Metastatic Squamous Cell Carcinoma of the Vulva to the Lung Confirmed With Allelotyping

Division of Gynecologic Oncology, Pathology, The Ohio State University College of Medicine, Columbus, OH, USA.
International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists (Impact Factor: 1.67). 10/2009; 28(5):497-501. DOI: 10.1097/PGP.0b013e3181a23c6c
Source: PubMed


A squamous-cell carcinoma (SCC) of the lung can be indistinguishable from metastatic SCC of gynecologic origin using common histopathologic techniques; however, establishing tumor origin can be clinically relevant. A patient with a Bartholin gland SCC was found to also have a pulmonary SCC, concerning for metastasis versus synchronous pulmonary primary. Hematoxylin and eosin and immunohistochemistry alone could not differentiate the lesion, and both tumors were human papilloma virus positive. Allelotyping for loss of heterozygosity established the pulmonary lesion as a rare event of vulvar pulmonary metastasis. The patient received palliative chemotherapy instead of curative treatment. Allelotyping for loss of heterozygosity is an effective tool to establish metastasis versus synchronous primary tumors in the presence of multiple lesions, helping to direct appropriate clinical management.

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    • "Most commonly, carcinomas can have areas on chromosomes in which the DNA is altered or sustains a LOH. Allelotyping is a process that involves withdrawing and amplifying the DNA to search for patterns of LOH or alteration [8]. "
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    ABSTRACT: Histopathologic techniques are insufficient for distinguishing primary squamous cell carcinoma (SCC) from metastatic SCC, which is clinically important. A patient with SCC of the anus was found to also have SCC of the lung, and the question of metastatic versus synchronous primary diseases was raised. Immunohistochemical and hematoxylin and eosin (H&E) staining on sections of tissue could not discriminate between the two entities. Immunostain for p16 and chromogenic in situ hybridization for human papillomavirus (HPV) type 16 were positive in both tumors. Additionally, allelotyping for loss of heterozygosity displayed similar findings and confirmed the histopathological impression of anal SCC metastasis to the lung. The patient was treated with palliative chemotherapy instead of additional surgical treatment. When multiple tumors are present, determining metastatic versus synchronous primary tumors is necessary for appropriate treatment. Identification can be achieved using allelotyping for loss of heterozygosity.
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    • "The sample was processed and detected for HPV-H and -L risk probes as described previously [20]. "
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    ABSTRACT: Most lesions of the Bartholin gland are cysts or abscesses. Clinicians are taught that lesions of the Bartholin gland occurring in older women should raise the differential diagnosis of malignancy, although these are uncommon. Avariety of more unusual and rare lesions of the Bartholin gland have been reported. This review focuses on these less common entities, which must be considered as well when encountering pathology of the Bartholin gland. © 2014, American Society for Colposcopy and Cervical Pathology.
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