ANALYSIS OF ALTERATIONS ADJACENT TO INVASIVE VULVAR CARCINOMA AND THEIR RELATIONSHIP WITH THE ASSOCIATED CARCINOMA - A STUDY OF 67 CASES

A retrospective analysis of histological lesions adjacent to 67 invasi ve vulvar squamous cell carcinomas (SCC) was undertaken to analyse the ir nature, as well as their relationship to SCC. Patient age, clinical presentation and histological type of carcinoma, ISSVD classification of its adjacent lesions, disease-free and overall survival were revie wed. Severe undifferentiated vulvar intra-epithelial neoplasia (VIN3) was found in 19.4% of cases and vulvar lichen sclerosus (VLS) in 76.1% of cases. All VLS, except 2 cases, were associated with squamous cell hyperplasia (SCH), and a concomitant differentiated VIN was found in 76.6% of cases. Undifferentiated VIN3 was never associated with VLS. V LS was significantly associated with a keratinizing, well-differentiat ed SCC (98% of cases), while undifferentiated VIN3, was linked prefere ntially to 2 other types of SCC: in 77% of cases, a moderately-differe ntiated SCC with the same histological features as the so-called basal oid carcinoma and, in 23% of cases, a well-differentiated SCC with a v ariable extent of koilocytic atypia, similar to the so-called warty ca rcinoma. Carcinoma of the fourchette was more often associated with un differentiated VIN3. Disease-free and overall survival were significan tly better for carcinoma associated with undifferentiated VIN3 (p < 0. 01 and p < 0.05, respectively). These findings suggest invasive vulvar SCC occurs on 2 distinct types of vulvar lesions: differentiated VIN and/or SCH associated with VLS and undifferentiated VIN3. Furthermore, the histological type of the carcinoma seems to differ according to a djacent lesions.