Implication of human papillomavirus-66 in vulvar carcinoma: a case report

We present the case of an 80-year-old Greek Caucasian woman with an undetermined obstetric and gynecologic history. The patient underwent radical vulvectomy and bilateral inguinal lymphadenectomy for a vulvar carcinoma. A human papillomavirus infection was suggested on the basis of histological and cytological examinations followed by human papillomavirus DNA typing, which revealed the presence of human papillomavirus-66.Even though human papillomavirus-16 and human papillomavirus-18 are most frequently implicated in the pathogenesis of vulvar carcinoma, human papillomavirus-66 can also be regarded as a causative factor. Suspicious lesions should be biopsied, and in the presence of carcinoma, vulvectomy with bilateral lymphadenectomy, if necessary, must be performed. Furthermore, polymerase chain reaction assay analysis with clinical arrays in cytological samples is an accurate test for the detection of a wide range of human papillomavirus genotypes and can be used to verify the infection and specify the human papillomavirus type implicated.Vulvar carcinoma in older women is seldom associated with any type of human papillomavirus (HPV) infection, representing less than 15% of reported cases [1]. Atypia of the squamous epithelium of the vulva is considered to be a co-factor in the carcinogenesis of vulvar cancer and usually a non-neoplastic lesion, such as vulvar inflammation, lichen sclerosus or hyperplasia of squamous cells, pre-exists [1]. Two models have been suggested for the development of vulvar cancer [1]. Type 1 occurs in relatively young women and is associated with warty or basaloid vulvar intra-epithelial neoplasia. According to its definition, type 2 is represented by keratinizing squamous cell carcinoma and mainly presents in post-menopausal women, and its association with HPV infection is quite rare (< 15%). Although smoking and sexually transmitted diseases are considered to be co-factors in type 1 vulvar cancer, there is a low correlation with type 2