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BioMed Research International
Volume 2014, Article ID 480573, 11 pages
http://dx.doi.org/10.1155/2014/480573
Review Article

A Clinical and Pathological Overview of Vulvar Condyloma Acuminatum, Intraepithelial Neoplasia, and Squamous Cell Carcinoma

1Department of Pathology, University Hospital of Liège, 4000 Liège, Belgium
2Department of Gynecology, University Hospital of Liège, 4000 Liège, Belgium
3Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, 4000 Liège, Belgium

Received 15 November 2013; Accepted 15 January 2014; Published 25 February 2014

Academic Editor: Gérald E. Piérard

Copyright © 2014 Boris Léonard et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. R. J. Kurman, L. H. Ellenson, and B. M. Ronnett, Blaustein's Pathology of the Female Genital Tract, Springer, New York, NY, USA, 6th edition, 2011. View at Publisher · View at Google Scholar
  2. H. Johansson, D. Bzhalava, J. Ekström, E. Hultin, J. Dillner, and O. Forslund, “Metagenomic sequencing of “HPV-negative” condylomas detects novel putative HPV types,” Virology, vol. 440, no. 1, pp. 1–7, 2013. View at Publisher · View at Google Scholar
  3. S. Cremin, J. F. Menton, L. Canier, M. Horgan, and L. J. Fanning, “The prevalence and genotype of human papillomavirus on cervical samples from an Irish female population with external genital warts,” Human Vaccin & Immunotherapeutics, vol. 8, no. 7, pp. 916–920, 2012. View at Publisher · View at Google Scholar
  4. M. R. Nucci and E. Oliva, in Gynecologic Pathology: A Volume in Foundation in Diagnostic Pathology Series, Churchill Livingstone, New York, NY, USA, 2009.
  5. F. A. Tavassoli and P. Devillée, World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Breast and Female Genital Organs, IARC Press, Lyon, France, 2003.
  6. J. A. Carlson, R. Ambros, J. Malfetano et al., “Vulvar lichen sclerosus and squamous cell carcinoma: a cohort, case control, and investigational study with historical perspective; implications for chronic inflammation and sclerosis in the development of neoplasia,” Human Pathology, vol. 29, no. 9, pp. 932–948, 1998. View at Publisher · View at Google Scholar · View at Scopus
  7. S. R. Sturgeon, L. A. Brinton, S. S. Devesa, and R. J. Kurman, “In situ and invasive vulvar cancer incidence trends (1973 to 1987),” American Journal of Obstetrics & Gynecology, vol. 166, no. 5, pp. 1482–1485, 1992. View at Publisher · View at Google Scholar · View at Scopus
  8. T. J. Colgan, “Vulvar intraepithelial neoplasia: a synopsis of recent developments,” Journal of Lower Genital Tract Disease, vol. 2, no. 1, pp. 31–36, 1998. View at Google Scholar · View at Scopus
  9. M. Preti, M. van Seters, M. Sideri, and M. van Beurden, “Squamous vulvar intraepithelial neoplasia,” Clinical Obstetrics and Gynecology, vol. 48, no. 4, pp. 845–861, 2005. View at Publisher · View at Google Scholar · View at Scopus
  10. American Cancer Society, “Vulvar cancer. State of vulvar cancer,” in Cancer Facts & Figures 2008, American Cancer Society, Atlanta, Ga, USA, 2008. View at Google Scholar
  11. H. P. van de Nieuwenhof, L. F. A. G. Massuger, I. A. M. van der Avoort et al., “Vulvar squamous cell carcinoma development after diagnosis of VIN increases with age,” European Journal of Cancer, vol. 45, no. 5, pp. 851–856, 2009. View at Publisher · View at Google Scholar · View at Scopus
  12. M. Saraiya, M. Watson, X. Wu et al., “Incidence of in situ and invasive vulvar cancer in the US, 1998–2003,” Cancer, vol. 113, supplement 10, pp. 2865–2872, 2008. View at Publisher · View at Google Scholar · View at Scopus
