Vulvar Intraepithelial Neoplasia & Extramammary Paget´s Disease

00:00 Vulvar Neoplasm Demographically, remember, because of the outside or external nature of these organs the type of cells of these organs then are outlined by will be squamous cells.

00:19 So 85% of any type of your vulvar neoplasia would have to be squamous cell.

00:26 Melanomas or adenomas could also be possible, keep that in mind.

00:30 But however, majority of a time is squamous cell.

00:33 If it is vulvar neoplasia, or think about who you are.

00:38 We still have not left the vulva, the types here would be the same strains as you do expect with your cervical cancer.

00:46 The highest strains 16, 18, 31, 33.

00:49 HPV negative associate with squamous cell hyperplasia or lichen sclerosus.

00:55 If you find you patient to be HPV-negative and the developing squamous cell cancer of the vulva.

01:03 There might be association as that I had earlier noted with lichen sclerosus.

01:14 A vulvar neoplasia that is quite different from squamous cell cancer.

01:19 Welcome to Extramammary Paget’s disease.

01:22 Put all this into perspective forming.

01:25 Mammary Paget’s disease.

01:27 Paget’s disease can be find in three different places for you on your Boards and Wards.

01:34 Paget’s disease at the bone called von Recklinghausen's disease of the bone.

01:38 Then we have Paget’s disease of the breast, mammary.

01:42 However, where are you right now? The vulva.

01:46 Therefore, you call this Extramammary Paget’s disease.

01:49 There are two major types of extramammary: the bone and the vulva.

01:54 the cell, histological will appear as being a Paget cell.

02:00 So what is Paget’s disease? What kind of cancer is this? Earlier, I had mentioned that vulvar disease if any type of cancer, 85% of time were going to squamous cell cancer.

02:14 I also said that there is a possibility of adenocarcinoma in developing.

02:19 This is an example of that.

02:21 Extramammary Paget’s disease, these are glandular cells and it’s an adenocarcinoma.

02:28 Don’t you ever forget that please? These are malignant cells confined to the epidermis as supposed to mammary or breast Paget’s.

02:36 So these are confined to the epidermis of the vulva.

02:39 Other causes of vulva neoplasia include the following: Malignant melanoma, rare but could occur in peak incidence with sixth a little bit later in age of you female, sixth or seventh decade.

02:53 Couple of important , vulvar neoplasia, make sure that you’ve understood the topic of vulvar cancer before moving on to next section.

03:02 Squamous cell cancer, HPV, higher strain, lichen sclerosus, predisposing factors perhaps.

03:08 Next, Extramammary Paget’s disease, what kind of cancer in the vulva, adeno, the malignant melanoma as where is it may be look for this perhaps in a female in her 60s or 70s.

03:21 Paget’s disease of vulva upon histologic examination will show you the following.

03:26 Clusters of large clear tumor cells within the squamous epithelium.

03:31 Clear.

03:33 These are adenocarcinoma.

03:35 Take a look at the picture on the right.

03:36 you’ll notice on the top right corner that those appears being glandular, it is an adenocarcinoma associated with pruritus.

03:48 Paget’s disease of the vulva.

03:50 Let us now take a look at what’s on the vulvar intraepithelial neoplasia.

03:54 Do not confuse it with Paget’s.

03:57 So here, with the fact that well the same type of progression that you’ll expect with cervical intraepithelial neoplasia could be found here with VIN as well.

04:07 More common.

04:08 Will progress to invasive squamous carcinoma if untreated.

04:11 Just like what you expect with CIN.

04:14 So, what is this? What would you call this? Would you call this insight too? Or would you call this dysplasia.

04:21 I’m hoping that you would tell me that this is good.

04:26 This is going to be your dysplasia.

04:29 So VIN would be increased dysplasia.

04:33 In other words, this ordered growth and in some point at time, when you go from VIN 1, 2 and 3, you will then rupture the membrane and go on to invasis squamous cancer of what organ right now? Vulva.