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National Cancer Institute®
Ultima Vez Modificado: 21 de noviembre del 2001
UI - 21411910
AU - Makar AP; Scheistroen M; van den Weyngaert D; Trope CG
TI - Surgical management of stage I and II vulvar cancer: the role of the sentinel node biopsy. Review of literature.
SO - Int J Gynecol Cancer 2001 Jul-Aug;11(4):255-62
AD - Department Gynecologic Oncology, Middelheim Hospital, Antwerp, Belgium.
Recognition of the psychosexual consequences of radical vulvectomy and better understanding of the lymphatic drainage and histopathologic features of vulvar cancer have led to a more conservative surgical approach, especially in patients with early-stage disease. Every patient with early vulvar cancer should be managed individually and the risk of conservative therapy balanced against the dangers and advantages of more radical therapy. The results of the sentinel node (SN) procedure in early cancer of the vulva are encouraging, and it might be possible in the near future to avoid the morbidity of inguino-femoral lymphadenectomy. This article reviews surgical management of early vulvar cancer and the place of SN biopsy.
UI - 21411920
AU - Kasamatsu T; Hasegawa T; Tsuda H; Okada S; Sawada M; Yamada T;
TI - Tsunematsu R; Ohmi K; Mizuguchi K; Kawana T Primary epithelioid sarcoma of the vulva.
SO - Int J Gynecol Cancer 2001 Jul-Aug;11(4):316-20
AD - Division of Gynecology, National Cancer Center Hospital, Tokyo, Japan.
A case of a 31-year-old woman with epithelioid sarcoma of the vulva which metastasized to the regional lymph node 8 years after onset of the disease is reported here. The patient first noticed a painless subcutaneous mass of 5 mm in diameter in the right labium majus at age of 21. This was excised locally at age 23, but recurred 17 months later. Although local excision was again performed, the tumor recurred and continued to enlarge very slowly. At this stage, based on the pathology of both the initial and second tumors, the diagnosis was of a benign inflammatory process. However, local recurrence and inguinal lymph node swelling occurred at age 29, and biopsy was taken. The pathology report indicated benign granulomatous changes. The slides were reconsidered and re-interpreted as epithelioid sarcoma, whereupon radical vulvectomy was performed at age 31. Vulvar epithelioid sarcoma with inguinal lymph node metastasis was first diagnosed at that time. Epithelioid sarcoma of the vulva is an exceedingly rare tumor, and only 15 cases have been reported thus far in the literature. Early diagnosis and curative treatment of this tumor may be problematic for gynecologists because of its rarity and therefore little-known characteristic clinical behavior and histology. Radical vulvectomy or extensive local excision with inguinal lymphadenectomy at the time of diagnosis is recommended as the treatment of choice.
UI - 21411921
AU - Donnellan R; Moodley M
TI - Vulval myxoid liposarcoma.
SO - Int J Gynecol Cancer 2001 Jul-Aug;11(4):321-2
AD - Department of Pathology, University of Natal Medical School, Durban, South Africa. email@example.com
A 26 year old woman presented with a 4-year history of a gradually enlarging fluctuant mass on the left labium majus. Histologic examination following excision revealed myxoid liposarcoma. Following the diagnosis, further surgery was performed to ensure complete resection. Routine excision of draining lymph nodes is not advocated. Although rare, myxoid liposarcoma should be considered in the differential diagnosis of a vulval soft tissue mass.
UI - 21354745
AU - Bauer G
TI - Lactobacilli-mediated control of vaginal cancer through specific reactive oxygen species interaction.
