HOME STUDY COURSE CLASSICS

Case #50 - October 2006

Charles J. Dunton, MD

History
An asymptomatic 38-year-old woman has a Pap smear interpreted as invasive squamous carcinoma.

1.

A 26-year-old renal transplant patient on immunosuppressive therapy presents with vulvar irritation. She has a history of human papillomavirus (HPV) and cervical intraepithelial neoplasia. Which of the following statements are INCORRECT?

a.

Transplant patients have a higher incidence of invasive squamous cell cancer of the lower genital tract than the general population.
b.

Dense acetowhite epithelium is present.
c.

Laser vaporization is appropriate treatment of this lesion.
d. Complete excision of the lesion without initial biopsy should be performed.


2. These slides demonstrate vulvar findings in a 55-year-old woman with prior excision of vulvar intraepithelial neoplasia (VIN). Which of the following statements are INCORRECT?

a.

Acetowhite changes are present.
b. Mosaic and punctation are present.
c. CIN 3 and unsatisfactory colposcopy
d.

Biopsy of the lesion should be performed

Click on image to enlarge.

Click on image to enlarge.

3. This slide demonstrates the histology of the lesions seen in the two previous slides.  It shows which of the following?

a.

VIN 1
b.

VIN 2
c. VIN 3
d. invasive cancer

Click on image to enlarge.

4. Treatment for the lesions seen in the slides shown in Question 2 include all of the following EXCEPT?

a.

laser vaporization
b.

5-fluorouracil cream
c. local excision
d. superficial inguinal node biopsy

5. The slide at the right demonstrates a vulvar lesion (>2cm) from a 70-year-old woman with abnormal cytology.  Colposcopic findings after the application of 5% acetic acid include all of the following EXCEPT?

a.

acetowhite epithelium
b.

atypical vessels
c. mosaic
d. friability

Click on image to enlarge.

6. Biopsy of this lesion shows:

a.

VIN 3
b.

invasive squamous carcinoma
c. invasive adenocarcinoma
d. sarcoma botryoides

Click on image to enlarge.

7. Concerning this lesion, which of the following statements are correct? (More than one answer may be correct.)

a.

Local excision is adequate treatment.
b.

Complete en bloc radical vulvectomy and node dissection are necessary.
c. Radical wide excision and groin node excision are appropriate.
d. Radiation and chemotherapy should be given prior to surgery.

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This program, with a posting date of October 1, 2006 is valid for 3 years. The information included in this Home Study Course Classics Case of the Month program reflects the views of the author only and not ASCCP. All participants should verify all information and data prior to treating patients or utilizing therapies noted in this case study.

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