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Author: Mikael Häggström [note 1]

Gross processing

Generally as per skin.

Microscopic examination

Histopathology of high-grade squamous intraepithelial lesion (HSIL) of vulva (left in image) with full thickness dysplasia, compared to normal epithelium at right.

Mainly look for squamous vulvar intraepithelial lesions:

  • Low-grade squamous intraepithelial lesion (LSIL):[1]
  • 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):[1]
  • 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:[2]

Primary tumor (T)
TNM FIGO Criteria
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)
TNM FIGO Criteria
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)
TNM FIGO Criteria
M0 No distant metastasis
M1 IVB Distant metastasis (including to pelvic lymph nodes)


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page


  1. 1.0 1.1 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
  2. 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 of Patholines.
    - 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)). edit

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