  13. H. Schöfer, A. van Ophoven, U. Henke, T. Lenz, and A. Eul, “Randomized, comparative trial on the sustained efficacy of topical imiquimod 5% cream versus conventional ablative methods in external anogenital warts,” European Journal of Dermatology, vol. 16, no. 6, pp. 642–648, 2006. View at Publisher · View at Google Scholar · View at Scopus
  14. R. J. Kurman, H. J. Norris, and E. J. Wilkinson, “Tumors of the cervix, vagina and vulva,” in Atlas of Tumor Pathology, Fascicle 3, Armed Forces Institute of Pathology, Washington, DC, USA, 1992. View at Google Scholar
  15. A. Al-Ghamdi, D. Freedman, D. Miller et al., “Vulvar squamous cell carcinoma in young women: a clinicopathologic study of 21 cases,” Gynecologic Oncology, vol. 84, no. 1, pp. 94–101, 2002. View at Publisher · View at Google Scholar · View at Scopus
  16. R. Rabah and D. Farmer, “Squamous cell carcinoma of the vulva in a child,” Journal of Lower Genital Tract Disease, vol. 3, no. 3, pp. 204–206, 1999. View at Google Scholar · View at Scopus
  17. D. R. Brown, J. T. Bryan, H. Cramer, and K. H. Fife, “Analysis of human papillomavirus types in exophytic condylomata acuminata by hybrid capture and Southern blot techniques,” Journal of Clinical Microbiology, vol. 31, no. 10, pp. 2667–2673, 1993. View at Google Scholar · View at Scopus
  18. W.-Y. Zhu, C. Leonardi, and N. S. Penneys, “Detection of human papillomavirus DNA in seborrheic keratosis by polymerase chain reaction,” Journal of Dermatological Science, vol. 4, no. 3, pp. 166–171, 1992. View at Publisher · View at Google Scholar · View at Scopus
  19. K. R. Beutner, M. A. Conant, A. E. Friedman-Kien et al., “Patient-applied podofilox for treatment of genital warts,” The Lancet, vol. 333, no. 8642, pp. 831–834, 1989. View at Publisher · View at Google Scholar · View at Scopus
  20. P. Kirby, A. Dunne, D. H. King, and L. Corey, “Double-blind randomized clinical trial of self-administered podofilox solution versus vehicle in the treatment of genital warts,” The American Journal of Medicine, vol. 88, no. 5, pp. 465–470, 1990. View at Publisher · View at Google Scholar · View at Scopus
  21. C. J. N. Lacey, R. L. Goodall, G. Ragnarson Tennvall et al., “Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts,” Sexually Transmitted Infections, vol. 79, no. 4, pp. 270–275, 2003. View at Publisher · View at Google Scholar · View at Scopus
  22. P. Komericki, M. Akkilic-Materna, T. Strimitzer, and W. Aberer, “Efficacy and safety of imiquimod versus podophyllotoxin in the treatment of anogenital warts,” Sexually Transmitted Diseases, vol. 38, no. 3, pp. 216–218, 2011. View at Publisher · View at Google Scholar · View at Scopus
  23. O. Arican, F. Guneri, K. Bilgic, and A. Karaoglu, “Topical imiquimod 5% cream in external anogenital warts: a randomized, double-blind, placebo-controlled study,” The Journal of Dermatology, vol. 31, no. 8, pp. 627–631, 2004. View at Google Scholar · View at Scopus
  24. S. M. Meltzer, B. J. Monk, and K. S. Tewari, “Green tea catechins for treatment of external genital warts,” American Journal of Obstetrics & Gynecology, vol. 200, no. 3, pp. 233.e1–233.e7, 2009. View at Publisher · View at Google Scholar · View at Scopus
  25. G. Gross, K.-G. Meyer, H. Pres, C. Thielert, H. Tawfik, and A. Mescheder, “A randomized, double-blind, four-arm parallel-group, placebo-controlled Phase II/III study to investigate the clinical efficacy of two galenic formulations of Polyphenon E in the treatment of external genital warts,” Journal of the European Academy of Dermatology and Venereology, vol. 21, no. 10, pp. 1404–1412, 2007. View at Publisher · View at Google Scholar · View at Scopus
