根据我们的系统文献综述(PRISMA指南),妊娠期间仅诊断出37例外阴鳞状细胞癌(VSCCs)(年龄范围:17~41岁).肿瘤大小范围为0.3-15cm。治疗后进行(14/37,38%),之前(10/37,27%),或交货前后(11/37,30%)。我们发现21/37(57%)病例为I期,2二(5%),11III(30%),和3例IVB(8%)。在11/37(30%)病例中报告了HPV相关特征(尖锐湿疣/疣;HPV感染;高度鳞状上皮内病变)。我们还发现9/37(24%)患者患有炎症(硬化性苔藓/扁平苔藓,牛皮癣,慢性皮炎)。复发/进展时间(12/37,32%)为0至36个月(平均9个月)。诊断后2.5-48个月,有8名妇女死于疾病(22%),2(5%)患有疾病,随访结束时23例(62%)无病.怀孕患者必须随访。即使它们很小,新出现的外阴病变应进行活检,特别是在有危险因素的女性中(HPV,皮肤病,等。).在妊娠晚期诊断为VSCCs的治疗可能会延迟到产后。选择性剖宫产可预防外阴伤口裂开。在少数报道的案例中,妊娠/胎儿结局似乎不受孕期侵入性治疗的影响.然而,临床医生必须小心;更大的队列应该定义最佳治疗。缺乏明确的指导方针,因此,多学科的方法和与患者的讨论是强制性的。
According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17-41 years). The tumor size range was 0.3-15 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before-and-after delivery (11/37, 30%). We found that 21/37 (57%) cases were stage I, 2 II (5%), 11 III (30%), and 3 IVB (8%). HPV-related features (condylomas/warts; HPV infection; high-grade squamous intraepithelial lesion) were reported in 11/37 (30%) cases. We also found that 9/37 (24%) patients had inflammatory conditions (lichen sclerosus/planus, psoriasis, chronic dermatitis). The time-to-recurrence/progression (12/37, 32%) ranged from 0 to 36 (mean 9) months. Eight women died of disease (22%) 2.5-48 months after diagnosis, 2 (5%) were alive with disease, and 23 (62%) were disease-free at the end of follow-up. Pregnant patients must be followed-up. Even if they are small, newly arising vulvar lesions should be biopsied, especially in women with risk factors (HPV, dermatosis, etc.). The treatment of VSCCs diagnosed in late third trimester might be delayed until postpartum. Elective cesarean section may prevent vulvar wound dehiscence. In the few reported cases, pregnancy/fetal outcomes seemed to not be affected by invasive treatments during pregnancy. However, clinicians must be careful; larger cohorts should define the best treatment. Definite guidelines are lacking, so a multidisciplinary approach and discussion with patients are mandatory.