••• Chapter 51^ Gynecologic Pathology^503
❍ Name three features in the staging of vulvar carcinoma, which are important in determining prognosis.
(1) Diameter of the tumor.
(2) Depth of invasion.
(3) Status of regional lymph nodes.
❍ What is the classic presentation of bowenoid papulosis of the vulva?
A pigmented papule in a young pregnant female.
❍ How common is the presence of an underlying, invasive adenocarcinoma in a patient with vulvar Paget
disease?
10% to 20% of the cases.
❍ What are the clinical features of Paget disease of the vulva?
The lesions may have eczematoid appearance but can develop a raised and velvety appearance with more extensive
lesions.
❍ Regarding depth of invasion of squamous cell carcinoma of the vulva, how much invasion is allowed before
there is a significant risk of lymph node metastases?
The so-called microinvasive carcinoma that invades 1 mm or less has almost no risk of lymph node metastases.
Those that invade as little as 3 mm show metastatic lymph node involvement in >10% of the cases.
❍ What are some risk factors involved in development of squamous cell carcinoma of the vulva?
Cigarette smoking, diabetes mellitus, presence of HPV (particularly younger patients), and immunosuppression.
❍ What is the protein produced by HPV infected cells that causes degradation of p53?
Protein E6.
❍ How common is lymph node metastases in verrucous carcinoma of the vulva?
While this tumor has a tendency to recur locally, it does not metastasize in the absence of altered, aggressive
behavior secondary to radiation therapy. The treatment is local excision.
❍ What tumor, more characteristically found in the salivary glands, can occur in the vulva and is characterized
by late hematogenous spread and perineural invasion?
Adenoid cystic carcinoma.
❍ What percentage of vulvar malignancies are melanomas?
<5%.
❍ What is Sampson’s theory regarding endometriosis?
This hypothesis states that endometriosis (endometrial glands and stroma) occurs outside of the uterine mucosa via
“reflux menstruation” through the fallopian tubes and into the abdominal cavity.