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National Cancer Institute®
Ultima Vez Modificado: 1 de enero del 2002
UI - 11396633
AU - Carlson JA; Amin S; Malfetano J; Tien AT; Selkin B; Hou J; Goncharuk V;
TI - Wilson VL; Rohwedder A; Ambros R; Ross JS Concordant p53 and mdm-2 protein expression in vulvar squamous cell carcinoma and adjacent lichen sclerosus.
SO - Appl Immunohistochem Mol Morphol 2001 Jun;9(2):150-63
AD - Department of Pathology, Albany Medical College, New York 12208, USA. CarlsoA@mail.amc.edu
To determine if carcinogenic events in vulvar skin precede the onset of morphologic atypia, the authors investigated for derangements in DNA content, cell proliferation, and cell death in vulvar carcinomas and surrounding skin in 140 samples of tumor and surrounding skin collected from 35 consecutive vulvectomy specimen for squamous cell carcinoma (SCC) or vulvar intraepithelial neoplasia (VIN) 3. Vulvar non-cancer excisions were used as controls. Investigations consisted of histologic classification and measurement of 9 variables--epidermal thickness (acanthosis and rete ridge length), immunolabeling index (LI) for 3 proteins (p53 protein, Ki-67, and mdm-2), pattern of p53 expression (dispersed vs. compact), DNA content index, and presence of aneuploidy by image analysis and apoptotic rate by Apotag labeling. Significant positive correlations were found for all nine variables studied versus increasing histologic severity in two proposed histologic stepwise models of vulvar carcinogenesis (lichen sclerosus (LS) and VIN 3 undifferentiated associated SCC groups). High p53 LI (>25) and the compact pattern of p53 expression (suspected oncoprotein) significantly correlated with LS and its associated vulvar samples compared with samples not associated with LS (P < or = 0.001). Furthermore, p53 LI, mdm-2 LI, and pattern of p53 expression were concordant between patient matched samples of LS and SCC. In addition, mdm-2 LI significantly correlated with dispersed pattern p53 LI suggesting a response to wild-type p53 protein accumulation. These findings support the hypothesis that neoplastic transformation occurs in sequential steps and compromises proteins involved in the cell cycle control. Concordance of p53 and mdm-2 protein expression in LS and adjacent SCC provides evidence that LS can act as a precursor lesion in the absence of morphologic atypia. Overexpression of mdm-2 with stabilization and inactivation of p53 protein may provide an alternate pathway for vulvar carcinogenesis.
UI - 11441690
AU - Losch A; Joura EA; Stani J; Breitenecker G; Lahodny J
TI - Leiomyosarcoma of the vulva. A case report.
SO - J Reprod Med 2001 Jun;46(6):609-12
AD - Department of Gynecology and Obstetrics, St. Polten Hospital, St. Polten, Austria.
BACKGROUND: Leiomyosarcoma of the vulva is a rare mesenchymal tumor. Biologic features of a low grade tumor were investigated by an immunohistochemical workup. CASE: A 38-year-old woman presented with a slowly growing vulvar mass. Surgical treatment was performed, and a low grade leiomyosarcoma of the vulva was diagnosed. Immunohistochemical reactions were performed with monoclonal antibodies against desmin, vimentin, smooth muscle actin, cytokeratin, S-100 protein, estrogen, progesterone and androgen receptor, p53 protein, Ki-67 antigen, leukocyte common antigen and polyclonal antibodies to factor VIII-related antigen. Expression of estrogen, progesterone and androgen receptor was present in addition to a moderate number of Ki-67-positive cells and absence of p53 protein overexpression and lymphatic cell infiltration besides adequate microvessel density for smooth muscle tumors. Since the immunohistochemical markers indicated a less aggressive tumor, any further adjuvant therapy was rejected. The patient was without recurrence 24 months later. CONCLUSION: The immunohistologic profile proved the low histologic grade of vulvar leiomyosarcoma. The findings helped to estimate prognosis and plan therapy.
