Spindle cell morphology is related to poor prognosis in vulvar squamous cell carcinoma.
BACKGROUND
Vulvar cancer is the fourth most common gynaecological malignancy, with an annual incidence of 2 out of 100,000 women. Although most cases of early stage vulvar cancer have a good prognosis, recurrence and rapid tumour progression can occur. We investigated the prevalence of spindle cell morphology in vulvar cancer and its association with survival.


METHODS
This retrospective cohort study included 108 patients with primary vulvar squamous cell carcinoma who were treated at the Leiden University Medical Center during 2000-2009. Paraffin-embedded tissue was examined for the presence of spindle cell morphology. Survival and histology data were compared between cases with spindle and without spindle cell morphology.


RESULTS
Twenty-two (20%) tumours showed spindle cells infiltrating the stromal tissue. All spindle cell tumours were human papillomavirus (HPV) negative. Spindle cell morphology was strongly associated with poor prognosis and with a high risk of lymph node involvement at the time of diagnosis (relative risk 2.26 (95% CI 1.47-3.47)). Five-year disease-specific survival was lower in patients with vs without spindle cell morphology (45.2% vs 79.7%, respectively; P=0.00057).


CONCLUSIONS
Vulvar spindle cell morphology occurs frequently and seems to develop through the non-HPV pathway. It is associated with a worse prognosis than conventional vulvar squamous cell carcinoma.
Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
M D
MD
Trietsch
A A W
AA
Peters
K N
KN
Gaarenstroom
S H L
SH
van Koningsbrugge
N T
NT
ter Haar
E M
EM
Osse
N
N
Halbesma
G J
GJ
Fleuren
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D014846:Vulvar Neoplasms / Q000473:pathology*