Vulva & vagina

Squamous carcinoma and precursor lesions

Squamous cell carcinoma-vagina

Last author update: 1 October 2014
Last staff update: 15 March 2022

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PubMed Search: Squamous cell carcinoma [title] vagina

Shweta Gera, M.D.
Arzu Buyuk, M.D.
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Cite this page: Gera S. Squamous cell carcinoma-vagina. website. Accessed May 19th, 2024.
Definition / general
  • Primary squamous cell carcinoma arising in vagina without involvement of surrounding structures, such as cervix or vulva
  • In some cases, vaginal intraepithelial neoplasia (VAIN) can be found prior to invasive squamous cell carcinoma
  • History of prior hysterectomy in up to 50% of cases
  • Also associated with vaginal or uterovaginal prolapse (Crit Rev Oncol Hematol 2015;93:211)
  • Strong relationship with high risk human papilloma virus (HPV), especially HPV 16 (seen in up to 80% of cases), HPV 18 and HPV 31
  • More common in smokers because smoking increases the risk of high grade VAIN in women with oncogenic HPV (Crit Rev Oncol Hematol 2015;93:211)
Clinical features
  • Clinical history along with histological features on biopsy / resection specimen
  • Tumor involving both the vagina and the cervix should be classified as a cervical carcinoma; similarly a tumor involving both the vagina and the vulva should be considered a vulvar carcinoma
Radiology description
  • Imaging required to determine extent of disease and to look for distant metastasis
Prognostic factors
  • FIGO stage is most important predictor of overall survival
  • Tumor size > 4 cm associated with decreased local control and lower overall survival, while total radiation dose in excess of 70 Gy is associated with improved local control of disease and improved overall survival (Gynecol Oncol 2013;131:380, Crit Rev Oncol Hematol 2015;93:211)
  • Vaginal squamous cell carcinoma can spread to vulva, cervix, bladder, rectum and through lymphatics can metastasize to obturator, hypogastric, external iliac and groin nodes
  • Rarely distant metastasis to liver, lungs, bones and brain (Crit Rev Oncol Hematol 2015;93:211)
Case reports
Gross description
  • Exophytic or ulcerative with necrosis
Microscopic (histologic) description
  • Histologically graded as well differentiated (G1), moderately differentiated (G2), poorly differentiated or undifferentiated (G3) (Crit Rev Oncol Hematol 2015;93:211)
  • Well differentiated tumors have polygonal squamous cells with ample eosinophilic cytoplasm, abundant keratin pearls and intercellular bridges
  • Poorly differentiated tumors have small cells with scant cytoplasm and hyperchromatic nuclei
  • Nuclear pleomorphism and mitotic activity increases from well to poorly differentiated
  • Moderately differentiated tumors have histological features intermediate between well and poorly differentiated
  • HPV+ tumors are more frequently of nonkeratinizing, basaloid or warty type than HPV- tumors (84% versus 14.3%; p < 0.001) and more often showed diffuse p16 immunoreactivity (96% versus 14.3%, p < 0.001)
Cytology description
  • Keratinizing squamous cell carcinomas have polygonal cells with bizarre shapes including spindle shaped and tadpole cells, with dense orangeophilic / eosinophilic cytoplasm
  • Cells can present singly or in small groups in a dirty necrotic background
Positive stains
Differential diagnosis
  • Nonkeratinizing SCC needs to be differentiated from repair and adenocarcinoma
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