Vulvar cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]

Overview

Vulvar cancer must be differentiated from other neoplastic vulvar lesions, non neoplastic vulvar lesions, and infectious disease lesions of vulva.

Differentiating vulvar cancer from other Diseases

  • Vulvar cancer must be differentiated from other neoplastic vulvar lesions such as:
  • Vulvar cancer must be differentiated from other non neoplastic vulvar lesions such as:
  • Vulvar cancer must be differentiated from infectious disease lesions of vulva such as:

Other differential considerations include:

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology
Abnormal

vaginal bleeding

Abnormal vaginal dyscharge Pelvic

pain

Itching or

burning of the vulva

Other Genitourinary/ Gastrointestinal symptoms B symptoms Abdominal pain Gynecological examinations Abdominal

mass

HPV Pap smear STI Panel Ultrasound MRI CT Scan
Vulvar cancer

+

+ +/- +/- + − − − Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
 Biopsy findings:
Vaginal cancer[1][2][3][4]

+

+ +/- +/- + − − − Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
 Biopsy findings:
Cervical cancer[5][6][7][8][9][10][11][12] + + + +

+

+ ± ±Chlamydia T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.
 PET/CT scan:
Cervical polyp[13][14][15] + − − − − − − − − − May reveal presence of tumor CT contrast may show presence of a well defined mass
Cervical leiomyoma[16][17][18][19][20][21][22][23] + + − − + ±
− − −
  • Well circumscribed hyperechoic mass
 T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
 N/A
Cervical lymphoma[24][25][26] − + − + +
  • Irregularity
 + − − −
  • Well-defined, solid, concentric, hypoechoic mass
 MRI: Diffuse heterogeneous uterine/cervical mass & hypoechoic enlarged iliac lymph nodes
Cervical sarcoma[27][28][29][30] ± + − ± + + − − − MRI: N/A
Cervical erosion(Ectropion)[31][32][33][34][35] + + ± − + − − − − - N/A N/A N/A
Cervicitis[36][37][38][39] + + +/- − − − To detect complications like PID N/A N/A N/A
IUD use[40][41][42] ± + − +/- − − − ± To detect IUD location and pregnancy N/A N/A N/A Physical exam and ultrasound
Pelvic inflammatory diseases[43][44] + +
  • Fever
 ±Abdominal

pain

− − − Thickened fluid filled fallopian tubes N/A May show endometritis
Endometriosis[45][46][47][48][49][50] ± − − + + − − −
  • Unilocular/multilocular cysts contating thin/thick septations
  • Increased vascularity showing increased doppler flow
  • Hyperintensity on T1 weighted images
  • Hypointensity on T2 weighted images
 Presence of endometrial tissue outside the uterus
Adenomyosis[51][52][53][54][55] − + − − +/- +/- − − − MRI:
  • Thickened junctional zone
Cervical ectopic pregnancy[56][57] − − − − + − − T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
 N/A
DES exposure (Clear cell adenocarcinoma)[58][59][60] + +/- +/- +/- + - − − − To determine uterine extent To detect metastases
Paget's disease of vulva to cervix[61][62][63] ± − − −
− − − − − N/A MRI:
  • Hyperintense on diffusion weighted images
Nabothian cyst[64][65][66][67] + − − − - − − − −
  • Intermediate or slightly high signal intensity on T1-weighted
  • High signal intensity on T2-weighted images
  • Small cysts not visible on CT
  • Large cysts seen as focal low attenuation region
Rectal cancer[68][69][70][71][72] - - + - Weight loss + LLQ + NL + - - +/- Endoscopic/transrectal US detects tumor extent Determine tumor stage Determine tumor stage Colonoscopy with biopsy
Submucous uterine leiomyoma[73][74][75] Menorrhagia - + - - + Enlarged, irregular, firm, nontender uterus + - - - Provides information on no: of fibroids, size, vascularization, relationship with endometrial cavity & serosal surface Not required Not required Physical examination with Ultrasound
Uterine cancer[76][77][78][79] + + - + + - - - Thickened endometrial lining >4cm Not required Histologic diagnosis
Vaginal lymphoma[80][81][82] + + + + Abdominal/pelvic pain - + Palpable mass between rectum & vagina +/- - - - Diffuse mass in external cervical orifice & invading the vagina Diffuse mass in external cervical orifice & invading the vagina Not required CD20 & CD79a positive Immunohistochemistry & biopsy
Vaginal polyp[83][84][85][86] Postmenopausal bleeding + + + - + Mass protruding from vagina +/- - - - To exclude uterine hyperplasia/carcinoma To determine the extent N/A Benign tissue/premalignant cells Excisional biopsy
Vaginal adenosis[87][88] +/- +/- +/- - - - Palpable cysts,nodularity or ulcers - - - - N/A N/A N/A Columnar cells in the ectocervix Biopsy with histopathological examination

