Vulval squamous cell carcinoma and its precursors

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Oncogenesis

Background:

• Vulval squamous cell carcinoma (VSCC) presents two distinct etiological pathways: human papillomavirus (HPV)-associated and HPV-independent.
• These VSCC variants differ in etiology, morphology, molecular events, precursor lesions, prognosis, and treatment response.
• The precursor to HPV-associated VSCC (high-grade squamous intraepithelial lesion [vulvar intraepithelial neoplasia 2/3]) resembles cervical HSIL.

Purpose of the Study:

• To review recent advancements in the diagnostic surgical pathology of VSCC and its precursor lesions.
• To highlight the clinical impact of accurate VSCC precursor diagnosis on patient management.

Main Methods:

• Review of current literature on VSCC and its precursor lesions.
• Discussion of diagnostic criteria and pathological features.
• Analysis of the clinical implications of differential diagnoses.

Main Results:

• HPV-associated VSCC precursors are morphologically similar to cervical HSIL.
• HPV-independent VSCC precursors, including differentiated VIN, have been historically under-recognized.
• Accurate pathological diagnosis is essential for differentiating VSCC subtypes and guiding treatment.

Conclusions:

• Advances in surgical pathology improve the diagnosis of VSCC and its precursors.
• Improved recognition of precursor lesions, particularly for HPV-independent VSCC, can reduce diagnostic delays.
• Precise pathological diagnosis directly influences patient management strategies for VSCC.