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Vulvar Vascular Tumors

A Clinicopathologic Study of 85 Patients

Papalas, John A., MD*; Sangueza, Omar P., MD; Puri, Puja K., MD; Robboy, Stanley J., MD§; Selim, Maria A., MD

The American Journal of Dermatopathology: February 2013 - Volume 35 - Issue 1 - p 1–10
doi: 10.1097/DAD.0b013e31823135c5
CME Article

Abstract: The subepidermal hormonally sensitive tissue of the vulva is anatomically unique and may give rise to a wide variety of vascular tumors. As a consequence, classifying vulvar vascular lesions has been challenging due both to the wide variety of lesions that may be encountered and the heterogeneity in reporting across several disciplines. The purpose of this study is to present an institutional experience of vulvar vascular lesions. Overall, 85 patients were identified over a 26-year period. Vascular lesions belonging to the following classes included (n, %total) benign vascular tumors (32, 38%), dilatations of preexisting vessels (31, 36%), hyperplasia/reactive (7, 8%), tumors with significant vascular component (11, 13%), malformations (3, 4%), and malignant vascular tumors (1, 1%). Two reaction patterns based on vulvar lymphatic pathology were identified: one is a stromal dominant pattern and the other is a vascular dominant pattern. Vulvar vascular malformations and true vascular malignancies, although rare, may have associated high morbidity. To accurately classify vulvar lymphatic lesions, the pathologist must carefully consider the patient's clinical history taking into account features such as preexisting lymphedema.

*Pathologist, Pathology section, Eastern Dermatology and Pathology, Greenville, NC

Professor of Pathology and Dermatology, Wake Forest University School of Medicine, Winston Salem NC

Pathologist, Center for Molecular Biology and Pathology, LabCorp Specialty Testing Group, Durham, NC

§Professor of Pathology and Obstetrics and Gynecology, Duke University Medical Center, Durham, NC

Associate Professor of Pathology and Dermatology, Duke University Medical Center, Durham, NC.

Reprints: John A. Papalas, MD, Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710 (e-mail:

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

© 2013 by Lippincott Williams & Wilkins.