SO - Med Hypotheses 2001 Aug;57(2):252-7
AD - Abteilung Virologie, Institut fur Medizinische Mikrobiologie und Hygiene, Universitat Freiburg, Germany. firstname.lastname@example.org
Klebanoff et al. proposed that hydrogen peroxide-producing lactobacilli and peroxidase in the vagina of healthy women might be responsible for the prevention of vaginosis and also might exert an antitumor effect (1). Based on recent evidence on superoxide anion generation by transformed cells (2,3) and on the potential of myeloperoxidase for selective apoptosis induction in transformed cells (4), a model for specific reactive oxygen species interaction during lactobacilli-mediated tumor control in the vagina is presented here.We propose that peroxidase, which converts hydrogen peroxide into hypochlorous acid, is responsible for creating a microbicidal vaginal milieu by maintaining a balanced, non-toxic, steady state level of the microbicides H(2)O(2)and HOCI. In case individual superoxide anion-producing transformed cells eventually appear in the mucosa they will be driven into apoptosis by interaction of HOCI with superoxide anions which leads to the generation of hydroxyl radicals. Hence selective apoptosis induction in transformed cells represents the key element of lactobacilli-mediated antitumor defense. Since papilloma virus infected cells are resistant to this pathway of apoptosis induction, they are plausible candidates for circumvention of lactobacilli-mediated control of oncogenesis. Copyright 2001 Harcourt Publishers Ltd.
UI - 21423099
AU - Izquierdo MJ; Pastor MA; Carrasco L; Moreno C; Kutzner H; Sangueza OP;
TI - Requena L Epithelioid blue naevus of the genital mucosa: report of four cases.
SO - Br J Dermatol 2001 Sep;145(3):496-501
AD - Department of Dermatology, Fundacion Jimenez Diaz, Universidad Autonoma, Avda. Reyes Catolicos 2, 28040-Madrid, Spain.
Epithelioid blue naevi are an unusual cytological variant of blue naevus that have been recently described mostly in patients with the Carney complex, although they may also occur in isolation. This variant of blue naevus is composed of melanin-laden polygonal epithelioid melanocytes situated within the dermis. The neoplastic cells show no maturation with progressive depth of dermal infiltration and, in contrast with the usual stromal changes in blue naevi, epithelioid blue naevi exhibit no dermal fibrosis. We describe four cases of epithelioid blue naevus located on the genital mucosa in four patients with no evidence of the Carney complex. Three male patients showed an epithelioid blue naevus on the mucosa of the glans penis and a female patient had a lesion of the right labium minoris. Histopathologically, the lesions consisted of entirely intradermal melanocytic naevi composed mostly of heavily pigmented epithelioid melanocytes involving the dermis of the genital mucosa. Immunohistochemically, in all cases, epithelioid melanocytes expressed immunoreactivity for S-100 protein, HMB-45, Melan-A and MiTF antibodies.
UI - 21439166
AU - Ramirez PT; Levenback C
TI - Sentinel nodes in gynecologic malignancies.
SO - Curr Opin Oncol 2001 Sep;13(5):403-7
AD - Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
The concept of sentinel node identification and lymphatic mapping is already established as part of standard practice in the surgical management of breast cancer and melanoma. To reduce extensive radical procedures and decrease morbidity in gynecologic malignancies, much effort is being focused on implementing less aggressive interventions. By combining the use of radioactive tracers and blue dyes, investigators are identifying sentinel nodes. In vulvar and cervical carcinomas, sentinel node identification may significantly reduce the number of patients undergoing unnecessary, extensive lymphadenectomy in the absence of disease. The addition of novel techniques, such as histopathologic ultrastaging, immunohistochemistry staining, and reverse transcriptase polymerase chain reaction assays, will help increase the accuracy and rate of detection of disease.
UI - 21302148
AU - Meniru GI; Wasdahl D; Onuora CO; Hecht BR; Hopkins MP
TI - Vaginal leiomyoma co-existing with broad ligament and multiple uterine leiomyomas.
SO - Arch Gynecol Obstet 2001 May;265(2):105-7
AD - Department of Obstetrics and Gynecology, Northeastern Ohio Universities College of Medicine, Aultman Hospital, Canton 44710, USA. email@example.com
A 48 year old African American woman presented with bladder pressure leading to the diagnosis of broad ligament and multiple uterine leiomyomas. She was also found to have a lateral vaginal wall mass which was confirmed to be a leiomyoma. Unlike uterine leiomyomas, vaginal leiomyomas are uncommon and are most often found in Caucasian women. Cases of such coexisting tumors are rare and their etiologic relationship is uncertain.
