title: Two distinct pathways to development of squamous cell carcinoma of the vulva.
abstract: Squamous cell carcinoma (SCC) accounts for approximately 95% of the malignant tumors of the vaginal vulva and is mostly found in elderly women. The future numbers of patients with vulvar SCC is expected to rise, mainly because of the proportional increase in the average age of the general population. Two different pathways for vulvar SCC have been put forth. The first pathway is triggered by infection with a high-risk-type Human Papillomavirus (HPV). Integration of the HPV DNA into the host genome leads to the development of a typical vulvar intraepithelial neoplasia (VIN), accompanied with overexpression of p14(ARF) and p16(INK4A). This lesion subsequently forms a warty- or basaloid-type SCC. The HPV vaccine is a promising new tool for prevention of this HPV related SCC of the vulva. The second pathway is HPV-independent. Keratinizing SCC develops within a background of lichen sclerosus (LS) through a differentiated VIN. It has a different set of genetic alterations than those in the first pathway, including p53 mutations, allelic imbalances (AI), and microsatellite instability (MSI). Further clinical and basic research is still required to understand and prevent vulvar SCC. Capsule. Two pathway for pathogenesis of squamous cell carcinoma of the value are reviewed.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.forename: Takayuki
authors.initials: T
authors.lastname: Enomoto
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kimura
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshino
authors.forename: Masami
authors.initials: M
authors.lastname: Fujita
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura