470 Obstetrics and Gynecology Board Review •••
❍ What is the effect of lymph node involvement on survival?
If lymph node involvement is negative overall, survival is 90% regardless of stage; however, survival rate drops
precipitously even if only one lymph node is positive for metastasis (57%).
❍ What is the survival rate with positive deep pelvic nodes in vulvar cancer regardless of stage?
20%.
❍ How does the International Society for the Study of Vulvar Disease (ISSVD) define microinvasive carcinoma
of the vulva?
A squamous carcinoma having diameter of 2 cm or less, with depth of invasion ≤1 mm. The presence of vascular
space involvement would exclude the lesion from this category.
❍ What parameters should be addressed in the pathology report in early superficial vulvar cancer?
(1) Tumor thickness.
(2) Vascular invasion.
(3) Depth of invasion.
(4) Confluence of invasive neoplastic tongues.
(5) Grade of cell differentiation.
(6) Host response.
❍ What has the term “giant condyloma of Buschke-Lowenstein” been used to describe?
Verrucous carcinoma of the cervix.
❍ What have postoperative spindle cell nodules on the vulva been confused with?
Leiomyosarcomas.
❍ What are the most common metastatic tumors to the vulva?
Squamous cell cancer of the cervix and adenocarcinomas of the endometrium. Other primary sites include the
vagina, ovary, urethra, kidney, breast, melanoma, choriocarcinoma, rectum, and lung.
❍ Prior to the treatment of Paget disease of the vulva, what screening should be performed?
Because of the high incidence of associated carcinomas of the breast and genitalia, a thorough search for such
tumors should be performed prior to any consideration of therapy. This should involve breast examination,
mammography, cytologic and colposcopic evaluation of cervix, vagina and vulva, and sigmoidoscopy/colonoscopy.
❍ What is the stage of a 3 cm vulvar cancer confined to the vulva with unilateral regional lymph node
metastasis of 3 mm?
Stage IIIA—T 2 N1A M 0.
❍ What is the stage of vulvar cancer that is 1 cm in size with adjacent spread to the lower urethra, nodes
negative?
Stage II—T 2 N 0 M 0.