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Generally as per skin.
Mainly look for squamous vulvar intraepithelial lesions:
- Low-grade squamous intraepithelial lesion (LSIL):
- Acanthosis, papillomatosis, and/or atypical koilocytosis in upper layers
- Usually mild atypia and mitoses, limited to the lower third of stratum spinosum and basale
- Binucleated epithelial cells
- High-grade squamous intraepithelial lesion (HSIL):
- Enlarged atypical nuclei and mitoses involving middle and upper third of the epithelium.
- Also telling are atypical mitoses and/or extension in hair follicles and skin appendages.
Staging of vulvar cancer
Tumors of the vulva are staged as per the AJCC, 8th Ed:
|Primary tumor (T)|
|TX||Primary tumor cannot be assessed|
|T0||No evidence of a primary tumor|
|Tisa||Carcinoma in situ (preinvasive)|
|T1a||IA||Lesions ≤2 cm, confined to the vulva or perineum and with stromal invasion ≤1 mmb|
|T1b||IB||Lesions >2 cm or any size with stromal invasion >1 mm, confined to the vulva or perineum|
|T2||II||Tumor of any size with extension to adjacent perineal structures (distal third of the urethra, distal third of the vagina, anal involvement)|
|T3||IVA||Tumor of any size with extension to any of the following proximal two thirds of the urethra, proximal two thirds of the vagina, bladder mucosa, or rectal mucosa or fixed to pelvic bone|
|Regional lymph nodes (N)|
|NX||Regional lymph nodes cannot be assessed|
|N0||No regional lymph node metastasis|
|N1||1 or 2 regional (inguinofemoral) lymph nodes with the following features (see N1a, N1b)|
|N1a||IIIA||1 or 2 lymph node metastases, each < 5 mm|
|N1b||IIIA||1 regional lymph node metastasis ≥5 mm|
|N2||Regional (inguinofemoral) lymph nodes with the following features (see N2a, N2b, N2c)|
|N2a||IIIB||3 or more lymph node metastases, each < 5 mm|
|N2b||IIIB||2 or more regional lymph node metastases ≥5 mm|
|N2c||IIIC||Regional lymph node metastasis with extracapsular spread|
|N3||IVA||Fixed or ulcerated regional lymph node metastasis|
|Distant metastasis (M)|
|M0||No distant metastasis|
|M1||IVB||Distant metastasis (including to pelvic lymph nodes)|
- Matthias Choschzick. Vulva, vagina & female urethra - Squamous carcinoma and precursor lesions - HPV associated SIL. PathologyOutlines. Topic Completed: 6 January 2021. Minor changes: 11 June 2021
- Amin, Mahul (2017). AJCC cancer staging manual
(8 ed.). Switzerland: Springer. ISBN 978-3-319-40617-6. OCLC 961218414.
- For access, see the Secrets chapter.
- Copyright note: The AJCC, 8th Ed. is published by a company in Switzerland, and the tables presented therein are Public Domain because they consist of tabular information without literary or artistic innovation, and therefore do not fulfil the inclusion criterion of the Swiss Copyright Act (CopA) which applies to "literary and artistic intellectual creations with individual character" (see Federal Act on Copyright and Related Rights (Copyright Act, CopA) of 9 October 1992 (Status as of 1 January 2022)).