Vulva
Malignant neoplasms
Basaloid carcinoma

Author: Priya Nagarajan, M.D., Ph.D. (see Authors page)
Editor: Sara Peters, Ph.D., M.D.

Revised: 6 October 2017, last major update April 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Basaloid carcinoma vulva

Cite this page: Nagarajan, P. Basaloid carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvabasaloidcarcinoma.html. Accessed October 17th, 2017.
Definition / general
  • Human papillomavirus (HPV) associated carcinoma occurring in younger population (35 - 65 years) than squamous cell carcinoma (55 - 85 years)
Terminology
  • Basaloid / warty carcinoma are often considered together due to common human papillomavirus (HPV) etiology
Epidemiology
  • Usually affects younger women - mean age at diagnosis is 54 years
  • Risk factors include multiplicity of sex partners, early age at initiation of sexual intercourse and history of abnormal Pap smears
  • Rarely is multifocal
  • Patients may have synchronous or metachronous (not synchronous) malignancies of cervix and vagina
Pathophysiology
Clinical features
  • Pruritus and pain are most common presenting symptoms
  • May have local discomfort, bleeding, mass, ulcer or swelling or be completely asymptomatic
  • Better disease free and overall survival in human papillomavirus (HPV) vs. non human papillomavirus (HPV) associated carcinomas
Radiology description
  • MRI, CT, PET / CT and ultrasound can assess extent of tumor, involvement of normal tissues and surrounding organs, presence of lymph node metastasis
  • Whole body FDG PET / CT is useful for initial workup and for assessing response to chemoradiotherapy
Prognostic factors
  • Early diagnosis and regular follow up for residual and recurrent lesions are the most important prognostic factors
  • Presence of perineural invasion can predict local recurrence
  • Metastasis is common in patients with lymphovascular space invasion
Case reports
Treatment
  • Surgical resection
    • Partial or total vulvectomy or conservative wide excision with or without sentinel lymph node biopsy
    • Inguinofemoral lymph node dissection may be considered for deep or large tumors
  • Neoadjuvant radiotherapy or chemotherapy
  • Palliative radiation therapy
Gross description
  • Lesions can be vegetating, ulcerated, infiltrative, nodular or pigmented
Microscopic (histologic) description
  • Hallmark of tumor is immature squamous epithelium
  • Cells are arranged in variably sized solid nests, cribriform lobules with comedonecrosis and peripheral palisading of nuclei
  • Occasionally infiltrative cords, nests or trabeculae are present, surrounded by densely hyalinized stroma often containing thin walled vessels
  • Tumor is composed of basaloid cells with scant basophilic cytoplasm, high nuclear to cytoplasmic ratio
  • Nuclei are oval to round, with coarsely granular chromatin, resulting in a stippled appearance
  • Mitotic figures are frequent and atypical mitotic figures can be easily identified
  • Small foci of keratinization may be identified in some tumors
  • Perineural invasion may be common and extensive
  • Vulvar intraepithelial neoplasia grade III is frequently associated with the invasive component
  • Admixture of warty architecture is not uncommon
Microscopic (histologic) images

Images hosted on other servers:

Large lobular nests

Comedonecrosis

Surface ulceration
and background
undifferentiated VIN


Perineural invasion

Smaller nests

Focal squamous differentiation

HPV positive vulvar squamous cell carcinomas

Positive stains
Negative stains
Electron microscopy description
  • Usually not performed
Differential diagnosis