Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 31
Vulvar Cancer

31–1. Squamous cell carcinoma is the most common histologic subtype of vulvar cancer. What is the second most common histologic type?

a. Sarcoma

b. Melanoma

c. Basal cell

d. Adenocarcinoma

31–2. Approximately how many women are diagnosed with vulvar cancer annually in the United States?

a. 1,000

b. 4,000

c. 8,000

d. 15,000

31–3. The internal pudendal artery is a branch of which artery?

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Reproduced, with permission, from Corton MM: Anatomy. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 38-6.

a. Femoral artery

b. External iliac artery

c. Internal iliac artery

d. Superficial pudendal artery

31–4. Which of the following is not part of the femoral triangle?

a. Gracilis muscle

b. Sartorius muscle

c. Inguinal ligament

d. Adductor longus muscle

31–5. What is the structure at the arrow tip?

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a. Gracilis muscle

b. Sartorius muscle

c. Adductor brevis muscle

d. Adductor longus muscle

31–6. Which of the following is not a risk factor for vulvar cancer?

a. Lichen planus

b. Tobacco abuse

c. Lichen sclerosus

d. Human papillomavirus

31–7. What is the most accurate description of Cloquet node?

a. It is a deep inguinofemoral node.

b. It is the most superior node in the femoral triangle.

c. If negative, no pelvic lymph node dissection is indicated.

d. All of the above

31–8. What percentage of vulvar cancers is positive for human papillomavirus (HPV)?

a. 0

b. 5

c. 30

d. 60

31–9. A 39-year-old woman is referred to you for a painful 3-cm vulvar mass. You biopsy the mass, and it reveals invasive squamous cell carcinoma. Which of the following tests should you perform prior to definitive surgery?

a. Pap smear

b. Vulvoscopy

c. Human immunodeficiency virus (HIV) test

d. All of the above

31–10. A 62-year-old woman presents for her annual well woman examination and complains of vulvar pruritis. During examination, you note an area of thickened white plaque. What is the most appropriate next step?

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Photograph contributed by Dr. Elaine Duryea.

a. Biopsy the lesion in your office

b. Prescribe estrogen cream and follow up in 3 months

c. Perform a wide local excision in the operating room

d. Prescribe clobetasol cream and follow up in 3 months

31–11. What is the maximum depth of invasion to still be considered minimally invasive vulvar cancer?

a. 1mm

b. 3mm

c. 5mm

d. 7mm

31–12. You perform a radical vulvectomy and bilateral inguinofemoral lymph node dissection for a 3-cm invasive squamous cell carcinoma of the vulva involving the lower third of the vagina. Final pathologic analysis of the specimen reveals margins and lymph nodes that are negative for cancer. Based on these findings, which International Federation of Gynecology and Obstetrics (FIGO) stage is she assigned?

a. I

b. II

c. III

d. IVA

31–13. Which of the following is not associated with an increased risk of lymph node metastasis?

a. High grade

b. Increasing age

c. Clitoral lesion

d. Lymphovascular space invasion

31–14. What is the most important prognostic factor in vulvar cancer?

a. Grade

b. Tumor size

c. Depth of invasion

d. Lymph node metastasis

31–15. What is the risk of recurrence (percent) if the tumorfree margin around a resected vulvar cancer is less than 8 mm?

a. 5

b. 25

c. 33

d. 50

31–16. What is the most common complication of an inguinofemoral lymph node dissection?

a. Lymphocele

b. Lymphedema

c. Groin infection

d. Wound dehiscence

31–17. What technique can decrease the risk of lymphedema?

a. Spare the saphenous vein

b. Use compression stockings

c. Transpose the sartorius muscle

d. Avoid drain placement at the time of inguinofemoral dissection

31–18. You perform a radical vulvectomy with bilateral inguinofemoral lymphadenectomy on a woman with a 4-cm squamous cell carcinoma tumor of the vulva. Margins are negative for cancer, but there are three positive lymph nodes. What is the most appropriate treatment?

a. Radiation alone

b. Chemoradiation

c. Close observation

d. Pelvic lymph node dissection

31–19. What is the most appropriate treatment for a 55-year-old patient with a 4-cm squamous cell carcinoma of the vulva involving the urethral meatus and a medical history significant for systemic lupus erythematosus?

a. Chemoradiation

b. Pelvic exenteration

c. Chemoradiation followed by radical vulvectomy

d. Radical vulvectomy with bilateral inguinofemoral lymph node dissection

31–20. What is the correct term for the lesion depicted by the arrow?

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a. Primary tumor

b. Satellite lesion

c. In-transit metastasis

d. None of the above

31–21. Which of the following is FALSE regarding the tumor shown here involving the outer surface of the right labia minora?

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a. It is typically a disease of the elderly.

b. It commonly arises from the labia minora and clitoris.

c. Differential diagnoses include seborrheic keratosis and dysplastic nevi.

d. It is more common in African American women than Caucasian women.

31–22. What is the most appropriate treatment for a 3-cm basal cell carcinoma of the right vulva, 2 cm from the midline?

a. Wide local excision with a 1-cm margin

b. Wide local excision with a 2-cm margin

c. Radical vulvectomy with right inguinofemoral lymph node dissection

d. Radical vulvectomy with bilateral inguinofemoral lymph node dissection

31–23. A 54-year-old woman presents with the persistent vulvar mass seen in the picture below and complaints of dyspareunia. She denies previous Bartholin gland abscess or mass in the past. What is the most appropriate management?

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Photograph contributed by Dr. William N. Denson.

a. Antibiotics

b. Resection of the Bartholin gland

c. Incision and drainage, Word catheter placement

d. Incision and drainage, cyst wall biopsy, and Word catheter placement

31–24. Which vulvar lesion can be associated with a primary cancer at a distant site?

a. Lichen planus

b. Lichen sclerosus

c. Vulvar Paget disease

d. Vulvar basal cell carcinoma

31–25. What condition is illustrated in these photographs? Grossly, one would expect to see an erythematous, eczematoid, possibly weeping lesion of the vulva. Histologically, cells pathognomonic to this condition are found (arrow).

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Photographs contributed by Drs. Claudia Werner and Kelley Carrick.

a. Vulvar melanoma

b. Lichen sclerosus

c. Vulvar Paget disease

d. Vulvar squamous cell carcinoma

Chapter 31 ANSWER KEY

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