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Small vulvar squamous cell carcinomas and adjacent tissues. A morphologic study.

Hemming Poulsen¹, Jette Junge, Mogens Vyberg

¹Department of Pathology, Hvidovre University Hospital, Institute of Pathology, Herlev University Hospital, Denmark.

APMIS : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica

|September 27, 2003

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Small vulvar squamous cell carcinomas may arise through two distinct pathways. One involves keratinizing carcinomas adjacent to lichen sclerosus and VIN1, while the other involves basaloid or keratinizing types with VIN2/VIN3 dysplasia.

Area of Science:

Gynecologic Oncology
Dermatopathology
Surgical Pathology

Background:

Vulvar squamous cell carcinomas (SCC) exhibit diverse subtypes and differentiation.
These tumors can be associated with lichen sclerosus and/or vulvar intraepithelial neoplasia (VIN).

Purpose of the Study:

To investigate the relationship between subtypes of small vulvar SCCs (diameter < 2 cm) and adjacent epithelial changes.
To explore potential distinct pathogenetic pathways for vulvar SCC development.

Main Methods:

Total embedding of 14 small vulvar SCCs in paraffin.
Serial sectioning for detailed lesion mapping.
Two- and three-dimensional imaging for comprehensive analysis.

Main Results:

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Seven keratinizing SCCs (median age 65) were associated with lichen sclerosus and VIN1.
Seven SCCs without lichen sclerosus (median age 58) included keratinizing (n=2) and basaloid (n=5) types.
The latter group often showed VIN2 and VIN3 dysplasia, suggesting different precursor lesions.

Conclusions:

Two distinct pathogenetic pathways for vulvar SCC are suggested.
The presence or absence of lichen sclerosus may indicate different developmental routes for vulvar SCC.