Verrucous Carcinoma of the Vulva

Abstract

Introduction: Vulvar verrucous carcinoma (VC) is extremely rare, accounting for less than 1% of vulvar cancer cases. Effectively, it is characterization by a slow growing, no metastasis or lymph node involvement. The aim of this study was to report our experience with this disease Material and Methods: This is a retrospective study of patients with vulvar VC who were treated at National Institute of Oncology between 2013 and 2018. Clinicopathological characteristics, treatment and follow-up were extracted from the medical records. Results: Three cases were identified in the National Institut of Oncology. The average age at diagnosis was 66 years (± 10.02). The average time from the onset of symptoms to diagnosis was 17 months (± 12,7). All patients complained of a vulvar mass or nodule, accompanied by vulvar pruritus and/or pain, which was the reason for consultation. A preliminary pathological diagnosis of squamous cell carcinoma was made in two cases. Surgical treatment included wide local excision, radical vulvectomy with lymph node dissection in the groin. Tumor size and invasion depth ranged from 50 to 105 mm and 17 to 35 mm respectively. In the final histology, VC of the vulva staged IB (2 cases) and staged III (1 case) with marginal limits in two cases. The concurrent radiochemotherapy was performed in one case, exclusive radiotherapy in one case and only surgery in one case. Regarding toxicity after concurrent radiochemotherapy and exclusive radiotherapy we had observed respectely grade 2 proctitis with renal toxicity and grade 2 radiodermatitis. The mean follow-up was 43 months with no recurrence in all cases. The prognosis is good, with low recurrent rate if wide local excision is performed. Conclusions: Vulvar VC is a distinct type of slow-growing, tumor with unclear etiology. Surgery is the most effective treatment. Concurrent radiochemotherapy indicated depending on disease stage and risk factors.

Surgical treatment of verrucous carcinoma of the vulva - 15-year experience and literature review

“…Similar results are presented in other studies. Lui et al in their paper show the results of treatment of 24 patients with VC vulva who underwent unilateral or bilateral lymphadenectomy also with negative lymph nodes [4]. In 1 (11.1%) patient radical vulvectomy was performed with bilateral inguinofemoral lymphadenectomy, because it was suspected to be an invasive squamocellular carcinoma of the vulva on the histopathological examination of the preoperative biopsy, which was not confirmed at the definitive pathohistological examination.…”

“…Verrucous carcinoma is a locally destructive malignant neoplasm with low metastatic potential and has a long growth period [3]. The pathogenesis of VC is directly related to the mutation of the HPV type 6 virus that causes benign condylomas [4,5]. Prognosis of VC of vulva depends on size of the tumor and presense of local invasion of the surrounding organs of the anogenital region [6,7].…”

“…Complete surgical excision of tumors with histopathologically confirmed negative edges (minimum 5-8 mm.) is a standard therapeutic procedure used in the treatment of VC vulva as it provides good local control of the disease [2,4]. The most common complications of surgical treatment are bleeding, infection and skin necrosis, as well as dehiscence of the wound, which can prolong hospitalization and occur more frequently in tumor masses that engulf large areas of the skin or infiltrate surrounding organs [8 -10] All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.…”