Groin metastasis after extensive microinvasive vulvar cancer. A case report.
BACKGROUND
An increasing incidence of vulvar intraepithelial neoplasia and microinvasive vulvar cancer is being observed in younger patients. The treatment of choice is wide local excision.


METHODS
A 53-year-old woman had HPV-related disease for more than 20 years. Following several operations for cervical and vulvar intraepithelial lesions (CIN 3 and VIN 3) and genital warts, she presented with extensive, multifocal VIN 3 and microinvasion at the age of 50. Since a radical approach was not feasible, combined excision and laser therapy was performed, preceded by mapping of the abnormal areas of the vulva. Two years after surgery the patient presented with a mass in the right groin. Histopathologic examination following excision revealed a groin metastasis. Postoperative radiotherapy was performed. Three years after the last vulvar surgery and 1 year after groin excision, the patient was well and disease free.


CONCLUSIONS
In high-risk patients with recurrent HPV-related disease of the lower genital tract and extensive microinvasive vulvar carcinoma, removal of the groin nodes should be considered. The sentinel node approach might be appropriate in the future.
Schausberger
Christiane
C
Department of Gynecology and Pathology, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria.
Six
Lucia
L
Horvat
Reinhard
R
Joura
Elmar A
EA
D005260:Female; D006119:Groin; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000628:therapy; D002578:Uterine Cervical Dysplasia / Q000556:secondary* / Q000628:therapy