Cancer of the vulva in a 28-year-old woman

Abstract

Prevalence of vulvar cancer in women under 30 years of age is very low. Human papillomavirus DNA is found in 20%–60% of women with invasive vulvar cancer and in 70%–80% of patients with vulvar neoplasia. In a young woman treated for recurrent, extensive vulvar condyloma acuminate, squamous cell carcinoma of the vulva was found. The aim of this work is to demonstrate that cancer of the vulva may occur in young women. It demonstrates the need for particular diligence in the diagnosis and treatment of vulvar diseases and building a good relationship with the patient in order to minimize the fear of invasive treatment and encourage compliance. The patient, a 28-year-old female, after surgical treatment of condyloma acuminata, was admitted with a 3 cm tumor of the vulva. The tumor was excised with a margin of tissue free from infiltration – keratinizing squamous cell carcinoma was diagnosed. The patient did not return for extension surgery. After 5 years she was admitted with 4 cm loco-regional recurrence. Radical resection of the vulva with bilateral inguinal lymphadenectomy was performed. Four lymph node metastases were found. Adjuvant radiotherapy was implemented. Observation time was 4 years after the surgery for recurrence and 10 years after first diagnosis of cancer. Vulvar lesions cause anxiety in women, associated with sexual activity and the appearance of external genitalia after surgical treatment. Doubts of both the physician and the patient, particularly young, associated with invasive diagnostic methods result in prolonged ineffective conservative treatment. In the presented case wide local excision of the tumor proved ineffective. Local recurrence metastasized to lymph nodes bilaterally and contralaterally. Treatment results of vulvar cancer are frequently dependent on patients' willingness to comply and minimizing the fear of consequences of the treatment. Women with oncological conditions of the vulva should be diagnosed and treated in specialized centers.