Radical vulvectomy for a rare case of squamous cell carcinoma vulva: a case report

Abstract

Cancer of the vulva is the fourth most common malignancy of the female genital tract. Vulvar carcinoma is a rare and aggressive gynecological malignancy. It affects elderly females, with the mean age at diagnosis being 55-60 years. Regional metastasis to inguinal lymph nodes is common. There is a high incidence of pelvic node involvement, especially in those with pathologically positive inguinal nodes. Surgery appears to be the only curative treatment option in the early stages of the disease. But in most patients, surgery is associated with considerable morbidities and psychosexual issues. Hence, in the quest for a less morbid form of treatment, multimodality approaches with various combinations of surgery, chemotherapy, and radiation therapy have been suggested for advanced vulvar cancers. Due to the low incidence of the disease, the level of evidence for the success of these treatment modalities is poor. Mrs. X, a 54-year-old female, P2L2 A0 presented at Apollo hospitals, Ahmedabad with a giant vulvar tumor of about 8x7 cm in size arising from anterior half of vulva involving clitoris and both labia minora. The vulval growth was initially small and had attained present size in last 15 days. She had complaints of postmenopausal bleeding per vaginum for 8 days, foul smelling discharge and itching vulva on and off for 1 month. Biopsy revealed moderate to well differentiated squamous cell carcinoma (SCC). MRI pelvis with contrast found suspicious lymph node in bilateral iliac vessel region and bilateral inguinal region. She underwent radical vulvectomy with bilateral inguinal lymph node dissection, and bilateral pelvic lymph node dissection. Early diagnosis, timely intervention and prompt surgical management could save the patient’s life. Histopathological report showed well differentiated SCC of vulva with no lymphnodes involvement. Depth of tumor was 12 mm and there was no lymphovascular and perineural invasion. All surgical margins and base of growth were free of tumor. According to TNM stabilization patient had SCC vulva stage IB (T1bN0M0). This patient was disease free after 18 months of follow-up. Vulvar cancer incidence is significantly high in post-menopausal and multiparous women. The most important prognostic factors are tumor stage and lymph node status. Oncological resection should be equated with functional outcome. The multidisciplinary team approach should be sought for this rare gynecological malignancy.