Warning: session_start(): open(/var/lib/php/session/sess_lnd1vhsmmr2d1p96nijk2mfgu1, O_RDWR) failed: Permission denied (13) in /home/radiologykey.com/public_html/wp-content/plugins/paid-memberships-pro/paid-memberships-pro.php on line 28
Vulvar Carcinoma | Radiology Key

Vulvar Carcinoma



Vulvar Carcinoma


Maryam Rezvani, MD




























































































(T) Primary Tumor


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


TX


Primary tumor cannot be assessed


T0


No evidence of primary tumor


Tis1


Carcinoma in situ (preinvasive carcinoma)


T1a


IA


Lesions ≤ 2 cm in size, confined to the vulva or perineum and with stromal invasion ≤ 1.0 mm>


T1b


IB


Lesions > 2 cm in size or any size with stromal invasion > 1.0 mm, confined to the vulva or perineum


T23


II/III


Tumor of any size with extension to adjacent perineal structures (lower/distal 1/3 urethra, lower/distal 1/3 vagina, anal involvement)


T34


IVA


Tumor of any size with extension to any of the following: Upper/proximal 2/3 of urethra, upper/proximal 2/3 vagina, bladder mucosa, rectal mucosa, or fixed to pelvic bone


(N) Regional Lymph Nodes


NX


Regional lymph nodes cannot be assessed


N0


No regional lymph node metastasis


N1


1 or 2 regional lymph nodes with the following features



N1a


IIIA


1 or 2 lymph node metastases each < 5 mm



N1b


IIIA


1 lymph node metastasis ≥ 5 mm


N2


IIIB


Regional lymph node metastasis with the following features



N2a


IIIB


≥ 3 lymph node metastases each < 5 mm



N2b


IIIB


≥ 2 lymph node metastases ≥ 5 mm



N2c


IIIC


Lymph node metastasis with extracapsular spread


N3


IVA


Fixed or ulcerated regional lymph node metastasis


(M) Distant Metastasis


M0


No distant metastasis


M1


IVB


Distant metastasis (including pelvic lymph node metastasis)


1 FIGO no longer includes stage 0 (Tis).

2 The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion.

3 FIGO uses the classification T2/T3. This is defined as T2 in TNM.

4 FIGO uses the classification T4. This is defined as T3 in TNM.






































































AJCC Stages/Prognostic Groups


Adapted from 7th edition AJCC Staging Forms.


Stage


T


N


M


0


Tis


N0


M0


I


T1


N0


M0



IA


T1a


N0


M0



IB


T1b


N0


M0


II


T2


N0


M0


IIIA


T1, T2


N1a, N1b


M0


IIIB


T1, T2


N2a, N2b


M0


IIIC


T1, T2


N2c


M0


IVA


T1, T2


N3


M0




T3


Any N


M0


IVB


Any T


Any N


M1








Low-power magnification of H&E section from vulvar biopsy specimen shows the surface of the stratified squamous epithelium. Deep to the surface is the intraepithelial lesion characterized by cellular disarray with lack of maturation that involves almost the full thickness of the epithelium image. (Original magnification 100x.)






Higher magnification shows the crowded, pleomorphic, and dysplastic cells that lack maturation. The nuclei are hyperchromatic with many mitotic figures image. Note that the basement membrane image is intact with no invasive component. (Original magnification 400x.)






H&E stain of a biopsy specimen from an ulcerated skin lesion image shows invasive squamous cell carcinoma with superficial stromal invasion of < 1 mm depth ( image = 0.7 mm depth of invasion). (Original magnification 40x.)






Higher magnification shows invasion of squamous cords and nests image into the superficial dermis. Note the keratinized nest on the right side image. (Original magnification 400x.)







Low magnification of H&E stain from vulvar biopsy specimen shows overlying stratified squamous epithelium image with an invasive squamous cell carcinoma image infiltrating to a depth of 3 mm. (Original magnification 40x.)






Higher magnification of the invasive component shows nonkeratinized cords and nests of malignant cells in a desmoplastic stroma. (Original magnification 100x.)






H&E stain of a biopsy specimen from the urinary bladder shows bladder mucosa with transitional epithelium image. Invasive vulvar carcinoma involves the wall of the bladder image and extends to involve the bladder mucosa in the left upper corner image. (Original magnification 100x.)






Higher magnification image depicts transitional epithelium image with squamous cell carcinoma of vulvar primary image in close approximation. (Original magnification 400x.)







External view of the female genitalia depicts tumor confined to the vulva or vulva and perineum measuring ≤ 2 cm in greatest dimension. In addition, depth of tumor invasion must be ≤ 1 mm for tumor stage T1a.






External view of the female genitalia depicts tumor confined to the vulva or vulva and perineum measuring > 2 cm in greatest dimension. In addition, tumor of any size with depth of invasion > 1 mm is stage T1b.






External view of the female genitalia depicts tumor extending to adjacent perineal structures. T2 tumors can be any size while invading the lower urethra, lower vagina, and anus.






Sagittal view of the pelvis depicts vulvar tumor invading the lower urethra, lower vagina, and anus. Invasion of the distal 1/3 of adjacent perineal structures characterizes tumor stage T2.







Sagittal view of the pelvis depicts vulvar tumor extending to the upper urethra, urinary bladder, and pubic bone. Invasion of the proximal urethra and bladder mucosa constitutes tumor stage T3, as does tumor fixed to the pelvic bone.






Sagittal view of the pelvis depicts vulvar tumor invading the rectum. Extension to the rectal mucosa constitutes tumor stage T3.






This graphic shows the inguinofemoral lymph node basin. Image on the left depicts 1 lymph node metastasis ≤ 5 mm. Only 1 or 2 regional lymph nodes with metastases ≤ 5 mm can be involved for nodal stage N1a. Image on the right depicts 1 lymph node metastasis ≥ 5 mm, which constitutes stage N1b.






Image on the left depicts 3 lymph node metastases, each < 5 mm. For nodal stage N2a, 3 or more regional lymph nodes with metastases < 5 mm can be involved. Image on the right depicts 2 lymph node metastases ≤ 5 mm. For nodal stage N2b, 2 or more lymph nodes with metastases ≥ 5 mm can be involved.







This graphic shows the inguinofemoral lymph node basin with a magnified lymph node inset. Regional lymph node metastases with extracapsular spread of tumor constitute nodal stage N2c.






Graphic of the inguinofemoral lymph node basin depicts regional lymph node metastases with the nodal mass fixed to surrounding tissues. Fixation or ulceration of adjacent tissues constitutes nodal stage N3.




















image


METASTASES, ORGAN FREQUENCY


Pelvic lymph nodes


Intraabdominal sites


Lung


Bone


Central nervous system



Distant metastatic disease beyond the pelvic lymph nodes is rare. The number is not sufficiently significant to determine organ frequency.




OVERVIEW


General Comments



  • 4th most common gynecologic malignancy


  • 4% of female genital tract malignancies


  • 90% are squamous cell carcinoma


Classification

Sep 18, 2016 | Posted by in OBSTETRICS & GYNAECOLOGY IMAGING | Comments Off on Vulvar Carcinoma
Premium Wordpress Themes by UFO Themes

Warning: Unknown: open(/var/lib/php/session/sess_lnd1vhsmmr2d1p96nijk2mfgu1, O_RDWR) failed: Permission denied (13) in Unknown on line 0

Warning: Unknown: Failed to write session data (files). Please verify that the current setting of session.save_path is correct (/var/lib/php/session) in Unknown on line 0