Vulva
Malignant neoplasms
Metastases

Author: Priya Nagarajan, M.D., Ph.D. (see Authors page)

Revised: 9 October 2017, last major update March 2015

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Metastases [title] vulva

Cite this page: Nagarajan, P. Metastases. PathologyOutlines.com website. http://pathologyoutlines.com/topic/vulvametstovulva.html. Accessed November 19th, 2017.
Definition / general
  • Uncommon
  • Diagnosis is fairly straightforward when a documented history of prior malignancy elsewhere is available
  • Most metastases occur within a few months after diagnosis of the primary tumor but late recurrences / metastases have been documented
  • Rarely, tumors are of unknown origin, presenting as widely metastatic tumor, with their origin difficult to determine due to poor histologic differentiation
  • > 50% of metastases to vulva have gynecologic primaries, most commonly from uterine cervix, followed by ovary, endometrium and vaginal origin
  • Nongyn primaries are most commonly from GI tract, followed by breast, melanoma, lung, lymphoma, bladder and kidney carcinomas
Epidemiology
  • 5 - 8% of all vulvar malignancies are metastases (Am J Surg Pathol 2003;27:799)
  • Often seen in peri or postmenopausal women
  • Reported frequently in Caucasian women
Sites
  • Labium majus (frequently unilateral), followed by clitoris
Clinical features
  • Common presenting symptom is mass (single or multiple nodules), followed by pain, ulceration, bleeding, pruritus, erythema and swelling (Am J Surg Pathol 2003;27:799)
  • Clitoromegaly
Diagnosis
  • CT and MRI of the abdominopelvic region will reveal the extent of tumor
  • FDG PET scan for staging and recurrence
  • Transvaginal ultrasonography for assessment of uterus and adnexae
Radiology images

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CT scan, tumor of the vulva

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Thickening of left vaginal wall

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PET images

Prognostic factors
  • Prognosis in most patients is poor and they frequently die of metastatic disease
  • Rarely the vulva is the only site of metastasis; these cases may have a "fair" prognosis
Case reports
Treatment
  • In most patients, the treatment is palliative
  • Surgical resection: tumor debulking or simple excision, wide local excision, vulvectomy
  • Chemotherapy
  • Radiotherapy
Clinical images

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Vulvar mass before and after radiotherapy

Microscopic (histologic) description
  • In most cases, the tumors can be readily identified as adenocarcinoma, squamous cell carcinoma, melanoma, lymphoma, etc.
  • However, presentation as poorly differentiated neoplasm is not uncommon, which necessitates examination of a panel of immunohistochemical markers to identify the primary organ of origin
  • Mammary type carcinomas arising from ectopic breast tissue and other tumors arising primarily in vulva should be ruled out
  • As with metastases to other sites, the tumors generally are well circumscribed with mostly pushing or rare infiltrative tumor edges
  • Though most are located within subcutaneous tissue or dermis, focal epidermotropism is seen rarely
Microscopic (histologic) images

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Cervical squamous cell primary

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Sigmoid colon primary



Images contributed by Dr. Priya Nagarajan:
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Melanoma metastatic to vulva

Immunohistochemistry