UI - 11444204
AU - Papiez JS; Hassenein A; Wilkinson E; Meynen CA
TI - Recurrent atypical myxoid fibroepithelial polyp associated with vulvar Crohn's disease.
SO - Int J Gynecol Pathol 2001 Jul;20(3):271-6
AD - Department of Pathology, University of Florida, College of Medicine, 1600 S.W. Archer Road, Gainesville, FL 32610, USA.
Fibroepithelial polyps of the lower female genital tract are common lesions that can rarely exhibit atypical features including increased and atypical mitoses, bizarre nuclei, and hypercellularity, a combination of findings that may suggest malignancy. Five recurrent cases have been published to date, two of which were in pregnant females; the other three followed incomplete excisions. Our case is that of a 25-year-old female with Crohn's disease who developed multiple recurrences of polypoid and domed lesions of the labium minus following surgical excision. Histologic findings in the initial and recurrent lesions were consistent with atypical myxoid fibroepithelial polyps with underlying vulvar Crohn's disease. The lesions subsequently improved with standard Crohn's treatment including 5-amino-salicylic acid (Pentasa) and prednisone. The present case represents the only example of this entity associated with Crohn's disease, and it is the only reported recurrent case not associated with pregnancy, tamoxifen administration, or positive excision margins. The clinical, microscopic, and immunohistochemical findings of this case suggest that atypical fibroepithelial polyps of the lower female genital tract, cutaneous pleomorphic fibroma, and lesions such as fibroepithelial polyps of the anus may represent variants of the same atypical reparative process.
UI - 11447997
AU - Castro CY; Deavers M
TI - Ductal carcinoma in-situ arising in mammary-like glands of the vulva.
SO - Int J Gynecol Pathol 2001 Jul;20(3):277-83
AD - Department of Pathology (KB 728), University of Alabama at Birmingham, 619 19th Street South, Birmingham, Alabama 35249-7331, USA.
Recently a variant of cutaneous glands has been recognized in the anogenital region that combines the morphologic and immunohistochemical features of eccrine, apocrine, and mammary glands, so-called 'mammary-like glands of the vulva'. Carcinoma arising in mammary-like tissue of the vulva is a rare occurrence. So far, there have been 11 cases of primary, mammary-type invasive carcinoma and one case of in-situ carcinoma reported in the vulva. We describe an unusual case of ductal carcinoma in-situ without invasion arising in mammary-like glands of the vulva. A 57-year old woman presented with a 1-year history of a 1 cm nodule in the right labium majus. Excision showed ductal carcinoma in-situ with cribriform and papillary morphology in an adenosis-like lesion associated with mammary-like glands. No invasion into the stroma was identified. Immunostains were positive for gross cystic disease fluid protein 15 (GCDFP-15) and estrogen and progesterone receptors. An extensive survey including bilateral mammograms was negative. One year postoperatively, the patient shows no evidence of disease. To our knowledge, this represents the second case of DCIS associated with mammary-like glands of the vulva reported in the English literature.
UI - 11446471
AU - Ben-Hur H; Ashkenazi M; Huszar M; Gurevich P; Zusman I
TI - Lymphoid elements and apoptosis-related proteins (Fas, Fas ligand, p53 and bcl-2) in lichen sclerosus and carcinoma of the vulva.
SO - Eur J Gynaecol Oncol 2001;22(2):104-9
AD - Department of Gynecology and Obstetrics, Kaplan Medical Center, Rehovot, Israel.
