VULVAR & VAGINAL TUMOR

BENIGN VULVAR TUMOR

Cyst tumor

Solid tumor
BENIGN VULVAR CYST TUMOR

BartholinDuct Cyst
Sebaceous Cyst
Epidermal Inclusion Cyst
Mucinous Cyst
Wolffian Duct Cyst
Nuck Duck Cyst
Endometriosis Cyst
BENIGN VULVAR SOLID TUMOR

Fibroma
Lipoma
Condyloma
Hemangioma
Hidradenoma
GranularCell Myoblastoma
Nevus Pigmentosum (Melanoma)
Bartholin Duct Cyst
Location : Behind labium Majus
Result from occlusion of the duct
Therapy : Extirpation
DD/. Nuck duck cyst
Sebaceous Cyst

Result from occlusion of sebaceous

duct with fibrosis or debris
Therapy : Excision
 Epidermal Inclusion Cyst

Result from burial of fragments of skin

after episiotomy
Therapy : Excision
Mucinous Cyst

Location : Near urethra, inside

labium minor
Therapy : Excision
Epidermal Inclusion Cyst

Result from burial of fragments of skin

after episiotomy
Therapy : Excision
Wollfian Cyst

Remnant of mesonephric duct

Therapy : Excision
Nuck Duct Cyst

Origin from round ligamen with

peritoneal element
Therapy : Incision & closing of
external inguinal canal
Endometriosis Cyst

Pain every menstrual cycle

Therapy : - Excision
- Hormon
Fibroma

Origin from fibrous tissue

Therapy : Local excision
Lipoma

Rare
Therapy : Excision
 Condyloma

Condyloma Acuminata :
- E/.Human papilloma virus, STD
- Leucore & pregnancy -> growth
- Th/. Podophyllin 10-25 %
Cautery : for lesion in vagina
Excision
Condyloma lata
- Rare, lesion of syphilis
 Hemangioma

Congenital, many will spontaneously

regress
If irritating, consider : cryotherapy, laser
therapy, sclerosing solution
Hidradenoma

Origin from sweat gland

Therapy : Excision
Granular Cell Myoblastoma

Rare, non spesific

Therapy : Excision
 Nevus Pigmentosus

Propable cause : iritation

7-10 % malignant melanoma in women:
external genitalia
Therapy : Excision
BENIGN VAGINAL TUMOR

Gartners Cyst
Inclusion Cyst
Other Benign Tumors : Asymptomatic
- Fibroma
- Fibromyoma
- Adenosis
- Condyloma accuminata
- Endometriosis
VULVAR & VAGINAL CANCER

dr. Maringan D.L.Tobing,SpOG

VULVAR CANCER

4% of malignancies of the female

genital tract.
HPV -> 20-60 % patients with invasive
vulvar cancer.
Associated with syphilis,
lymphogranuloma venereum &
granuloma inguinal.
TYPES OF VULVAR CANCER

Squamous cell (92 %)

Melanoma (2-4 %)
Basal cell (2-3 %)
Bartholin gland (1 %)
Metastatic (1 %)
Verrucous (<1 %)
Sarcoma (<1 %)
SQUAMOUS CELL CARCINOMA

90-92 % of all invasive vulvar cancer

Atypical keratinization
Microinvasive squamous carcinoma
-> lesions < 2 cm with < 1 mm stromal
invasion.
Clinical feature :

Post menopausal women

Mean age : 65 years
Vulvar lump or mass, pruritus, vulvar
bleeding, discharge, dysuria.
Most occur on the labia majora.
Diagnosis :
Wedge biopsy

Routes of spead :
Direct
extension
Lymphatic embolization
Hematogenous spread
 STAGING (FIGO) :

Stage I : Carcinoma in situ

Stage II : Tumor confined to the vulva
< 2 cm, groin nodes (-)
Stage III : Tumor of any size
1. Adjacent spread to the urethra
and/or the vagina, the perineum &
the anus and/or
2. Clinically suspicious lymph nodes
in either groin.
 Stage IV : Tumor of any size

1. Infiltrating the bladder mucosa, or

the rectal mucosa, or both, including
the upper part of the urethral mucosa and/or
2. Fixed to the bone and/or
3. Other distant metastase
TREATMENT :
Standard treatment :
Radical vulvectomy & en bloc groin dissection
with or without pelvic lymphadenectomy.
During the past 15 years -> changes :
- Individualization treatment
- Vulvar conservation -> unifocal tumors
- Omission of the groin dissection
- Preoperative radiation therapy
- Postoperative radiation therapy
 Role of radiation :
1. Preoperative -> advanced disease
2. Postoperative -> pelvic lymph nodes &
groin of patient with 2/more groin
nodes (+)
 MELANOMA

Postmenopause women
Most common : Labia minora, clittoris
Lesion < 1 mm : Radical local excision
Diagnosis : Poor
BARTHOLIN GLAND CARCINOMA

5 % of all vulvar malignancy

Criteria : 1. Correct anatomic position
2. Deep in the labium majus
3. Intact skin
4. Normal gland (+)
 Treatment :
Radical vulvectomy, with bilateral
groin & pelvic node dessection.
Prognosis :
-> same with squamous cell carcinoma
Other adenocarcinoma :
Arise in a Bartholin gland or occur with
Pagets disease.
BASAL CELL CARCINOMA

2 %
Lesions < 2 cm, anterior labia majora
Post menopause white women
Locally agressive
VERRUCOUS CARCINOMA

Post menopause women

Slowly growing, locally destructive,
even bone
Treatment : Radical local excision
Radiation therapy : Contra indicated
VULVAR SARCOMA

Most common : Leiomyosarcoma

SECONDARY VULVAR TUMOR

8 %
Most common primary site : cervix
VAGINAL CANCER

80% : Squamous cell carcinoma

Mean age : 60 years
Cause :
- Unknown
- Associated with HPV
Possible mechanisms of the occurance
of vaginal cervical neoplasma :

- Residual in vaginal epithelium

- New primary disease, role of HPV ?
- Radiation therapy

Sign & symptoms :

- Painless vaginal bleeding & discharge
- Posterior vaginal wall -> tenesmus,
constipation, blood in stool.
- Usually : 1/3 upper posterior vaginal wall
 STAGING (FIGO)
Stage 0 : Carcinoma in situ
Stage I : Carcinoma limited to thevaginal wall
Stage II : Involved the subvaginal tissue, not
extend to the pelvic wall.
Stage III: Extended to the pelvic wall
Stage IV: Extended beyond the true pelvis or
involved mucosa of the bladder or
or rectum. (a). Adjacent organs
(b). Distant organs.
Treatement :
Mosttumors : Radiation therapy
Operative : Selective

Prognosis :
5 year survival rate lower than cervical
or vulvar cancer.
 OTHER VAGINAL CANCER

Adenocarcinoma: 9% of primary tumors

Malignant melanoma: Rare of extremely
lethal
Sarcoma : Usually fibrosarcoma or leio-
myosarcoma
 Embryonal Rhabdomyosarcoma

- Solid form
- Multi cystic -> Botryoid sarcoma
- Treatment : Preoperative
chemotherapy -> conservative
surgery or radiation
SECONDARY VAGINAL TUMORS

Common
Metastatic from :
- Cervical carcinoma
- Corpus carcinoma
- Vulvar carcinoma
- Choriocarcinoma