Total Radical Vulvectomy and Bilateral Inguinofemoral Lymphadenectomy for Vulva Carcinoma: Case Report and Review of Literature

Introduction: Vulva cancer is an uncommon disease. It represents about 3% to 5% of gynecologic cancers worldwide, but its incidence is increasing with age and Human Papilloma Virus (HPV) and HIV infection. In Cameroon, annual number of new cases was 52 in 2020. Surgery is the treatment of choice and it is only realized in teaching hospitals. Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH) is one of the centers where cancer cases are referred to. Case Report: We report a case of a 49-year-old woman, gravida 2 para 1, known HIV positive for twenty years, who complained of vulva pruritis for last two years. Six months after the onset of pruritis, she presented a local swelling of both labia majora, which got ulcerated on the right, associated with severe pain. On clinical examination, she was in good general condition with a 3 × 3.5 cm ulcerated, budding mass in the middle third of the right labia majora, approaching the midline formed by the vaginal orifice, with no locoregional infiltration (vagina, bladder, urethra, anus and rectum). The left labia majora was abnormally thickened by about 1 cm, with no palpable mass. There were no palpable inguinal lymph nodes. Punch biopsy revealed an invasive non keratinizing carcinoma of the vulva. MRI showed no suspicious lymph nodes or invasion of pelvic organs. The patient underwent radical vulvectomy with bilateral inguinofemoral lymph nodes dissection. The postoperative period was uneventful, and anatomopathological examination confirmed vulvar carcinoma without lymph node invasion or lymphovascular emboli, and excision margins were in sano. No adjuvant treatment was therefore initiated. Conclusion: Vulva cancer is extremely rare, and frequently associated with HIV infection. Any suspected vulvar lesion should be biopsied. Although other treatment modalities are available, surgery remains the cornerstone of its management.