Pathomorphological and pathohistological characteristics of vulvar cancer associated with lichen sclerosus

Purpose of the study. To study the pathomorphological and pathophysiological characteristics of vulvar cancer associated with sclerosing lichen.

Patients and methods. The study included 73 patients who underwent examination and treatment at the G. V. Bondar Republican Cancer Center in the period from 2002 to 2019. We performed a comprehensive morphological study, including an assessment of the specific volume of microhemocirculatory vessels and cellular infiltrates.

Results. The tumor was most often localized in the area of the labia majora (57.5 %), with affected of the clitoris (12.3 %) and urethra (6.8 %), sometimes affecting both the labia minora and labia majora (23.3 %). Macroscopically, the infiltrative‑ edematous form predominates (63 %), followed by endophytic (20.6 %) and exophytic forms (16.4 %). In patients with invasive vulvar carcinoma associated with lichen sclerosus, undifferentiated types of VIN are often detected: in 52 cases out of 73 observations (71.2 ± 5.3 %). VIN1 was noted in 11 (15.1 ± 4.2 %), VIN2 in 16 (21.9 ± 4.8 %) and VIN3 in 25 (34.2 ± 5.5 %) cases. Thus, in VIN3 associated with LS, the specific volume of vessels was on average 0.1104 ± 0.0103. In well‑differentiated invasive squamous cell carcinoma in patients with LS, this indicator was statistically significantly higher – 0.1677 ± 0.0090 (p < 0.001). The number of cells per 1 mm² of stroma increased with decreasing differentiation degree: 1439 ± 56 in G1, 1550 ± 74 in G2, and 1729 ± 138 in G3. The average number of cells in the field of view also increased: 356 ± 05 in G1, 396 ± 30 in G2, and 520 ± 35 in G3. The specific volume of lymphocytes decreased with increasing tumor malignancy: G1–96.3 ± 2.1 %, G3–78.4 ± 3.9 %. The content of neutrophilic leukocytes and macrophage cells increased: neutrophils, G1–3.3 ± 0.5 %, G3–5.9 ± 0.2 %; macrophages, G1–2.6 ± 0.13 %, G3–4.8 ± 0.3 %. The specific volume of the parenchyma was 0.3501 ± 0.0194 in G1, 0.3711 ± 0.0203 in G2, and 0.4030 ± 0.0219 in G3. The specific volume of the stroma, on the contrary, decreased: G1–0.2052 ± 0.0218, G2–0.1650 ± 0.0206, G3–0.1477 ± 0.0198.

Conclusion. The study showed a significant impact of the degree of differentiation of vulvar cancer on the morphological characteristics of the tumor and vessels of the microhemocirculatory bed, which can be used to improve diagnostic and therapeutic approaches.

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