Vulvar carcinoma in postmenopause: a rare case series presentation with MRI correlation

Introduction: Primary vulvar carcinoma is an uncommon gynecological malignancy, representing 5–8% of cases and ranking as the fourth most frequent gynecologic cancer. It predominantly affects postmenopausal women, with a median age of 68 years. Magnetic resonance imaging (MRI) plays a pivotal role in local staging, evaluating lymph node involvement, and guiding treatment planning. This case series aims to highlight MRI features of vulvar carcinoma in postmenopausal women and to emphasize the prognostic role of lymph node involvement according to FIGO 2021. Case description: We report three cases of postmenopausal women aged 55–70 years diagnosed with vulvar carcinoma. Clinically, all patients presented with vulvar masses exhibiting irregular, fragile, and easily bleeding surfaces, ranging from 5–12 cm. Histopathology confirmed vulvar carcinoma in all cases. MRI revealed solid vulvar masses with partially indistinct margins, lobulated borders, and variable cystic components. All lesions demonstrated restricted diffusion on DWI/ADC sequences and early enhancement on DCE imaging, consistent with malignancy. Regional lymphadenopathy was observed in each case, characterized by loss of fatty hilum and irregular contours. Conclusion: MRI is the most reliable modality for local staging of vulvar carcinoma and assessment of lymph node involvement. Accurate imaging-based staging is essential for treatment planning and prognosis.