References

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  2. ↑ Miccò, Maura; Sala, Evis; Lakhman, Yulia; Hricak, Hedvig; Vargas, Hebert Alberto (2015). "Imaging Features of Uncommon Gynecologic Cancers". American Journal of Roentgenology. 205 (6): 1346–1359. doi:10.2214/AJR.14.12695. ISSN 0361-803X.
  3. ↑ Kim, Hwi-Gon; Song, Yong Jung; Na, Yong Jin; Choi, Ook-Hwan (2013). "A Case of Vaginal Cancer with Uterine Prolapse". Journal of Menopausal Medicine. 19 (3): 139. doi:10.6118/jmm.2013.19.3.139. ISSN 2288-6478.
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  7. ↑ Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R (February 2019). "Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report". Gynecol Oncol Rep. 27: 38–41. doi:10.1016/j.gore.2018.12.006. PMC 6302027. PMID 30603660. Vancouver style error: name (help)
  8. ↑ . doi:10.1097/PAS.0000000000000498. Check |doi= value (help). Missing or empty |title= (help)
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  16. ↑ Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H (November 2016). "Large primary leiomyoma causing progressive cervical deformity". J Surg Case Rep. 2016 (11). doi:10.1093/jscr/rjw190. PMC 5159177. PMID 27887011.
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  72. ↑ Mohammad Sadegh Fazeli & Mohammad Reza Keramati (2015). "Rectal cancer: a review". Medical journal of the Islamic Republic of Iran. 29: 171. PMID 26034724.
  73. ↑ Jacques Donnez & Marie-Madeleine Dolmans (2016). "Uterine fibroid management: from the present to the future". Human reproduction update. 22 (6): 665–686. doi:10.1093/humupd/dmw023. PMID 27466209. Unknown parameter |month= ignored (help)
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  76. ↑ "ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer". Obstet Gynecol. 106 (2): 413–25. August 2005. PMID 16055605.
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  78. ↑ Bokhman JV (February 1983). "Two pathogenetic types of endometrial carcinoma". Gynecol. Oncol. 15 (1): 10–7. PMID 6822361.
  79. ↑ Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F (November 2010). "Factors associated with Type I and Type II endometrial cancer". Cancer Causes Control. 21 (11): 1851–6. doi:10.1007/s10552-010-9612-8. PMC 2962676. PMID 20628804.
  80. ↑ Vera Silva, Paulo Correia, Nuno Oliveira & Luis Sa (2015). "Primary Vaginal Non-Hodgkin's Lymphoma: Report of a Rare Clinical Entity". Clinics and practice. 5 (4): 821. doi:10.4081/cp.2015.821. PMID 26918105. Unknown parameter |month= ignored (help)
  81. ↑ Feng Wang, Xuquan Jing, Bo Liu, Xue Meng, Xindong Sun, Yongsheng Gao, Linlin Wang & Zheng Fu (2018). "Primary non-Hodgkin's lymphoma of the vagina: A case report". Oncology letters. 15 (3): 3504–3507. doi:10.3892/ol.2018.7805. PMID 29556272. Unknown parameter |month= ignored (help)
  82. ↑ Salvatore Guastafierro, Amando Tedeschi, Clelia Criscuolo, Maria Celentano, Luigi Cobellis, Raffaele Rossiello & Umberto Falcone (2012). "Primary extranodal non-Hodgkin's lymphoma of the vagina: a case report and a review of the literature". Acta haematologica. 128 (1): 33–38. doi:10.1159/000337336. PMID 22584110.
  83. ↑ A. I. al-Nafussi, G. Rebello, D. Hughes & K. Blessing (1992). "Benign vaginal polyp: a histological, histochemical and immunohistochemical study of 20 polyps with comparison to normal vaginal subepithelial layer". Histopathology. 20 (2): 145–150. PMID 1302457. Unknown parameter |month= ignored (help)
  84. ↑ Sunil Kumar Samal, Setu Rathod & Seetesh Ghose (2015). "Fibroepithelial Polyps of the Vagina in Pregnancy". Journal of clinical and diagnostic research : JCDR. 9 (10): QJ01–QJ02. doi:10.7860/JCDR/2015/13329.6656. PMID 26557576. Unknown parameter |month= ignored (help)
  85. ↑ M. Petrova, J. Laco, K. Cervicek & M. Tomsova (2015). "[Tubulo-squamous polyp of the vagina]". Ceska gynekologie. 80 (3): 173–175. PMID 26087210. Unknown parameter |month= ignored (help)
  86. ↑ Alexis Heller, Adanna Ukazu & Qing Wang (2017). "Pseudosarcomatous Vaginal Polyp". International journal of surgical pathology. 25 (1): 54–55. doi:10.1177/1066896916666676. Unknown parameter |month= ignored (help)
  87. ↑ Marguerite B. Vigliani (2017). "A Report of Two Cases of Age-Related Changes in Cervical Morphology in Postmenopausal Women with Vaginal Adenosis". Case reports in obstetrics and gynecology. 2017: 9523853. doi:10.1155/2017/9523853. PMID 28316850.
  88. ↑ Tiantian Han, Ying Jin, Yan Li, Yalan Bi & Lingya Pan (2018). "Clinicopathologic features and outcomes of primary vaginal adenosis as a dermatologic and gynecologic burden: A retrospective study". Medicine. 97 (49): e13470. doi:10.1097/MD.0000000000013470. PMID 30544435. Unknown parameter |month= ignored (help)
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