Current issue
Journal content
Articles in press
Archive
About the Journal
About the Polish Annals of Medicine
Editorial Board
Open Access policy
Abstracting & indexing
Affiliated institutions
Contact
Instructions
Peer review process
Guide for authors
Publication ethics
Ethics and Patient Consent
User License
Usage of third party materials
Disclaimer
Reviewers
Guide for reviewers
List of reviewers
Review Form
CASE REPORT
Cancer of the vulva in a 28-year-old woman
| 1 | Clinic of Gynecology and Obstetrics, Gynecological Oncology and Gynecological Endocrinology, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland |
| 2 | Department of Gynecology, Obstetrics and Gynecological Oncology, Provincial Specialist Hospital in Olsztyn, Poland |
CORRESPONDING AUTHOR
Janina Lipińska
Clinic of Gynecology and Obstetrics, Gynecological Oncology and Gynecological Endocrinology, Faculty of Medical Sciences, University of Warmia and Mazury, Department of Gynecological Oncology, Provincial Specialist Hospital in Olsztyn, Żołnierska 18, 10-516 Olsztyn, Poland. Tel.: +48 89 538 64 83.
Clinic of Gynecology and Obstetrics, Gynecological Oncology and Gynecological Endocrinology, Faculty of Medical Sciences, University of Warmia and Mazury, Department of Gynecological Oncology, Provincial Specialist Hospital in Olsztyn, Żołnierska 18, 10-516 Olsztyn, Poland. Tel.: +48 89 538 64 83.
Submission date: 2013-06-04
Acceptance date: 2013-10-10
Online publication date: 2013-10-15
Publication date: 2020-04-08
Pol. Ann. Med. 2013;20(2):132–134
KEYWORDS
squamous cell carcinomaSCC of the vulvagenital wartshuman papillomavirusHPVgroin lymph node metastasisrecurrence
ABSTRACT
Introduction:
Prevalence of vulvar cancer in women under 30 years of age is very low. Human papillomavirus DNA is found in 20%–60% of women with invasive vulvar cancer and in 70%–80% of patients with vulvar neoplasia. In a young woman treated for recurrent, extensive vulvar condyloma acuminate, squamous cell carcinoma of the vulva was found.
Aim:
The aim of this work is to demonstrate that cancer of the vulva may occur in young women. It demonstrates the need for particular diligence in the diagnosis and treatment of vulvar diseases and building a good relationship with the patient in order to minimize the fear of invasive treatment and encourage compliance.
Case study:
The patient, a 28-year-old female, after surgical treatment of condyloma acuminata, was admitted with a 3 cm tumor of the vulva. The tumor was excised with a margin of tissue free from infiltration – keratinizing squamous cell carcinoma was diagnosed. The patient did not return for extension surgery. After 5 years she was admitted with 4 cm loco-regional recurrence. Radical resection of the vulva with bilateral inguinal lymphadenectomy was performed. Four lymph node metastases were found. Adjuvant radiotherapy was implemented. Observation time was 4 years after the surgery for recurrence and 10 years after first diagnosis of cancer.
Results and discussion:
Vulvar lesions cause anxiety in women, associated with sexual activity and the appearance of external genitalia after surgical treatment. Doubts of both the physician and the patient, particularly young, associated with invasive diagnostic methods result in prolonged ineffective conservative treatment. In the presented case wide local excision of the tumor proved ineffective. Local recurrence metastasized to lymph nodes bilaterally and contralaterally.
Conclusions:
Treatment results of vulvar cancer are frequently dependent on patients' willingness to comply and minimizing the fear of consequences of the treatment. Women with oncological conditions of the vulva should be diagnosed and treated in specialized centers.
Prevalence of vulvar cancer in women under 30 years of age is very low. Human papillomavirus DNA is found in 20%–60% of women with invasive vulvar cancer and in 70%–80% of patients with vulvar neoplasia. In a young woman treated for recurrent, extensive vulvar condyloma acuminate, squamous cell carcinoma of the vulva was found.
Aim:
The aim of this work is to demonstrate that cancer of the vulva may occur in young women. It demonstrates the need for particular diligence in the diagnosis and treatment of vulvar diseases and building a good relationship with the patient in order to minimize the fear of invasive treatment and encourage compliance.
