Unclassified Spindle-Cell Sarcoma of the Vulva: Case Report and Literature Review

Abstract

Background: Soft-tissue sarcomas of the vulva comprise a rare group of gynecologic malignancies. Case: The case of a 57-year-old woman with a 1-month history of an enlarging vulvar mass is presented. She had had a lesion excised from the same location in the past. Physical examination revealed a 3×3 cm solid mass attached to the left labium majus. An excisional biopsy of this lesion was performed. Histopathology revealed a cellular spindle-cell neoplasm with mild cytologic atypia and an infiltrative growth pattern. The lesional cells showed ovoid to tapered nuclei and scattered mitotic figures. Prominent stromal blood vessels with fibrinoid change were also noted. Immunostaining was negative for Pan-Keratin, cluster of differentiation 34 (CD34), smooth muscle actin (SMA), and glial fibrillary acidic protein (GFAP). Results: These immunohistologic findings were consistent with the diagnosis of an unclassified spindle-cell sarcoma (low-grade). Following this diagnosis, the patient underwent a left partial vulvectomy with adequate margins. She subsequently had an uneventful postoperative recovery. Conclusions: Surgical excision and histopathologic evaluation are imperative for distinguishing vulvar sarcomas from other mesenchymal lesions of the vulva. As these tumors tend to recur, long-term surveillance is necessary to maintain a favorable prognosis for patients. (J GYNECOL SURG 30:291)