  26. S. Tatti, E. Stockfleth, K. R. Beutner et al., “Polyphenon E: a new treatment for external anogenital warts,” British Journal of Dermatology, vol. 162, no. 1, pp. 176–184, 2010. View at Publisher · View at Google Scholar · View at Scopus
  27. V. R. Yanofsky, R. V. Patel, and G. Goldenberg, “Genital warts: a comprehensive review,” The Journal of Clinical and Aesthetic Dermatology, vol. 5, no. 6, pp. 25–36, 2012. View at Google Scholar
  28. J. Sherrard and L. Riddell, “Comparison of the effectiveness of commonly used clinic-based treatments for external genital warts,” International Journal of STD & AIDS, vol. 18, no. 6, pp. 365–368, 2007. View at Publisher · View at Google Scholar · View at Scopus
  29. R. J. C. Gilson, J. Ross, R. Maw, D. Rowen, C. Sonnex, and C. J. N. Lacey, “A multicentre, randomised, double-blind, placebo controlled study of cryotherapy versus cryotherapy and podophyllotoxin cream as treatment for external anogenital warts,” Sexually Transmitted Infections, vol. 85, no. 7, pp. 514–519, 2009. View at Publisher · View at Google Scholar · View at Scopus
  30. C. J. N. Lacey, “Therapy for genital human papillomavirus-related disease,” Journal of Clinical Virology, vol. 32, supplement, pp. 82–90, 2005. View at Publisher · View at Google Scholar · View at Scopus
  31. S. L. Jensen, “Comparison of podophyllin application with simple surgical excision in clearance and recurrence of perianal condylomata acuminata,” The Lancet, vol. 2, no. 8465, pp. 1146–1148, 1985. View at Google Scholar · View at Scopus
  32. H. T. Khawaja, “Treatment of condyloma acuminatum,” The Lancet, vol. 1, no. 8474, pp. 208–209, 1986. View at Google Scholar · View at Scopus
  33. C. J. Lacey and G. P. Garnett, “Promising control of genital warts: but is elimination possible?” The Lancet Infectious Diseases, vol. 11, no. 1, pp. 4–6, 2011. View at Publisher · View at Google Scholar · View at Scopus
  34. J. Dillner, S. K. Kjaer, C. M. Wheeler et al., “Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial,” The British Medical Journal, vol. 341, article c3493, 2010. View at Publisher · View at Google Scholar · View at Scopus
  35. B. Donovan, N. Franklin, R. Guy et al., “Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data,” The Lancet Infectious Diseases, vol. 11, no. 1, pp. 39–44, 2011. View at Publisher · View at Google Scholar · View at Scopus
  36. M. van Beurden, F. J. ten Kate, H. L. Smits et al., “Multifocal vulvar intraepithelial neoplasia grade III and multicentric lower genital tract neoplasia is associated with transcriptionally active human papillomavirus,” Cancer, vol. 75, no. 12, pp. 2879–2884, 1995. View at Google Scholar
  37. M. Preti, M. van Seters, M. Sideri, and M. van Beurden, “Squamous vulvar intraepithelial neoplasia,” Clinical Obstetrics and Gynecology, vol. 48, no. 4, pp. 845–861, 2005. View at Publisher · View at Google Scholar · View at Scopus
  38. R. W. Jones and D. M. Rowan, “Vulvar intraepithelial neoplasia III: a clinical study of the outcome in 113 cases with relation to the later development of invasive vulvar carcinoma,” Obstetrics & Gynecology, vol. 84, no. 5, pp. 741–745, 1994. View at Google Scholar · View at Scopus
  39. I. A. M. van der Avoort, H. Shirango, B. M. Hoevenaars et al., “Vulvar squamous cell carcinoma is a multifactorial disease following two separate and independent pathways,” International Journal of Gynecological Pathology, vol. 25, no. 1, pp. 22–29, 2006. View at Publisher · View at Google Scholar · View at Scopus
