••• Chapter 48^ Vulvar and Vaginal Carcinoma^469
❍ How does the lymph node spread pattern of Bartholin gland cancer differ from typical squamous cell vulvar
carcinoma?
The lesion can have a tendency to spread into the ischiorectal fossa and can spread posteriorly directly to the deep
pelvic nodes in addition to the typical inguinal lymph node spread pattern.
❍ What is the reported lymph node metastasis rate of stage I squamous carcinoma of the vulva with a
thickness of 5 mm or more?
At least 15%.
❍ Have squamous cell vulvar tumors with a depth of £1 mm shown any significant risk of lymph node metastasis?
No. Tumors of this depth or less carry little or no risk of lymph node metastasis.
❍ What is the name of the vulvar tumor that is a neuroendocrine tumor of the skin, morphologically
resembles small-cell carcinomas of neuroendocrine type in other body sites and is associated with frequent
lymph node metastasis and a poor prognosis?
Merkel cell tumor.
❍ What HPV subtype has been associated with verrucous carcinomas of the vulva?
HPV type 6.
❍ Where is the most common site on the vulva to find an adenoid cystic carcinoma?
The Bartholin gland. It comprises 15% of all Bartholin gland carcinomas.
❍ Name the most frequent primary vulvar sarcoma identified and its usual location.
Leiomyosarcoma. It commonly arises in the labium majus or the Bartholin gland area.
❍ What is the single most important prognostic factor in women with vulvar cancer?
Lymph node metastasis. The presence of inguinal node metastasis routinely results in a 50% reduction in
long-term survival.
❍ What is the incidence of positive lymph node involvement in T1 and T2 lesions?
The incidence of positive inguinal and pelvic lymph nodes varies considerably; however, in the largest study to
date it was found that 20% of T1 lesions and 45% of T2 lesions had positive lymph node involvement (higher if
adjuvant radiation therapy is administered).
❍ What are the two most common complications associated with radical vulvectomy?
Wound breakdown occurs in approximately 50% of patients in most series and lymphedema following surgery has
been reported in up to 70% of patients.
❍ What is the 5-year survival rate by stage in vulvar cancer?
Stage I—91%.
Stage II—81%.
Stage III—48%.
Stage IV—15%.