UI - 21302144
AU - Strohmer H; Roehlich M; Hafner E; Maier U
TI - Leiomyoma of the vesicovaginal septum.
SO - Arch Gynecol Obstet 2001 May;265(2):94-5
AD - Department of Obstetrics and Gynaecology, Medical School, University of Vienna, Austria.
A 69-year-old woman presented with a solid homogenous mass in the area of the posterior wall of the urinary bladder. A transvaginal approach was used to remove the mass located in the vesicovaginal septum. Histology revealed a benign smooth spindle cell tumor and immunohistochemistry confirmed leiomyoma.
UI - 21321411
AU - Tochika N; Takeshita A; Sonobe H; Matsumoto M; Kobayashi M; Araki K
TI - Angiomyofibroblastoma of the vulva: report of a case.
SO - Surg Today 2001;31(6):557-9
AD - Department of Surgery, Kochi Medical School, Okocho, Japan.
A 45-year-old woman was first seen by us 2 years after becoming aware of a slightly painful subcutaneous mass in her left vulva. The mass was 7.5 x 3.0 cm in size, well circumscribed, mobile, and rubbery. It was at first clinically considered to be a benign tumor. Microscopically, the resected mass was composed of spindle or polygonal tumor cells which were cellularly or hypocellularly arranged with perivascular accentuation in a mucoid or fibrocollagenous background. Immunohistochemically, myxoid tumor cells were positive for vimentin but not for alpha-smooth muscle actin, CD34, CD31, desmin, or S-100 protein. The tumor was diagnosed as an angiomyofibroblastoma (AMBF), based on the typical findings of histology and immunohistochemistry. There are many histological types of vulvar tumors, and establishing a preoperative diagnosis is difficult in many patients. Rapid intraoperative pathological diagnosis should be performed if possible, considering the possibility of diseases such as AMFB and aggressive angiomyxoma (AAM). When AAM is suspected, the peripheral tissues should also be resected to prevent recurrence.
UI - 21369555
AU - Gonzalez-Peramato P; Jimenez-Heffernan JA; Cuevas J
TI - Fine-needle aspiration cytology of "proximal-type" epithelioid sarcoma.
SO - Diagn Cytopathol 2001 Aug;25(2):122-5
AD - Department of Pathology, University Hospital, Guadalajara, Spain.
The cytologic and immunocytologic findings in a case of recurrent "proximal-type" epithelioid sarcoma (ES) of the vulva are presented. This is a recently described neoplasm that differs clinically and morphologically from conventional ES. Cytologic smears showed a dissociated population of large, atypical neoplastic cells with bi- and multinucleated cells, abundant cytoplasm, and rhabdoid-like morphology. Due to its different clinical management it must be differentiated from metastatic carcinoma and melanoma. From a practical perspective, its differentiation from other epithelial-like sarcomas is less important. In conclusion the cytopathologic findings of "proximal-type" ES show a good correlation with histopathology, permitting the diagnosis of recurrences and metastases. When accompanied by adequate clinical information and ancillary studies, a specific preoperative recognition seems possible. Copyright 2001 Wiley-Liss, Inc.
UI - 21369559
AU - Gatscha RM; Abadi M; Babore S; Chhieng D; Miller MJ; Saigo PE
TI - Smears diagnosed as ASCUS: interobserver variation and follow-up.
