Sigrid Regauer1, Olaf Reich2, Barbara Eberz3. 1. Institute of Pathology, Medical University Graz, Graz, Austria. Electronic address: sigrid.regauer@medunigraz.at. 2. Department of Gynecology, Medical University Graz, Graz, Austria. 3. General Gynecology Practice, Mürzzuschlag, Austria.
Abstract
BACKGROUND: Vulvar squamous cell carcinomas (SCCs) arising in association with vulvar lichen planus (LP) are poorly documented. OBJECTIVES: We sought to present clinicopathological features of 38 patients (median age 61 years, range 39-90 years) with LP-associated vulvar SCCs. METHODS: Evaluated were location of vulvar SCC and metastases at presentation, recurrences, survival, precursor lesions, presence of human papillomavirus DNA, p16ink4a, and p53 expression. RESULTS: In all, 32 solitary (5 pT1a, 20 pT1b, 7 pT2) and 6 multifocal SCCs, located in the vestibulum (n=20) and in nonhair-bearing modified and glycogenated mucosa (n=18), arose in erosive (n=13) and nonerosive (n=25) LP. All SCCs were human papillomavirus DNA and p16ink4a negative. Sixteen of 38 (42%) women had inguinal metastases at presentation. Treatment was surgery with clear margins (36/38) and chemoradiation (2/38). Fourteen of 36 (39%) surgically treated patients developed between 1 and 5 new SCCs in the residual diseased mucosa. Of all recurrences, 68% developed within 12 months via precursors revealing various histologic features including elongated, but also flat rete ridges, basaloid and hypertrophic differentiation with inconsistent p53 expression. Fourteen of 38 (37%) patients died of SCCs. LIMITATIONS: Retrospective study and lack of a standardized treatment protocols are limitations. CONCLUSION: LP-associated SCCs were located in nonhair-bearing vulvar mucosa. Patients had a high rate of inguinal metastases, recurrent vulvar cancers in diseased mucosa, and disease-related death.
BACKGROUND: Vulvar squamous cell carcinomas (SCCs) arising in association with vulvar lichen planus (LP) are poorly documented. OBJECTIVES: We sought to present clinicopathological features of 38 patients (median age 61 years, range 39-90 years) with LP-associated vulvar SCCs. METHODS: Evaluated were location of vulvar SCC and metastases at presentation, recurrences, survival, precursor lesions, presence of human papillomavirus DNA, p16ink4a, and p53 expression. RESULTS: In all, 32 solitary (5 pT1a, 20 pT1b, 7 pT2) and 6 multifocal SCCs, located in the vestibulum (n=20) and in nonhair-bearing modified and glycogenated mucosa (n=18), arose in erosive (n=13) and nonerosive (n=25) LP. All SCCs were human papillomavirus DNA and p16ink4a negative. Sixteen of 38 (42%) women had inguinal metastases at presentation. Treatment was surgery with clear margins (36/38) and chemoradiation (2/38). Fourteen of 36 (39%) surgically treated patients developed between 1 and 5 new SCCs in the residual diseased mucosa. Of all recurrences, 68% developed within 12 months via precursors revealing various histologic features including elongated, but also flat rete ridges, basaloid and hypertrophic differentiation with inconsistent p53 expression. Fourteen of 38 (37%) patients died of SCCs. LIMITATIONS: Retrospective study and lack of a standardized treatment protocols are limitations. CONCLUSION: LP-associated SCCs were located in nonhair-bearing vulvar mucosa. Patients had a high rate of inguinal metastases, recurrent vulvar cancers in diseased mucosa, and disease-related death.
Authors: Mario Preti; Elmar Joura; Pedro Vieira-Baptista; Marc Van Beurden; Federica Bevilacqua; Maaike C G Bleeker; Jacob Bornstein; Xavier Carcopino; Cyrus Chargari; Margaret E Cruickshank; Bilal Emre Erzeneoglu; Niccolò Gallio; Debra Heller; Vesna Kesic; Olaf Reich; Colleen K Stockdale; Bilal Esat Temiz; Linn Woelber; François Planchamp; Jana Zodzika; Denis Querleu; Murat Gultekin Journal: J Low Genit Tract Dis Date: 2022-06-21 Impact factor: 3.842