DR. ROOPAM JAIN, Professor & Head, Department of Pathology & Blood Bank

1. FEMALE GENITAL SYSTEM: VULVAL
TUMOUR
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. VULVAL TUMOUR
STROMAL POLYPS
• Stromal (fibroepithelial) polyps or acrochordons may form in the vulva or
vagina.
• There may be single or multiple polypoid masses.
• Histologically, they are covered by an orderly stratified squamous
epithelium. The stroma consists of loose fibrous and myxomatous
connective tissue with some adipose tissue and blood vessels.

3. PAPILLARY HIDRADENOMA
(HIDRADENOMA PAPILLIFERUM)
• This is a benign tumour arising from apocrine sweat glands of the vulva.
• Most commonly, it is located in the labia
Histologically
• the tumour lies in the dermis under a normal epidermis.
• The tumour consists of papillary structures
• covered by double layer of epithelial

4. CONDYLOMA ACUMINATUM
• Condyloma acuminata or anogenital warts are benign papillary lesions of
squamous epithelium
• transmitted venereally to male sex partner.
• They may be solitary but more frequently are multiple forming soft
warty masses.
• The common locations are the anus, perineum, vaginal wall, vulva and
vagina.
• They are induced by HPV, particularly types 6 and 11.

5. CONDYLOMA ACUMINATUM
Histologically
• they are identical to their counterparts on male external genitalia.
• The features consist of a tree-like proliferation of stratified
squamous epithelium, showing marked acanthosis,
hyperkeratosis, parakeratosis, papillomatosis & perinuclear
vacuolisation of epithelium called koilocytosis, indicative of HPV
infection.
• The papillary projections consist of fibro vascular stoma.

6. VULVAL INTRAEPITHELIAL NEOPLASIA
& INVASIVE CARCINOMA
• Vulval intraepithelial neoplasia (VIN) and invasive squamous cell
carcinoma are morphologically similar to those in the cervix and vagina.
• viruses in carcinogenesis, particularly high-risk HPV types 16 and 18
• VIN is often multifocal within vulva and may be multicentric as well
• Vulval carcinoma constitutes 3% of all female genital tract cancers.
• VIN occurs in reproductive age

7. VULVAL INTRAEPITHELIAL NEOPLASIA
& INVASIVE CARCINOMA
• Grossly, VIN and vulval carcinoma in early stage is a ‘white’ lesion (leukoplakia)
while later the area develops an exophytic or endophytic (ulcerative) growth
pattern.
• The traditional VIN lesion, described as Bowen’s disease of the vulva, is
generally a slightly elevated, velvety, plaque lesion.

8. VULVAL INTRAEPITHELIAL NEOPLASIA &
INVASIVE CARCINOMA
Microscopically,
• VIN may also range from VIN I to VIN III, higher grade being also called
Bowen’s disease (in situ carcinoma).
• Vulvar cancer is squamous cell type with varying degree of anaplasia
and depth of invasion depending upon the stage (Fig.).
• HPV-positive tumours are more often poorly-differentiated squamous cell
carcinoma
• while HPV-negative are well-differentiated kerati nising type.
• Verrucous carcinoma is a rare variant which is a fungating tumour but is
locally malignant.

9. Vulval intraepithelial neoplasia (VIN) (Bowen’s disease)
There is hyperkeratosis, parakeratosis, acanthosis, koilocytosis and presence
of atypical anaplastic cells throughout the entire thickness of the epithelium.
Photomicrograph on right under higher magnification shows mitotic figures in
the layers of squamous epithelium.

10. • Clinical staging for vulval carcinoma based on tumour
size (< or > 2 cm) and extent of spread has been
described by International Federation of Gynaecology
and Obstetrics (FIGO staging)

11. FIGO staging of carcinoma of the vulva