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Fernandez M, Kop M, Terada K, Shimizu D, Vierkoetter KR. Squamous Cell Carcinoma of the Vulva: Clinicopathologic Features of Human Papillomavirus (HPV) Associated and Independent Lesions. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Vulvar squamous cell carcinoma (VSCC) develops via HPV-associated and HPV-independent pathways. Each subset is notable for distinct precursor lesions, morphology, epidemiology and prognoses. There is no consensus regarding the incidence of HPV-associated VSCC, although the literature estimates a range of 15–79%. The current investigation aims to determine the incidence and clinicopathologic features of HPV-associated and HPV- independent VSCC in a diverse, multi-ethnic population.
Methods/Case Report
Resections specimens of VSCC from 1991 to 2020 were retrospectively identified. Cases were reviewed for confirmation of diagnosis, followed by immunohistochemical staining for p16. Age at diagnosis, ethnicity, body mass index, smoking history, tumor size, depth of invasion, and stage were obtained. Statistical analyses included t and Fisher’s exact tests as appropriate, with p<0.05 considered statistically significant.
Results (if a Case Study enter NA)
Sixty-seven VSCC cases were reviewed. By immunohistochemistry, 34 (51%) were HPV-associated. Age at diagnosis was statistically significant (p = 0.0008), with an average age of 63 years for HPV-associated and 75 years for HPV-independent VSCC.Tumor size approached statistical significance (p = 0.0577), with larger tumors occurring in the absence of HPV. Additionally, the incidence of HPV-independent VSCC nearly doubled every 10 years while the incidence of HPV-associated VSCC remained constant.
Conclusion
In this diverse, multi-ethnic cohort, the incidence of HPV-associated VSCC (51%) is at the higher end of the global range of 15-79%. Differences in age demonstrated statistical significance, supporting existing data describing HPV-associated VSCC diagnosed in relatively younger women. Tumor size approached statistical significance, signaling a correlation between HPV-independent VSCC and larger tumors; findings that may support reports of HPV-independent VSCC being associated with a worse prognosis. The increasing incidence of HPV- independent VSCC compared to a constant rate of HPV-associated VSCC suggests changing patterns of detection and pathogenesis.
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Affiliation(s)
- M Fernandez
- Pathology, University of Hawaii John A. Burns School of Medicine Hawaii Residency Program , Honolulu, Hawaii , United States
| | - M Kop
- The Queen’s Medical Center , Honolulu, Hawaii , United States
| | - K Terada
- University of Hawaii John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health , Honolulu, Hawaii , United States
| | - D Shimizu
- University of Hawaii John A. Burns School of Medicine Department of Pathology , Honolulu, Hawaii , United States
| | - K R Vierkoetter
- University of Hawaii John A. Burns School of Medicine Department of Pathology , Honolulu, Hawaii , United States
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