Vulva, vagina & female urethra
Vulva & vagina
Squamous tumors and precursors
Basaloid carcinoma


Topic Completed: 1 April 2014

Minor changes: 13 August 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: Basaloid carcinoma vulva

Priya Nagarajan, M.D., Ph.D.
Sara B. Peters, M.D., Ph.D.
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Cite this page: Nagarajan P, Peters SB. Basaloid carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/vulvabasaloidcarcinoma.html. Accessed August 15th, 2020.
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

Contributed by Priya Nagarajan, M.D., Ph.D.

Large lobular nests

Comedonecrosis

Surface ulceration
and background
undifferentiated VIN


Perineural invasion

Smaller nests

Focal squamous differentiation



Images hosted on other servers:

HPV positive vulvar squamous cell carcinomas

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