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VERRUCOUS CARCINOMA OF VULVA A Case Report

17th Sep.2002. Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal

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VERRUCOUS CARCINOMA OF VULVA A Case Report

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    1. VERRUCOUS CARCINOMA OF VULVA A Case Report Prof. S.N.Panda, Dr. A. Sanyal & Dr. A.Nayak Department of Obstetrics and Gynecology M.K.C.G.Medical College Berhampur, Orissa, India

    2. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 2 Introduction Diseases of the vulva in the aggregate constitute only a small fraction of gynaecologic practice of which tumours are the most important lesions. Vulva contains a variety of tissues and hence all types of tumours can occur in the vulva. Many types have been recorded, both benign and malignant. Vulval malignancies account for about 4% - 5% of all genital malignancies

    3. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 3 Introduction However epithelial malignant tumours (Carcinomas) arising from the skin, mucosa or rarely bartholin gland are by far the commonest malignant tumours seen, representing about 3% of all genital cancers in the female. Ninety per cent of these epithelial malignant tumours are squamous cell carcinomas, the remainder being basal cell carcinomas, melanomas, or adenocarcinomas

    4. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 4 Verrucous carcinoma of vulva It is an uncommon variant of squamous cell carcinoma with low malignant potential. It may, however, grow very large. These lesions were originally described as occurring in the oral cavity but have also been described involving the vagina, cervix, and vulva. Clinically, these tumours are very slow growing and carry an excellent prognosis. The lesion grossly appears cauliflower-like in nature.

    5. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 5 Verrucous carcinoma of vulva This rare variant of squamous cell carcinoma may also resemble condyloma acuminatum and present as a large fungating tumor. Microscopically, the papillary fronds lack the connective tissue core that characterizes condyloma acuminata. These features are very similar to those of the giant condylomata of Buschke-Loewenstein, possibly representing successive stages of the same pathologic process.

    6. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 6 Verrucous carcinoma of vulva Local invasion confirms the malignant nature of the lesion, but it rarely metastasises and can be cured by wide excision. If there are suspicious groin nodes, FNA or excisional biopsy should be carried out. Usually enlarged nodes are caused by inflammatory hypertrophy, but if they do contain metastases, radical vulvectomy and bilateral groin lymph node dissections are indicated.

    7. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 7 Verrucous carcinoma of vulva As metastasis to regional lymph nodes is rare, radical local excision is the standard treatment. However, a course of radiotherapy is usually given after local excision and may prove beneficial. We had encountered a case, which we report here considering its rarity.

    8. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 8 The History of the case A 40 years lady, married for 20 years, presented with gradually increasing intense pruritus in the anterior aspect of vulva and a slowly enlarging clitoris for the last one year. She has been attending the OPD and had been prescribed steroid ointments (for pruritus)which she has been using for the last one year intermittently. As the pruritus became severe she again came for advice.

    9. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 9 The History of the case Her menstrual periods were normal. Her parity was 3-3-0-0 and had undergone sterilisation 13 years back. She was of average body built, weighed 48Kgs, was not anemic, BP-118/80, pulse-86/m, heart & lungs were normal, liver and spleen were not palpable. There was a small healthy scar of the tubectomy operation.

    10. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 10 The History of the case Examination of vulva revealed leucoplakia of the labia minora and the introitus. There was a small firm growth measuring about 3cms X 2cms over the clitoris, which was cracked & ulcerated but without any discharge.It was not fixed and was freely mobile. Inguinal glands were normal. Speculum examination revealed normal vagina and cervix.

    11. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 11 The History of the case Bimanual examination revealed a firm, normal sized anteverted uterus and appendages were not palpable. No other pathology was detected on examination. A provisional diagnosis of Vulval Carcinoma was made and a pap smear & a scrap smear from the growth were taken and sent for cytological study. She was hospitalized on 12/05/2002 and investigated.

    12. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 12 The History of the case Hb: -10.8Gm% DC: -N-66, E- 06, L- 28 Urine & Stool: - NAD Fasting Blood Sugar: - 87mg% Blood Urea: - 29mg%, X-Ray Chest: - Normal Cardiac status & ECG: - Normal Pap smear: - Chronic nonspecific cervicitis Scrap smear: - Verrucous carcinoma. Advised biopsy.

    13. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 13 The History of the case The patient was put up for local excision. The patient underwent the surgery on 15/05/2002, under spinal anaesthesia. The excised mass was sent for histopathological study. Post operative period was uneventful & healing was complete. Histopathology of the specimen was reported as Verrucous Carcinoma. She was referred for radiotherapy on 10th day. Radiotherapy started from 12th day. Last seen on the 20th day. No complications.

    14. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 14 Gross View of the Lesion

    15. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 15 Gross View of the Lesion

    16. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 16 Surgery in Progress

    17. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 17 Surgery in Progress

    18. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 18 Surgery Completed

    19. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 19 Cytology of the Lesion

    20. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 20 Histopathology of the Lesion

    21. 17th Sep.2002 Verrucous Carcinoma of Vulva - Prof.S.N.Panda, Dr.A.Sanyal & Dr.A.Nayak 21 Thank You

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