Case study:
The patient, a 28-year-old female, after surgical treatment of condyloma acuminata, was admitted with a 3 cm tumor of the vulva. The tumor was excised with a margin of tissue free from infiltration – keratinizing squamous cell carcinoma was diagnosed. The patient did not return for extension surgery. After 5 years she was admitted with 4 cm loco-regional recurrence. Radical resection of the vulva with bilateral inguinal lymphadenectomy was performed. Four lymph node metastases were found. Adjuvant radiotherapy was implemented. Observation time was 4 years after the surgery for recurrence and 10 years after first diagnosis of cancer.
Results and discussion:
Vulvar lesions cause anxiety in women, associated with sexual activity and the appearance of external genitalia after surgical treatment. Doubts of both the physician and the patient, particularly young, associated with invasive diagnostic methods result in prolonged ineffective conservative treatment. In the presented case wide local excision of the tumor proved ineffective. Local recurrence metastasized to lymph nodes bilaterally and contralaterally.
Conclusions:
Treatment results of vulvar cancer are frequently dependent on patients' willingness to comply and minimizing the fear of consequences of the treatment. Women with oncological conditions of the vulva should be diagnosed and treated in specialized centers.
CONFLICT OF INTEREST
None declared.
REFERENCES (15)
1.
Centrum Onkologii Warszawa. Krajowy Rejestr Nowotworów [online database]. Available at: 〈epid.coi.waw.pl/krn〉.
2.
Coleman RL, Ali S, Levenback CF, Gold MA, Fowler JM, Judson PL, et al. Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173. Gynecol Oncol. 2013;128(2):155–159.
3.
Gajewska M, Figat M, Bidziński M. Analiza wybranych czynników klinicznych i histologicznych usposabiających do wystąpienia wznowy u kobiet po pierwotnym leczeniu płaskonabłonkowego raka sromu [Analysis of the selected clinical and histological factors predisposing to recurrence in women after primary treatment of squamous cell carcinoma of the vulva]. Curr Gynecol Oncol. 2009;7(3):161–168.
4.
Gonzales Bosquet JC, Marina JF, Magtibay PM, Gaffey TA, Cha SS, Jones MB, et al. Patterns of inguinal groin metastases in squamous cell carcinoma of the vulva. Gynecol Oncol. 2007;105(3):742–746.
5.
Gordinier ME, Malpica A, Burke TW, Bodurka DC, Wolf JK, Jhingran A, et al. Groin recurrence in patients with vulvar cancer with negative nodes of superficial inguinal lymphadenectomy. Gynecol Oncol. 2003;90(3):625–628.
6.
Homesley HD, Bundy BN, Sedlis A, Yordan E, Berek JS, Jahshan A, et al. Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva (a Gynecologic Oncology Group study). Gynecol Oncol. 1993;49(3):279–283.
7.
Hopkins MP, Reid GC, Morley GW. The surgical management of recurrent squamous cell carcinoma of the vulva. Obstet Gynecol. 1990;75(6):1001–1005.
8.
Hudson PL, Habermann EB, Baxter NN, Durham SB, Virnig BA. Trends in the incidence of invasive and in situ vulvar carcinoma. Obstet Gynecol. 2006;107(5):1018–1022.
9.
Jackson KS, Das N, Naik R, Lopes A, Monaghan JM. Contralateral groin node metastasis following ipsilateral groin node dissection in vulvar cancer: a case report. Gynecol Oncol. 2003;89(3):529–531.
10.
Joura EA, Leodolter S, Hernandez-Avila M, Wheeler CM, Perez G, Koutsky LA, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulvar and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet. 2007;369(9574):1693–1702.
11.
Maggino T, Landowi F, Satori E, Zola P, Gadducci A, Alessi C, et al. Patterns of recurrence in patients with squamous cell carcinoma of the vulva. Cancer. 2000;89(1):116–122.
12.
Majewski S, Pniewski T, Goyal-Stec M. Rola wiruso´w brodawczaka w rozwoju zmian łagodnych i złośliwych okolicy narządów płciowych [The role of human papillomavirus in the development of benign and malignant lesions of the genital area]. Zakażenia. 2005;6:58–62.
13.
Makarewicz H, Emerich J. Ciąża i poród po wieloetapowym, oszczędzającym leczeniu chirurgicznym i radioterapii z powodu raka sromu [Pregnancy and delivery after multi- attempt conservation surgery and radiotherapy in the treatment of vulvar cancer]. Gin Pol. 2003;74(1):61–65.
14.
Smith JS, Backes DM, Hoots BE, Kurman RJ, Pimenta JM. Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstet Gynecol. 2009;113(4):917–924.
15.
Villa L, Costa R, Petta C. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16 and 18) L1 virus-like particle vaccine in young women: a randomized double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005;6(5):271–278.
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.