CASE REPORT
Andreja Glis
ˇ
ic
´
Simultaneous diagnosis and therapy of invasive cervical carcinoma
and invasive vulvar carcinoma. A case report
Received: 11 July 2005 / Accepted: 1 September 2005 / Published online: 21 October 2005
Ó Springer-Verlag 2005
Abstract Invasive squamous cell carcinoma of the vulva
is predominantly a disease of postmenopausal woman
with a mean age of approximately 65 years. After
treatment for cervical cancer patients have an increased
risk of developing second squamous cell malignancy of
the lower genital tract. This study reports the case of a
patient with double malignancy—invasive cervical can-
cer and invasive vulvar cancer. She underwent radical
hysterectomy, bilateral adnexectomy and pelvic bilateral
lymphadenectomy and at the same time radical vulvec-
tomy and bilateral inguinal lymphadenectomy. After
surgery she was referred to radiotherapy. The postop-
erative course was uneventful and at 14 months of fol-
low-up, the patient showed no evidence of recurrence.
Keywords Cervical carcinoma Æ Vulvar carcinoma Æ
Simultaneous tumor
Vulvar cancer is uncommon. Invasive squamous cell
carcinoma of the vulva represents 5% of all malignan-
cies of the female genital tract and 95% of all vulvar
malignant tumors. Invasive squamous cell carcinoma of
the vulva is predominantly a disease of postmenopausal
woman with a mean age of approximately 65 years.
Incidence increases with age. However, there is recent
evidence of an increased frequency in the younger pop-
ulation. There is a long history of pruritus, usually
associated with vulvar dystrophy and lichen sclerosus
and atrophicus as pre existing phenomena in some pa-
tients. In older woman, invasive squamous cell carci-
noma may extend to the vulva, perineum and anal
margins. Inguinal lymph nodes are the first site for
metastases and then it may involve deep pelvic nodes.
The hematogenous spread to distant sites includes the
lungs, liver and bones. Cutaneous metastases can occur
but are extremely rare. Radical vulvectomy and en bloc
groin dissection have been considered the standard
treatment for all operable patients. Five-year survival
rate will be 90%, if there is no lymph node involvement
and 25% if metastasis to deep pelvic nodes is present.
Cancer of the cervix already is the second most prevalent
cancer in woman worldwide and the fifth leading cause
of cancer death. After treatment for cervical cancer pa-
tients have an increased risk of developing second
squamous cell malignancy of the lower genital tract [1].
The case of a patient with double malignancies, invasive
cervical cancer and invasive vulvar cancer, is reported.
Case report
A 53-year-old housewife, mother of two, presented with
the complaint of excessive vaginal discharge for
6 months. She had chronic itching and a burning sen-
sation for the past 2 years. She had not undergone
gynecological examination for more than 5 years. She
has had arterial hypertension since 5 years and was on
amlopin and bromazepam since then. She was obese
(162 cm/95 kg) and a non smoker. Colposcopic finding
was high-grade AW epitel on the cervix and leukoplakia
on the vulva. PAP smear was reported as class III. The
vulvar lesion was 30 mm in diameter on the right labia
minor that extended to labia mayor. Inguinal lymph
nodes were neither large nor palpable. Human papil-
loma virus (HPV) testing was not performed because of
obvious clinical presentation of the tumor. Biopsy of the
cervix and vulva showed the following histological
finding: H-SIL (CIN II and CIN III focalis) and carci-
noma squamocellulare partim keratodes invasivum
vulvae (G2 NGII, FIGO II).
There was no report of distant metastases on the chest
X ray, liver ultrasound or on the abdomen and pelvic CT
scans. Sonographic finding: uterus in AVF
75 mm·40 mm·55 mm. Left ovary 30 mm·20 mm, right
A. Glis
ˇ
ic
´
(&)
Department of Obstetrics and Gynecology,
Clinical Center of Serbia, Vis
ˇ
egradska 26, Belgrade,
Serbia and Montenegro
E-mail: gan@eunet.yu
Arch Gynecol Obstet (2006) 274: 54–55
DOI 10.1007/s00404-005-0077-z