Lesions of the Vulva and Vagina

Abstract

Tumors of vulva and vagina are generally classified into squamous, glandular, melanocytic, and mesenchymal neoplasms. Squamous carcinoma is by far the most common primary malignancy involving both organs. Squamous intraepithelial neoplasia is the most common preinvasive condition of squamous cell carcinoma (SCC). Lichen sclerosus is also considered as a preneoplastic condition of vulvar SCC (Fig. 2.1). Condyloma acuminatum is the most common squamous disorder, caused by low-risk HPV subtypes (HPV 6 and 11), and does not progress to malignancy, except in rare cases where high-risk HPV is a causal factor. Conventional mullerian ­adenocarcinomas are rare in vulva and vagina. Extramammary Paget’s disease represents a special form of glandular malignancy outside of the breast and is generally not associated with an invasive component. Primary clear cell carcinoma of the vagina is famous for its association with intrauterine DES exposure in the past, but is very rare nowadays. Melanoma represents 5% of vulvar cancers and is capable of widespread metastasis. A variety of benign and malignant mesenchymal tumors can be seen in the vulvar and vaginal regions, with benign angiomyofibroblastoma and deep aggressive angiomyxoma primarily involving these areas.