Fatal Progression of Vulvar Cancer in Pregnancy: A Case Report on Delayed Intervention
BACKGROUND Vulvar cancer (VC) in pregnancy is a rare case, and its incidence is unknown until now. This case report highlights the rapid progression of disease 3 months after delivery, and our limitation in low resource setting. CASE REPORT A pregnant woman in her early 40's presented with a left vulvar lesion. The lesion was 7×5 cm, with clitoris involvement. No infiltration to adjacent organs was present. Her biopsy showed well-differentiated squamous cell vulva carcinoma. After C-section delivery at 34 weeks of gestation, the diagnosis remained FIGO stage IB (T1b N0 M0). MRI and radical vulvectomy were planned immediately, but due to National Health Insurance limitations the procedure was performed 3 months later. After evaluation 3 months later, the clinical diagnosis had progressed to advanced-stage vulva carcinoma. This case report highlights rapid progression of VC in pregnancy and 3 months after delivery. The possibility of rapid progression of VC during the postpartum period should not be overlooked, and timely treatment of VC in pregnancy is essential to ensure better outcomes. CONCLUSIONS Gynecologists should not overlook the possibility of rapid progression of VC after delivery due to several factors, such as immunologic and physiological changes during the puerperium phase. The operation should be carried out as soon as possible, but could be delayed after delivery, considering inguinal lymphadenectomy is an integral part of frozen section surgical staging.