We studied some of the morphological and immunohistochemical parameters of lichen sclerosus (LS) and carcinomas of the vulva in order to verify some characteristics in LS related to neoplasm transformation. Parameters such as proliferating index, rate of proliferation of lymphoid elements into a tumor and types of such elements were studied. In parallel, the number of cells positive to apoptosis-related proteins such as Fas, Fas ligand, p53 and bcl-2 were evaluated. Biopsy material from patients with different vulvar disorders--22 samples with LS and 23 samples with vulvar squamous cell carcinoma (VSCC)--was studied by the methods of morphometry and immunohistochemistry. In LS, the number of T cells is a few times higher than those of B cells. Among the T cells, the number of killers is significantly higher than the number of helpers. Carcinomas, especially those with lymphoid depletion, are characterized by a further significant increase in some parameters such as the rate of lymphoid proliferation and the number of T helpers and killers. The progression in to tumorigenesis was accompanied with a significant increase in the number of Fas+ and FasL+ lymphocytes. In tumor epithelial cells the proliferative index increased in carcinomas with lymphoid depletion. The number of p53+ epithelial cells increased whereas the number of bcl-2+ cells showed a distinct tendency to decrease with progression in to tumorigenesis. Development of a tumor is manifested in deep changes in relationships between different lymphoid components. Only two lymphoid markers are significantly different in VSCC compared to LS: the number of T killers and macrophages. The other parameters studied (rate of proliferative activity, the total number of T cells and T helpers, B cells, IL-2-connective cells) already showed high expression in LS as the first signs of transformation of this inflammation into neoplasia.
UI - 11446481
AU - Porzio G; Ficorella C; Calvisi G; Paris I; Ricevuto E; Marchetti P
TI - Ductal breast carcinoma metastatic to the vulva: a case report.
SO - Eur J Gynaecol Oncol 2001;22(2):147-8
AD - Medical Oncology Unit, University of L'Aquila, Italy.
UI - 11503927
AU - Torreggiani W; Zwirewich C; Lyburn I; Harris A; Davis JE; Wilkie D;
TI - Fenster H; Marchinkow L Translabial sonography of vaginal fibroids: report of 2 cases and review of the literature.
SO - J Ultrasound Med 2001 Aug;20(8):909-13
AD - Department of Radiology, Vancouver General Hospital, British Columbia, Canada.
OBJECTIVE: To determine the role of translabial sonography in the diagnosis of vaginal fibroids. METHODS: Two women with vaginal masses of undetermined origin were examined by various imaging procedures, including translabial sonography. RESULTS: Initial examinations, which included transabdominal sonography, cystoscopy, and cystourethrography, yielded inconclusive findings. Translabial sonography, however, suggested isolated vaginal leiomyomas in both patients, and in both the diagnosis was confirmed histologically after surgery. CONCLUSIONS: Translabial sonography should be considered as an adjunct to transabdominal and transvaginal sonography for patients with suspected vaginal fibroids.
UI - 11501774
AU - Krasevic M; Haller H; Iternicka Z; Valstelic I; Matejcic N
TI - Adenoid cystic carcinoma of Bartholin's gland: a case report.
SO - Eur J Gynaecol Oncol 2001;22(3):213-4
AD - Department of Pathology, University of Rijeka, Croatia.
OBJECTIVE: A case of adenoid cystic carcinoma (ACC) of the Bartholin's gland in a 34-year-old woman with unusual presentation and early recurrence is reported. METHODS: Clinical and histologie features were recorded. Immunohistochemical stains and cell-cycle analysis by flow cytometry technique on paraffin-embedded tumor tissue were performed. RESULTS: The tumor presented as a painful nodule in the episiotomy scar three months after delivery. Initial treatment included only wide local excision. Six months later local recurrence occurred despite clear surgical margins. Histologically a predominant "classic" cribriform growth pattern was identified. Immunoreactivity in tumor cells supported dual epithelial-myoepithelial differentiation. Estrogen and progesterone receptors were negative. The DNA histogram revealed a diploid stemline and a low S-phase fraction. CONCLUSION: ACC of the Bartholin's gland is a rare malignant tumor with great propensity for local recurrence. The optimal therapeutic approach has not been established due to the lack of well-defined prognostic parameters.
UI - 11550285
AU - Nucci MR; Weremowicz S; Neskey DM; Sornberger K; Tallini G; Morton CC;
TI - Quade BJ Chromosomal translocation t(8;12) induces aberrant HMGIC expression in aggressive angiomyxoma of the vulva.
