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CASE REPORT
Year : 2018  |  Volume : 11  |  Issue : 4  |  Page : 357-359  

Squamous cell carcinoma of clitoris


1 Department of Pathology, Government Medical College, Kota, Rajasthan, India
2 Department of Obstetrics and Gynaecology, Government Medical College, Kota, Rajasthan, India
3 Department of Radiodiagnosis, Government Medical College, Kota, Rajasthan, India

Date of Web Publication2-Aug-2018

Correspondence Address:
Nilima Soni
Department of Pathology, Government Medical College, Kota - 324 002, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.MJDRDYPU_193_17

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  Abstract 


Carcinoma of Clitoris is very rare and is important because of its aggressive nature and clinical course leading to early death. Cancer of vulva accounts to 4 % of all malignancies of female genital tract and 0.6% of all cancers in women. The case of a 68 year old female who presented to gynaecology outdoor with a clitoral growth involving adjacent vulva. CT scan showed involvement of clitoris, labia majora and inguinal lymph nodes. FNAC from the lesion followed by Biopsy proved a case of well - differentiated squamous cell carcinoma. Management of such case is a challenge for the surgical oncologist, due to advanced stage at presentation. Hence, such lesions require early biopsy to avoid delay in diagnosis and further management of the case.

Keywords: Clitoris, squamous cell carcinoma, malignancy


How to cite this article:
Soni N, Saxena B, Tanwar R K, Pathak V. Squamous cell carcinoma of clitoris. Med J DY Patil Vidyapeeth 2018;11:357-9

How to cite this URL:
Soni N, Saxena B, Tanwar R K, Pathak V. Squamous cell carcinoma of clitoris. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2019 Oct 22];11:357-9. Available from: http://www.mjdrdypv.org/text.asp?2018/11/4/357/238167




  Introduction Top


Tumors of the clitoris are very rare,[1] and they are important because of aggressiveness in the clinical course, leading to an early death. Approximately 4% of all gynecologic malignancies are vulvar carcinomas,[2] of which localizing to clitoris makes it a rarity. Localization of squamous cell carcinoma (SCC) on the clitoris has a worse prognosis, and the risk factors include infection with human papillomavirus, vulvar intraepithelial neoplasia, cervical intraepithelial neoplasia, lichen sclerosus, squamous hyperplasia, cigarette smoking, alcohol consumption, immunosuppression, a prior history of cervical cancer, and Northern European ancestry.

The localization of tumor, its size, status of lymph node, and intensity and depth of invasion are some of the important prognostic factors. A large number of papers are published on vulvar cancers, including the malignancies in its different parts, however; there is a paucity of literature on cancer of clitoris.[3],[4] In view of (i) the significance of clitoris in normal sexual function (ii) the difference in histology of vulvar and clitoral cancer, and (iii) a paucity of literature, it was found worthwhile to make it a rare case report.


  Case Report Top


A 68-year-old female presented in the gynecological outdoor for a swelling in vulva that has recently increased in size and associated with itching [Figure 1]. On examination, a firm mass, 4 cm × 3 cm, fungating, over the clitoral area, and involving the urethra. The inguinal nodes were palpable. The patient was investigated further.
Figure 1: Enlarged clitoris with eroded surface

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X-ray chest, pelvis, and ultrasonography abdomen were performed with no positive finding. Fine-needle aspiration cytology from the growth of clitoris revealed severe dysplastic squamous epithelial cells. PAP's Smear examination revealed no significant finding. Computed tomography scan was also done which showed clitoral space occupying lesion (SOL) involving labia majora on the left side and urethra. Bilateral lymphadenopathy was seen [Figure 2]. A biopsy was done that proved a case of well-differentiated thoroughly invasive SCC [Figure 3]. Pap stained liqud-based cytology (LBC), however, showed dysplastic cells [Figure 4]. Patient's response to radiotherapy is shown in [Figure 5].
Figure 2: CT scan showing clitoral SOL

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Figure 3: H & E stained section showing well differentiated squamous cell carcinoma

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Figure 4: PAPS stained LBC smears

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Figure 5: Post Radiotherapy

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  Discussion Top


The vulvar cancer is usually diagnosed in later stages, due to ignorance of the symptoms by the patient, and due to embarrassment to divulge the personal details to a health provider. Due to follow-up treatment with the basic investigations and biopsy only as the last resort for diagnosis, valuable time is lost because the cancer is growing masked by the seemingly normal investigation profiles.

Patients with clitoral SCC have worse prognosis compared to patients without clitoral involvement, which may be explained by the deeper invasiveness of the primary tumors resulting in more groin metastases and its central location, involving bilateral lymph nodes.

Thus, any suspicious lesion needs to be biopsied early for good prognosis of the patient. In our case, our patient had already lost 2 years' time due to reluctance to seek healthcare and late biopsy.


  Conclusion Top


Clitoral carcinoma is a rare tumor encountered in day-to-day practice, even rarer in the younger age group of patients. Management of such cases is a challenge for the surgeon due to late diagnosis and lack of well-accepted protocol for management of such cases.[5] Religious, ethical, and economic factor should be considered along with thorough discussion with the patient and her relatives regarding the risks and hazards of the disease, investigations, and the treatment options available.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Al-Shebaily MM, Qureshi VF. Malignancies in clitoris a review of literature on etiology, diagnosis, pathology and treatment strategies. Int J Canc Res 2008;4:110-26.  Back to cited text no. 1
    
2.
Haidopoulos D, Elsheikh A, Vlahos G, Sotiropoulou M, Rodolakis A, Voulgaris Z, et al. Malignant rhabdoid tumor of the clitoris in an elderly patient: Report of a case. Eur J Gynaecol Oncol 2002;23:447-9.  Back to cited text no. 2
    
3.
Bond SJ, Seibel N, Kapur S, Newman KD. Rhabdomyosarcoma of the clitoris. Cancer 1994;73:1984-6.  Back to cited text no. 3
    
4.
Bokhman JV, Maximov SJ, Ebert AD. Effectiveness of radical therapy in vulvar carcinoma. An analysis of 148 cases. Zentralbl Gynakol 1997;119:166-72.  Back to cited text no. 4
    
5.
Popovici A, Mitulescu G, Pop V, Iliescu CA. Cancer of the vulva. Chirurgia (Bucur) 1996;45:51-62.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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   Abstract
  Introduction
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  Discussion
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