  40. IARC, Human Papillomavirus, IARC, Lyon, France, 2007.
  41. M. Schiffman, P. E. Castle, J. Jeronimo, A. C. Rodriguez, and S. Wacholder, “Human papillomavirus and cervical cancer,” The Lancet, vol. 370, no. 9590, pp. 890–907, 2007. View at Publisher · View at Google Scholar · View at Scopus
  42. B. Yang and W. R. Hart, “Vulvar intraepithelial neoplasia of the simplex (differentiated) type: a clinicopathologic study including analysis of HPV and p53 expression,” The American Journal of Surgical Pathology, vol. 24, no. 3, pp. 429–441, 2000. View at Publisher · View at Google Scholar · View at Scopus
  43. M. Choschzick, W. Hantaredja, P. Tennstedt, F. Gieseking, L. Wölber, and R. Simon, “Role of TP53 mutations in vulvar carcinomas,” International Journal of Gynecological Pathology, vol. 30, no. 5, pp. 497–504, 2011. View at Publisher · View at Google Scholar · View at Scopus
  44. A. H. Holway, K. M. Rieger-Christ, W. R. Miner et al., “Somatic mutation of PTEN in vulvar cancer,” Clinical Cancer Research, vol. 6, no. 8, pp. 3228–3235, 2000. View at Google Scholar · View at Scopus
  45. D. Guerrero, R. Guarch, A. Ojer et al., “Differential hypermethylation of genes in vulvar cancer and lichen sclerosus coexisting or not with vulvar cancer,” International Journal of Cancer, vol. 128, no. 12, pp. 2853–2864, 2011. View at Publisher · View at Google Scholar · View at Scopus
  46. F. B. Lillo, “Human papillomavirus infection and its role in the genesis of dysplastic and neoplastic lesions of the squamous epithelia,” The New Microbiologica, vol. 28, no. 2, pp. 111–118, 2005. View at Google Scholar · View at Scopus
  47. W. R. Hart, “Vulvar intraepithelial neoplasia: historical aspects and current status,” International Journal of Gynecological Pathology, vol. 20, no. 1, pp. 16–30, 2001. View at Google Scholar · View at Scopus
  48. R. R. Raju, J. R. Goldblum, and W. R. Hart, “Pagetoid squamous cell carcinoma in situ (Pagetoid Bowen's disease) of the external genitalia,” International Journal of Gynecological Pathology, vol. 22, no. 2, pp. 127–135, 2003. View at Publisher · View at Google Scholar · View at Scopus
  49. M. Sideri, R. W. Jones, E. J. Wilkinson et al., “Squamous vulvar intraepithelial neoplasia: 2004 modified terminology, ISSVD vulvar oncology subcommittee,” The Journal of Reproductive Medicine, vol. 50, no. 11, pp. 807–810, 2005. View at Google Scholar · View at Scopus
  50. M. Santos, S. Landolfi, A. Olivella et al., “P16 overexpression identifies HPV-positive vulvar squamous cell carcinomas,” The American Journal of Surgical Pathology, vol. 30, no. 11, pp. 1347–1356, 2006. View at Publisher · View at Google Scholar · View at Scopus
  51. M. Santos, C. Montagut, B. Mellado et al., “Immunohistochemical staining for p16 and p53 in premalignant and malignant epithelial lesions of the vulva,” International Journal of Gynecological Pathology, vol. 23, no. 3, pp. 206–214, 2004. View at Publisher · View at Google Scholar · View at Scopus
  52. B. M. Hoevenaars, I. A. M. van der Avoort, P. C. M. de Wilde et al., “A panel of p16INK4A, MIB1 and p53 proteins can distinguish between the 2 pathways leading to vulvar squamous cell carcinoma,” International Journal of Cancer, vol. 123, no. 12, pp. 2767–2773, 2008. View at Publisher · View at Google Scholar · View at Scopus
  53. P. Hillemanns, X. Wang, S. Staehle, W. Michels, and C. Dannecker, “Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO2 laser vaporization, photodynamic therapy, excision and vulvectomy,” Gynecologic Oncology, vol. 100, no. 2, pp. 271–275, 2005. View at Publisher · View at Google Scholar