SO - Genes Chromosomes Cancer 2001 Oct;32(2):172-6
AD - Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Benign mesenchymal neoplasms associated with rearrangements of the DNA architectural factor gene HMGIC on chromosome 12 include lipomas, uterine leiomyomata, pulmonary chondroid hamartomas, endometrial polyps, salivary gland pleomorphic adenomas, and breast fibroadenomas. Although HMGIC also has been implicated in the pathobiology of aggressive angiomyxoma of the vulva, the molecular mechanisms pertaining to this neoplasm are unclear. Tissue from a recurrent aggressive angiomyxoma was investigated by cytogenetic and expression analysis for HMGIC and HMGIY. The trypsin-Giemsa-banded karyotype showed a clonal translocation between chromosomes 8 and 12 [46,XX,t(8;12)(p12;q15)]. Fluorescence in situ hybridization (FISH) analysis with whole chromosome paint probes for chromosomes 8 and 12 excluded cryptic involvement of other chromosomes. The chromosome 12 breakpoint was mapped with two-color FISH analysis using cosmid probes at the 5' and 3' termini of HMGIC. Both cosmid probes showed hybridization to the normal chromosome 12 and the der(12) chromosome, indicating that the breakpoint was 3' (telomeric) to the gene. Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis revealed HMGIC expression in the tumor, and immunohistochemistry localized HMGIC expression to the tumor's spindle cells. Like numerous benign mesenchymal tumors, this locally aggressive tumor is associated with rearrangements near or within HMGIC, but chimeric gene formation was not required for tumorigenesis. Inappropriate expression of this DNA binding protein, however, may be important in the pathobiology of this tumor. Understanding the pathogenetic mechanism may also be helpful in developing new diagnostic tools for identifying residual disease. Copyright 2001 Wiley-Liss, Inc.
UI - 11563872
AU - Gastrell FH; McConnell DT
TI - Human papillomavirus and vulval intra-epithelial neoplasia.
SO - Best Pract Res Clin Obstet Gynaecol 2001 Oct;15(5):769-82
AD - Women's Health Service, Capital Coast Health Limited, Wellington South, New Zealand.
The association between human papillomavirus vulval skin infection and vulval intra-epithelial neoplasia is strong. Vulval skin carcinogenesis is, however, multifactorial. Both human papillomavirus oncogenic subtype infection and p53 mutations are likely to contribute to the risk of malignant transformation of normal epithelium. The long-term cumulative risk of developing vulval squamous carcinoma following the diagnosis of high-grade vulval intra-epithelial neoplasia is thought to be approximately 6% per decade, but observational data supporting this are mostly non-population based and retrospective. Surgical treatment may reduce this risk, but the rates of recurrence and treatment-related morbidity are high. Surveillance should therefore be discussed as an alternative. New treatments being researched include photodynamic therapy, human papillomavirus vaccines, immunotherapy, immune modulators and gene therapy. The advantages of these new modalities over surgery is the potential to preserve body image and sexual functioning while targeting more generalized epithelial molecular dysfunction. Copyright 2001 Harcourt Publishers Ltd.
UI - 11606084
AU - Levenback C; Coleman RL; Burke TW; Bodurka-Bevers D; Wolf JK; Gershenson
TI - DM Intraoperative lymphatic mapping and sentinel node identification with blue dye in patients with vulvar cancer.
