468 Obstetrics and Gynecology Board Review •••
❍ What is the definition of a stage IA vulvar cancer using the latest International Federation of Gynecologists
and Obstetricians (FIGO) staging (2009)?
Tumor confined to vulva or perineum; 2 cm or less in greatest dimension; no nodal metastasis with stromal
invasion ≤1.0 mm.
❍ Name the three mechanisms of the spread of vulvar cancer.
(1) Local growth and extension.
(2) Embolization to regional lymph nodes in the groin.
(3) Hematogenous dissemination to distant sites.
❍ Name the three characteristics that describe the growth pattern of vulvar cancer as these growth patterns
influence the rate of lymph node metastasis and survival.
(1) Confluent.
(2) Compact.
(3) Fingerlike (or spray).
❍ What is the name and location of the last node of the deep femoral nodal group?
The Cloquet node, or node of Rosenmüller, is located just beneath the Poupart ligament.
❍ Name, in order, the five most common histologic subtypes of vulvar neoplasms.
(1) Epidermoid (squamous cell).
(2) Melanoma.
(3) Sarcoma.
(4) Basal cell.
(5) Bartholin gland.
❍ True or False: The deep pelvic nodes are essentially never involved with metastatic disease when the more
superficial inguinal nodes are uninvolved, even with a clitoral lesion.
True.
❍ Which vulvar lesion has the classic “cake-icing effect” appearance secondary to hyperemic areas associated
with a superficial white coating?
Paget disease of the vulva.
❍ What underlying malignancy must be ruled out when Paget disease of the vulva is diagnosed?
Adenocarcinoma of the vulva.
❍ What is the treatment of Paget disease without an underlying adenocarcinoma?
This is a true intraepithelial neoplasia and can be treated as such with wide local excision.
❍ What is the most frequent histologic subtype seen in Bartholin gland cancer?
Adenocarcinoma and squamous cell carcinoma occur with equal frequency and comprise 80% of all primary
malignant tumors at this site.