  54. M. van Seters, M. van Beurden, and A. J. de Craen, “Is the assumed natural history of vulvar intraepithelial neoplasia III based on enough evidence? A systematic review of 3322 published patients,” Gynecologic Oncology, vol. 97, no. 2, pp. 645–651, 2005. View at Google Scholar
  55. A. Terlou, M. van Seters, P. C. Ewing et al., “Treatment of vulvar intraepithelial neoplasia with topical imiquimod: seven years median follow-up of randomized clinical trial,” Gynecologic Oncology, vol. 121, no. 1, pp. 157–162, 2011. View at Publisher · View at Google Scholar
  56. E. A. Joura, S. Leodolter, M. Hernandez-Avila et al., “Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials,” The Lancet, vol. 369, no. 9574, pp. 1693–1702, 2007. View at Publisher · View at Google Scholar
  57. J. W. Gargano, E. J. Wilkinson, E. R. Unger et al., “Prevalence of human papillomavirus types in invasive vulvar cancers and vulvar intraepithelial neoplasia 3 in the United States before vaccine introduction,” Journal of Lower Genital Tract Disease, vol. 16, no. 4, pp. 471–479, 2012. View at Publisher · View at Google Scholar
  58. R. J. Kurman, T. Toki, and M. H. Schiffman, “Basaloid and warty carcinomas of the vulva: distinctive types of squamous cell carcinoma frequently associated with human papillomaviruses,” The American Journal of Surgical Pathology, vol. 17, no. 2, pp. 133–145, 1993. View at Publisher · View at Google Scholar · View at Scopus
  59. G. O. Downey, T. Okagaki, R. S. Ostrow, B. A. Clark, L. B. Twiggs, and A. J. Faras, “Condylomatous carcinoma of the vulva with special reference to human papillomavirus DNA,” Obstetrics & Gynecology, vol. 72, no. 1, pp. 68–73, 1988. View at Google Scholar · View at Scopus
  60. T. Toki, R. J. Kurman, J. S. Park, T. Kessis, R. W. Daniel, and K. V. Shah, “Probable nonpapillomavirus etiology of squamous cell carcinoma of the vulva in older women: a clinicopathologic study using in situ hybridization and polymerase chain reaction,” International Journal of Gynecological Pathology, vol. 10, no. 2, pp. 107–125, 1991. View at Google Scholar · View at Scopus
  61. A. Kondi-Paphitis, H. Deligeorgi-Politi, A. Liapis, and M. Plemenou-Frangou, “Human papilloma virus in verrucus carcinoma of the vulva: an immunopathological study of three cases,” European Journal of Gynaecological Oncology, vol. 19, no. 3, pp. 319–320, 1998. View at Google Scholar · View at Scopus
  62. H. Japaze, T. V. Dinh, and J. D. Woodruff, “Verrucous carcinoma of the vulva: study of 24 cases,” Obstetrics & Gynecology, vol. 60, no. 4, pp. 462–466, 1982. View at Google Scholar · View at Scopus
  63. B. Andreasson, J. E. Bock, K. V. Strom, and J. Visfeldt, “Verrucous carcinoma of the vulval region,” Acta Obstetricia et Gynecologica Scandinavica, vol. 62, no. 2, pp. 183–186, 1983. View at Google Scholar · View at Scopus
  64. M. Brisigotti, A. Moreno, C. Murcia, X. Matias-Guiu, and J. Prat, “Verrucous carcinoma of the vulva. A clinicopathologic and immunohistochemical study of five cases,” International Journal of Gynecological Pathology, vol. 8, no. 1, pp. 1–7, 1989. View at Google Scholar · View at Scopus
  65. M. del Pino, M. C. Bleeker, W. G. Quint, P. J. Snijders, C. J. Meijer, and R. D. Steenbergen, “Comprehensive analysis of human papillomavirus prevalence and the potential role of low-risk types in verrucous carcinoma,” Modern Pathology, vol. 25, pp. 1354–1363, 2012. View at Publisher · View at Google Scholar
  66. American Joint Committee on Cancer, “AJCC cancer staging handbook,” in AJCC Cancer Staging Manual, pp. 463–467, Springer, New York, NY, USA, 7th edition, 2010. View at Google Scholar
  67. H. D. Homesley, B. N. Bundy, A. Sedlis et al., “Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (a Gynecologic Oncology Group study),” American Journal of Obstetrics & Gynecology, vol. 164, no. 4, pp. 997–1004, 1991. View at Google Scholar · View at Scopus