SO - Gynecol Oncol 2001 Nov;83(2):276-81
AD - Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. email@example.com
OBJECTIVE: To determine the effectiveness of intraoperative lymphatic with blue dye alone as a means of localizing sentinel nodes in patients with vulvar cancer. METHODS: All patients undergoing primary surgical treatment for vulvar cancer were eligible for this prospective study. Isosulfan blue dye was injected intradermally at the edge of the primary tumor closest to the adjacent groin. Bilateral dye injections and groin dissections were performed if the tumor was within 2 cm of the midline. RESULTS: Fifty-two patients were enrolled in the study between 1993 and 1999. The median age was 58 years. Eighty-seven percent of the patients had T1 or T2 lesions, and 92% had nonsuspicious lymph nodes on palpation. Sixty-seven percent of the patients had squamous cell carcinoma; the remaining patients had melanoma or adenocarcinoma. The sentinel node was identified in 46 of the 52 patients (88%), comprising 22 of the 25 patients with lateral tumors and 24 of the 27 patients with midline lesions. The sentinel node was successfully identified in 57 of the 76 (75%) dissected groins. Sentinel node identification in the groin was hampered by the effects of prior excisional biopsy vs punch biopsy (11 of 25 vs 8 of 51, P = 0.007) and by the lateral vs midline location of the tumor (22 of 25 groins vs 35 of 51 groins, P = 0.067). During the first 2 years (1993-1994), a sentinel node could not be identified in 4 of the 25 (16%) patients and 13 of the 36 (36%) groins dissected, compared with 2 of the 27 (7%) of patients treated and 6 of the 40 (15%) groins dissected from 1995 through 1999 (P = 0.034). A total of 556 nodes were removed (median, 7 per groin), of which 83 (median, 1 per groin) were sentinel. The sentinel node was not identified in 2 of the 12 groins that proved to have metastatic disease. Both events occurred in the first 2 years of the study. There were no false-negative sentinel nodes. Since 1995, we have successfully identified the sentinel node in 16 of the 16 patients (25 of 25 groins) with T1 or T2 primary lesions, squamous histology, and nonsuspicious groin nodes on physical examination. CONCLUSIONS: Experience and careful patient selection can permit sentinel node identification with blue dye injection alone in more than 95% of patients with vulvar cancer. Copyright 2001 Academic Press.
UI - 11606098
AU - Dodge JA; Eltabbakh GH; Mount SL; Walker RP; Morgan A
TI - Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia.
SO - Gynecol Oncol 2001 Nov;83(2):363-9
AD - Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
OBJECTIVE: The best treatment modality and factors affecting recurrence among women with vaginal intraepithelial neoplasia (VAIN) are yet to be determined. The aims of the current study were to describe the clinical features, results of treatment, and factors affecting recurrence among patients with VAIN. METHODS: We conducted a retrospective review of 121 women with VAIN after confirming the histologic diagnosis. Patient demographics, clinical features, and results of therapy were recorded. Factors affecting recurrence were assessed using the odds ratio and the 95% confidence intervals among patients who were followed up for 7 months or more and had at least one posttreatment Papanicolaou smear. Significant univariate odds ratios were assessed jointly in a multivariate model with a stratified analysis. RESULTS: The mean age of the patients was 35.0 (+/-17), 41% of the patients smoked, 39% had a history of human papillomavirus infection, 27% had history of sexually transmitted diseases, 22% had history of surgery for cervical intraepithelial neoplasia (CIN), and 23% had total hysterectomy. The upper third of the vagina was the most common site of VAIN and 61% of the lesions were multifocal. Associated cervical and vulvar intraepithelial neoplasia (VIN) were present in 65 and 10%, respectively. Recurrences of VAIN and progression to invasive vaginal cancer occurred in 33 and 2%, respectively. Recurrences following partial vaginectomy, laser, and 5-fluorouracil were 0, 38, and 59%, respectively (P = 0.0001). Multifocality and method of treatment were significant independent predictors of VAIN recurrences (odds ratio 3.3, 95% CI 1.2, 9.2, P = 0.02, and 22.4, 95% CI 1.3, 393.6, P = 0.001, respectively), with no interaction, based on a stratified analysis. CONCLUSIONS: VAIN occurs most often among women with CIN or VIN, commonly involves the upper third of the vagina, and is often multifocal. Partial vaginectomy provides the highest cure rate and multifocality is a risk factor for recurrence. Copyright 2001 Academic Press.
UI - 11606106
AU - Rodriguez A; Isaac MA; Hidalgo E; Marquez B; Nogales FF
TI - Villoglandular adenocarcinoma of the vulva.
