Human papillomavirus, lichen sclerosis and vulvar squamous cell carcinoma

Abstract

Scurry J, Flowers L, Wistuba I, Vanin K, Mulvany N, Reyes H, Gazdar A. Human papillomavirus, lichen sclerosis and vulvar squamous cell carcinoma. Int J Gynecol Cancer 1998; 8: 298–306. The objective of the study was to compare human papillomavirus (HPV) detection, adjacent lesions, age and prognosis in different histologic types of overtly invasive squamous cell carcinoma (SCC). One hundred and thirty consecutive cases of overtly invasive vulvar SCC were assayed for HPV DNA by the polymerase chain reaction (PCR). The carcinomas were classified into keratinizing and basaloid types, on the basis of cytoplasmic maturation and keratin production. Changes in the adjacent epidermis were recorded as lichen sclerosis, squamous cell hyperplasia, differentiated vulvar intraepithelial neoplasia (VIN), undifferentiated VIN or normal. Prognosis was assessed as unfavorable or favorable according to whether at least one of recurrence, groin node or distant metastasis was present. Results showed HPV DNA was present in 29 (22%) of SCCs and absent in 101 (78%), with HPV 16 being the commonest type, found in 23 cases. One hundred and four SCCs (80%) were classified as keratinizing and 26 (20%) as basaloid. Twelve (12%) of the keratinizing and 17 (65%) of the basaloid SCCs contained HPV DNA. Women with HPV-positive carcinomas had a mean age of 63 years compared with 73 in those with HPV-negative tumors. HPV-positive tumors were associated with undifferentiated VIN in the adjacent skin and HPV-negative with lichen sclerosis, squamous cell hyperplasia and differentiated VIN. HPV status and histologic type did not confer different prognosis. In conclusion, histologic classification of vulvar SCCs was of value in determination of etiology and some clinical features and is therefore likely to be of use in managing patients, epidemiological research and tumor registry surveillance. While this study showed no difference in prognosis with HPV detection and histologic type, it will be impossible to conclude definitively that different types of vulvar carcinoma have a similar prognosis without performing a large population-based study.