SO - Diagn Cytopathol 2001 Aug;25(2):138-40
AD - Department of Cytology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. firstname.lastname@example.org
The purpose of this study was to apply atypical squamous cells of undetermined significance (ASCUS) criteria from the Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses (TBS) to the rescreen of cases previously diagnosed as ASCUS, to compare initial and rescreen diagnoses, and to analyze agreement with follow-up (cytology or histology). Two cytotechnologists (S.B. and M.J.M.) and one cytopathology fellow (M.A.) rescreened 632 cervicovaginal specimens diagnosed as ASCUS between June 1, 1992-December 31, 1995. Age and LMP were provided. Rescreen diagnoses were categorized as within normal limits (WNL), ASCUS, low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), or carcinoma (CA). Complete agreement was found in 200 specimens (32%): 31 (15%) WNL; 91 (45%) ASCUS; 77 (38.5%) SIL; and one (0.50%) CA. Follow-up revealed no abnormality in 67% of the cases reclassified as WNL, 49% of the cases reclassified as ASCUS, and 48% of the cases reclassified as squamous intraepithelial lesions (SIL). SIL was found in 29% of cases reclassified as WNL, 29% of specimens rediagnosed as ASCUS, and 34% of cases reclassified as SIL. Partial agreement was found in 391 specimens (62%). In 41 specimens (6%), rescreeners were in complete disagreement, and follow-up revealed 9/41 (22%) SIL or worse; 21/41 (51%) WNL; and 4/41 (10%) inconclusive. Applying established criteria, 14% (91/632) of cases diagnosed as ASCUS resulted in complete agreement, and 30% (190/632) resulted in partial agreement. Follow-up of cases initially diagnosed as ASCUS revealed SIL or CA in 30% of cases. ASCUS is a significant diagnosis warranting careful patient follow-up. Copyright 2001 Wiley-Liss, Inc.
UI - 21416553
AU - Hayama M; Niitsu N; Tamaru J; Higashihara M
TI - [Primary lymphoma of the vagina]
SO - Rinsho Ketsueki 2001 Jul;42(7):565-70
AD - Department of Hematology and Internal Medicine, Kitasato University School of Medicine.
Primary vaginal non-Hodgkin's lymphomas (NHL) are rare, and are clinically difficult to differentiate from inflammatory diseases or vaginal cancer. Here, we present such a case in a 74-year-old woman complaining of fever and difficulty with urination. Pelvic examination revealed a tumor involving most of the vaginal wall, and pelvic MRI demonstrated vaginal wall thickening. A biopsy of this lesion confirmed NHL (diffuse large B-cell lymphoma), and the patient was admitted. Abdominal CT and MRI detected a vaginal tumor, and Ga scintigraphy confirmed accumulation in the pelvis, but no abnormalities were seen in other areas. Therefore, the patient was diagnosed as having NHL at clinical stage IB with low-intermediate risk (international prognosis index) (LDH 1,309 IU/L). The patient underwent three courses of CHOP therapy followed by radiotherapy, and complete remission was achieved. Primary vaginal NHL often affects women younger than 50 years of age, and abnormal hemorrhage is the initial symptom in many cases. There have been a number of reports of long-term survival following appropriate early chemotherapy and radiation therapy, suggesting that early diagnosis and treatment based on vaginal biopsy findings greatly influence the prognosis.
UI - 21485116
AU - Shamini N; Tay EH; Ho TH
TI - Vulvar cancer--what do we know about our patients?
SO - Singapore Med J 2001 Jul;42(7):292-6
AD - Gynaecological Oncology Unit, KK Women's and Children's Hospital, Singapore. email@example.com
INTRODUCTION: Vulvar cancer is uncommon in Singapore and to date there have been no local reports on this rare cancer. This is a descriptive study that aims to evaluate our patients' profiles, their management and 1998, there were 35 patients with vulvar cancer treated at KK Women's and Children's Hospital. The case records of these patients were reviewed. Survival was calculated using the Kaplan-Meier method. RESULTS: The modal age at diagnosis was 74.0 years (range 17.0-89.0 years). Chinese patients accounted for 88% of the study group, Malays for 6%, Indians for 3% and other races made up 3% of the study group. The most common presenting symptom was an ulcer or lump (83.8%). Squamous cell carcinoma was the most common histological type (80.0%). Vulvar intraepithelial neoplasia III was found in 20% of the cases. There were five patients with other lower genital tract malignancies. Surgery was the most common treatment modality and wound breakdown was the most common complication. The overall five year survival was 75.9%. For stage 1&2 disease, the five year survival was 90.0%. For stage 3&4 disease, the five year survival was 26.0%. CONCLUSION: The rarity of vulvar cancer makes it best treated in a tertiary centre. There is a definite survival advantage in early diagnosis and treatment of vulvar cancer. Lymph node surgery was associated with a longer operating time and a higher chance of wound breakdown.
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