SO - Gynecol Oncol 2001 Nov;83(2):409-11
AD - Department of Pathology, University Hospital, Granada, Spain.
BACKGROUND: Only two previous cases of villoglandular adenocarcinoma of the vulva, an entity morphologically similar to tumors found in the uterine cervix and colorectum, have been reported. This paper communicates the first complete immunohistochemical study in villoglandular adenocarcinoma in order to determine its phenotype and histogenesis. CASE: A 69-year-old woman had a 1.5-cm nodule in the right labium majus. Histologically, it corresponded to a minimally atypical, villoglandular adenocarcinoma with a small microinvasion. Immunohistochemically, it was positive to OC125, CEA, and OC19.9 and coexpressed cytokeratins 7 and 20. Chromogranin, nuclear estrogen, and progesterone receptors were negative. CONCLUSION: Phenotypic expression was more consistent with a papillary mucinous ovarian or cervical neoplasm than of a colonic one. Its behavior was similar to that of its morphologic counterpart in the cervix, since the patient had no recurrence 3 years after a wide local excision. Copyright 2001 Academic Press.
UI - 11683949
AU - Tardio JC; Salas C
TI - Vaginal papillary carcinomas with transitional cell differentiation: a morphological variant of squamous cell carcinoma?
SO - Histopathology 2001 Oct;39(4):436-8
UI - 11699381
AU - Trope C; Scheistroen M; Aas M; Abeler V; Lie K; Makar A
TI - [Surgery and sentinel node examination in early vulvar cancer]
SO - Tidsskr Nor Laegeforen 2001 Sep 30;121(23):2723-7
AD - Avdeling for gynekologisk onkologi, Det Norske Radiumhospital 0310 Oslo.
BACKGROUND: Less than radical vulvectomy for primary vulvar cancer has been controversial. Less mutilating surgery without sacrificing benefits in prognosis is warranted. MATERIAL AND METHODS: Based on relevant literature and our own experience, we give a review of surgery and sentinel node examination in early vulvar cancer. RESULTS: Regional lymph node metastasis rarely occurs when tumour thickness is less than 1 mm. Smaller lesions (< 2 cm in diameter) should therefore be treated by wide excision only and without lymph node dissection. Other T1 lesions with deeper invasion should be radically excised with at least 2 cm margins and extend deep to the inferior fascia of the urogenital diaphragm. Complete inguinal-femoral lymphadenectomy should be performed in patients without groin metastases to avoid a small, but definite risk of recurrence, although the incidence of lymph node metastases for all clinical stage I patients is less than 10%. Lymphatic mapping with 99mTechnetium and patent blue technique is a potentially valuable intraoperative tool for assuring removal of the sentinel node most likely to have metastasis, defining the extent of the superficial inguinal lymphadenectomy and identifying uncommon anatomic variations. INTERPRETATION: Until reliable data on the benefits of selective lymphadenectomy using intraoperative lymphoscintigraphy are available, the procedure should only be performed in an approved research setting.
UI - 11706786
AU - Fukushima A; Yaegashi Y; Utsugisawa Y; Matsuta M; Kagabu T; Sugai T;
TI - Nakamura S Malignant fibrous histiocytoma of the vagina.