  68. N. Husseinzadeh, R. Zaino, W. A. Nahhas, and R. Mortel, “The significance of histologic findings in predicting nodal metastases in invasive squamous cell carcinoma of the vulva,” Gynecologic Oncology, vol. 16, no. 1, pp. 105–111, 1983. View at Google Scholar · View at Scopus
  69. A. Sedlis, H. Homesley, and B. N. Bundy, “Positive groin lymph nodes in superficial squamous cell vulvar cancer. A Gynecologic Oncology Group study,” American Journal of Obstetrics & Gynecology, vol. 156, no. 5, pp. 1159–1164, 1987. View at Google Scholar · View at Scopus
  70. S. Riethdorf, E. F. Neffen, A. Cviko, T. Löning, C. P. Crum, and L. Riethdorf, “P16INK4A expression as biomarker for HPV 16-related vulvar neoplasias,” Human Pathology, vol. 35, no. 12, pp. 1477–1483, 2004. View at Publisher · View at Google Scholar · View at Scopus
  71. I. Rufforny, E. J. Wilkinson, C. Liu, H. Zhu, M. Buteral, and N. A. Massoll, “Human papillomavirus infection and p16INK4a protein expression in vulvar intraepithelial neoplasia and invasive squamous cell carcinoma,” Journal of Lower Genital Tract Disease, vol. 9, no. 2, pp. 108–113, 2005. View at Publisher · View at Google Scholar · View at Scopus
  72. I. Alonso, V. Fusté, M. del Pino et al., “Does human papillomavirus infection imply a different prognosis in vulvar squamous cell carcinoma?” Gynecologic Oncology, vol. 122, no. 3, pp. 509–514, 2011. View at Publisher · View at Google Scholar · View at Scopus
  73. C. Bergeron, J. Ordi, D. Schmidt, M. J. Trunk, T. Keller, and R. Ridder, “Conjunctive p16INK4a testing significantly increases accuracy in diagnosing high-grade cervical intraepithelial neoplasia,” American Journal of Clinical Pathology, vol. 133, no. 3, pp. 395–406, 2010. View at Publisher · View at Google Scholar · View at Scopus
  74. S. Pecorelli, “Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium,” International Journal of Gynaecology & Obstetrics, vol. 105, no. 2, pp. 103–104, 2009. View at Google Scholar · View at Scopus
  75. J. K. Chan, V. Sugiyama, H. Pham et al., “Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis,” Gynecologic Oncology, vol. 104, no. 3, pp. 636–641, 2007. View at Publisher · View at Google Scholar · View at Scopus
  76. F. Hinten, L. C. G. van den Einden, J. C. M. Hendriks et al., “Risk factors for short-and long-term complications after groin surgery in vulvar cancer,” British Journal of Cancer, vol. 105, no. 9, pp. 1279–1287, 2011. View at Publisher · View at Google Scholar · View at Scopus
  77. M. H. M. Oonk, H. P. van de Nieuwenhof, A. G. J. van der Zee, and J. A. de Hullu, “Update on the sentinel lymph node procedure in vulvar cancer,” Expert Review of Anticancer Therapy, vol. 10, no. 1, pp. 61–69, 2010. View at Publisher · View at Google Scholar · View at Scopus
  78. R. Rouzier, B. Haddad, G. Dubernard, P. Dubois, and B.-J. Paniel, “Inguinofemoral dissection for carcinoma of the vulva: effect of modifications of extent and technique on morbidity and survival,” Journal of the American College of Surgeons, vol. 196, no. 3, pp. 442–450, 2003. View at Publisher · View at Google Scholar · View at Scopus
  79. M. H. Oonk, J. A. de Hullu, and A. G. J. van der Zee, “Current controversies in the management of patients with early-stage vulvar cancer,” Current Opinion in Oncology, vol. 22, no. 5, pp. 481–486, 2010. View at Publisher · View at Google Scholar · View at Scopus
  80. J. A. de Hullu and A. G. J. van der Zee, “Surgery and radiotherapy in vulvar cancer,” Critical Reviews in Oncology/Hematology, vol. 60, no. 1, pp. 38–58, 2006. View at Publisher · View at Google Scholar · View at Scopus