[Synchronous squamous vulvar and cervical cancer--a case report with literature review and analysis of therapeutic strategies].
We report on a suboptimal surgical treated cancer of the vulva with the accidental diagnosis of a second cancer within the completion of the surgery three weeks later. The patient was 48 years old, presenting with a central, multifocal, exophytic tumor of the clitoris. The primary surgery was: vulvectomy with bilateral inguinal lymphadenectomy ("triple incision"). However, the pathological examination revealed an unsatisfactory surgical result--on the one site (laterally) the tumor reached the resection edge, and on the other site (dorsally) the tumor-free margin was only 1-2 mm. There were 5 nodal metastases--4 ipsilateral (one macrometastasis), and 1-contralateral. The next step was total abdominal hysterectomy (co-existing 10cm myoma) and pelvic lymph node sampling (on both sites negative). We discuss two problems in light of the current literature: the preoperative therapy planning of advanced vulvar cancer (exenteration vs. neoadjuvant chemotherapy with subsequent radical vulvectomy, triple incision vs. en bloc resection, pelvic lymphadenectomy) and the importance of a careful evaluation of the cervix in each case of vulvar cancer--the coincidence of both tumor localizations is up to 7-10%. The diagnosis of the second cancer probably remains in many cases delayed.
Watrowski
Rafal
R
Klinika Ginekologii Katedry Perinatologii i Ginekologii, Akademii Medycznej, Poznań.
Friebe
Zbigniew
Z
D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000601:surgery*