SO - Int J Clin Oncol 2001 Jun;6(3):153-6
AD - Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan. firstname.lastname@example.org
We describe here the case of an 82-year-old woman presenting with a hemorrhagic tumor on the anterior vaginal wall. She was diagnosed with malignant fibrous histiocytoma (MFH) from the findings of cytological analysis of biopsied surface tissue, histopathologic analysis of biopsied tissue, immunohistochemical staining, and electron microscopy. Cytological analysis of the biopsy sample harvested from the tumor surface showed multinucleated giant cells and large atypical cells with rough, granular, chromatin, as well as notable nucleoli. A storiform pattern was observed histopathologically, and immunohistochemical staining confirmed positive reactions to alpha 1-antichymotripsin (alpha 1-ACT), vimentin, and lysosome, but negative reactions to epithelial membrane antigen (EMA), cytokeratin, and alpha-smooth muscle action (alpha-SMA). Electron microscopy showed histiocyte-derived cells with a segmented nucleus with a large groove, pseudopodic cytoplasmic projections, and lysosome-like structures. However, intercellular adhesion factors were not notable, and microvilli were absent. Based on the above findings, a diagnosis of MFH originating from the vaginal wall was made. Because of the patient's advanced age, and, in accordance with her wishes, three courses of cancer chemotherapy, consisting of doxorubicin hydrochloride, fluorouracil, and cisplatin were carried out, without surgery. No reduction in the size of the tumor was seen at follow up, and despite the absence of metastasis and no exacerbation of her general condition, she died suddenly at home 2 years after being discharged.
UI - 11704223
AU - Anderson J; Behbakht K; De Geest K; Bitterman P
TI - Adenosarcoma in a patient with vaginal endometriosis.
SO - Obstet Gynecol 2001 Nov;98(5 Pt 2):964-6
AD - Department of Pathology, Rush Medical College, Chicago, Illinois 60612, USA.
BACKGROUND: Adenosarcoma in a patient with extraovarian endometriosis is a rare event and can be easily overlooked. CASE: A woman with a history of endometriosis underwent multiple resections of a vaginal mass and medical treatment for presumed recurrent endometriosis. Eventually, a vaginal adenosarcoma was diagnosed. CONCLUSION: The possibility of adenosarcoma should be considered if an enlarging mass occurs at the site of extraovarian endometriosis.
UI - 11702846
AU - Lavery S; Gillmer M
TI - Malignant transformation of residual endometriosis in women on unopposed oestrogen hormone replacement therapy.
SO - BJOG 2001 Oct;108(10):1106-7
AD - IVF Unit Hammersmith Hospital, London, UK.
UI - 11721736
AU - Morimura Y; Hashimoto T; Soeda S; Fujimori K; Yamada H; Yanagida K; Sato
TI - A Angiosarcoma of vagina successfully treated with interleukin-2 therapy and chemotherapy: a case report.
SO - J Obstet Gynaecol Res 2001 Aug;27(4):231-5
AD - Department of Obstetrics and Gynecology, Fukiushima Medical University, Japan.
We report a case of angiosarcoma of the vagina in a 61-year-old woman who had undergone radical hysterectomy and pelvic irradiation for uterine cervical adenocarcinoma 14 years previously. Combination chemotherapy (cyclophosphamide, vincristine, doxorubicin and dacarbazine) and interleukin-2 induced complete remission of the tumor. The patient remained free from disease for 15 months.
UI - 11732726
AU - Kimura C; Furuya K
TI - A case of pedunculated malignant melanoma of the vaginal mucosa.
SO - J Dermatol 2001 Oct;28(10):564-8
AD - Department of Plastic and Reconstructive Surgery, Hakodate Central General Hospital, Japan.
We report an 84-year-old Japanese woman who presented with a pedunculated malignant melanoma of the vaginal mucosa. Mucosal melanoma is believed to be more common in Japan than other countries, but such tumors of the vulvovaginal region are quite unusual. In our patient, three tumors were connected by a narrow pedicle. Three black tumors measuring 5-10 mm in diameter with a common pedicle were seen on the vaginal mucosa at five o'clock from the cervix. The tumors were hanging from the narrow pedicle. On histologic examination, they were diagnosed as malignant melanoma. Resection was done with a distal margin of 3 cm from the tumors and a margin of 1 cm from the cervix. The patient has had no evidence of local recurrence or distant metastasis. In our patient, the three main tumors had a common pedicle, which seems to be a unique finding. Since pedunculated malignant melanomas are rare, making a clinical diagnosis is difficult. Although pedunculated melanomas are recognized as having a high malignant potential because these lesions are generally thick, a relatively good outcome is sometimes reported. In our patient, there was no tumor infiltration into the dermis of the pedicle, and this may be one reason for the good outcome at present. There has been no previous report of a mucosal melanoma consisting of three tumors like those in the present patient.
