of reduced fertility following treatment with radiotherapy and chemotherapy. 31 With the increasing incidence of HPV, VIN and HIV, and a concomitant increase in the incidence of vulval carcinoma in younger women, we are progressively more likely to encounter patients with either vulval carcinoma in pregnancy or pregnancy following treatment for vulval cancer. Given the paucity of available information to assist in managing these patients, and the increased likelihood of seeing this condition, a review of the management strategies in squamous cell vulval cancer associated with pregnancy is timely. MethodWe performed a computerised search (MEDLINE ® /embase ® ) to Squamous Cell Vulval Carcinoma and Pregnancy -A Review AbstractMaternal vulval carcinoma and pregnancy following vulval cancer are rare. However, vulval carcinoma in younger women is increasing, thus we are progressively more likely to encounter patients with either vulval carcinoma in pregnancy, or pregnancy following treatment for vulval cancer. Given the paucity of available information we performed a literature review considering the strategies employed in the management of these women. A computerised search (MEDLINE ® /embase ® ) was performed to identify all registered articles pertaining to squamous cell vulval carcinoma diagnosed or treated in pregnancy, and all cases of pregnancy following treatment for vulval cancer. In addition, cross-references of all selected articles were checked. Twenty-four reports were identified in the literature. In total, 21 cases of vulval carcinoma in pregnancy and 13 cases of pregnancy following vulval cancer were considered. Reports in the literature of vulval cancer associated with pregnancy span a time period of over 65 years making the production of definitive guidelines problematic as significant changes in the management of vulval cancer and changes in obstetrical and neonatal care need to be accounted for. Longer-term maternal and neonatal outcomes are also difficult to substantiate. Centralised data collection would be beneficial in these rare tumours, and in other malignant tumours diagnosed and treated during pregnancy. KeywordsVulval/vulvar carcin...

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Section: Vulval Carcinoma In Pregnancymentioning

confidence: 98%

Squamous Cell Vulval Carcinoma and Pregnancy — A Review

Palmer¹,

Vatish²,

Tidy³

2010

European Oncology &Amp; Haematology

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“…The patients' age range at presentation was 17-41 years (mean 30 years) (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]17,20,22,24,26,33,38,39], 6 in Asia (1 Iran, 1 Nepal, 1 Turkey, 1 Malaysia, 1 Saudi Arabia) [14,16,19,21,32,34], 2 in Australia [28] and 2 in Africa (1 Congo, 1 Nigeria) [15,25]. Eight patients were black [15,25,27,29,31,36,41], 6 were white/Caucasian [13,17,22,30,31,40], and 6 were of different Asian races [14,16,21,…”

Section: Age and Racementioning

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.…”

Section: Primary Tumor (T)mentioning

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]…”

Section: Primary Tumor (T)mentioning

confidence: 99%

“…Unilateral [14,15,17,19,20,[22][23][24]27,29,31,33,34,36,40,41] and bilateral cases [13,18,21,[23][24][25][26]28,[30][31][32][35][36][37][38][39] were almost equally distributed (17/37, 46% and 18/37, 49% respectively) (unavailable information for the remaining cases). Eight unilateral tumors occurred on the right hemivulva [15,17,19,20,22,31,36,40], and 9 on the left hemivulva [14,23,24,27,29,33,34,36,41].…”

Section: Primary Tumor (T)mentioning

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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