UI - 11726102
AU - Takeshima N; Tabata T; Nishida H; Furuta N; Tsuzuku M; Hirai Y; Hasumi K
TI - Peripheral primitive neuroectodermal tumor of the vulva: report of a case with imprint cytology.
SO - Acta Cytol 2001 Nov-Dec;45(6):1049-52
AD - Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan. email@example.com
BACKGROUND: Peripheral primitive neuroectodermal tumor (PNET) of the vulva is an extremely rare disease, and, to our knowledge, only two cases have been previously reported. CASE: A 45-year-old woman presented with a mass in the right labium major. Three years after removal of the tumor, she noticed a new lesion in the same place and underwent a partial vulvectomy. The imprint cytology of the recurrent tumor showed a monomorphic appearance, composed of small round cells with scant cytoplasm against a hemorrhagic background. These tumor cells were loosely connective, but rosettelike structures were observed focally. On pathologic examination, the neoplasm was composed of small round tumor cells showing sinusoidal, diffuse or micropapillary growth. Immunohistochemically, the neoplastic cells stained positively for neuron-specific enolase, vimentin and HBA 71 and negatively for cytokeratin, HBA 45 and muscle-specific actin. The morphologic characteristics of the disease were well expressed in the imprint cytology, and this influenced the selection of immunohistochemical studies. CONCLUSION: Cytologic examination for vulvar tumors, even imprint cytology, can be a useful tool in obtaining an accurate pathologic diagnosis of a rare disease, such as peripheral PNET.
UI - 11726119
AU - Ylagan LR; Mutch DG; Davila RM
TI - Transvaginal fine needle aspiration biopsy.
SO - Acta Cytol 2001 Nov-Dec;45(6):927-30
AD - Department of Pathology, Washington University Medical Center, St. Louis, Missouri 63110, USA.
OBJECTIVE: To assess the role of transvaginal fine needle aspiration biopsy (FNAB) in the evaluation of palpable gynecologic masses. STUDY DESIGN: Transvaginal FNABs from 1994 to 1999 were identified from the files of Barnes-Jewish Hospital. Histologic correlation was obtained using the Pathology Department's computer database. Two pathologists reviewed the pathologic samples. Pertinent clinical information was obtained by reviewing the medical records. RESULTS: Twenty-two transvaginal FNABs from 22 patients were studied. The patients' mean age was 59 years (range, 29-84). Most patients (77%) had a previous history of a gynecologic malignancy, and 73% had a previous total abdominal hysterectomy and bilateral salpingo-oophorectomy. The size of the lesion sampled was provided in 15 cases and ranged from <1 to 5.4 cm in diameter. The location of the mass was reported as follows: vaginal (10 cases), vaginal cuff (5), rectovaginal septum (2), cul-de-sac (1), fornix (1), vaginal apex (1), right side of pelvis (1), and not specified (1). The cytologic diagnoses were: negative for malignancy (10 cases), positive for malignancy (9) and unsatisfactory (3). Most cases (77%) had histologic correlation or clinical follow-up. There was one false negative and no false positive cytologic diagnosis. CONCLUSION: Cytologic interpretation of transvaginal FNAB is an effective toolfor the evaluation of palpable pelvic and vaginal masses. Its specificity and sensitivity are 100% and 88%, respectively.
UI - 11758209
AU - Guo L; Liu T; Li C; Li M
TI - [Studies on the relationship between clinicopathological features and human papillomavirus types in female lower genital tract carcinoma]
SO - Zhonghua Bing Li Xue Za Zhi 2001 Aug;30(4):245-8
AD - Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
OBJECTIVE: To investigate the relationship between clinicopathological features and human papillomavirus types in female lower genital tract carcinoma. METHODS: Clinicopathological features of 100 cases of female lower genital tract carcinoma (63 cervical carcinoma and 37 vulvar carcinoma) were studied retrospectively. Standard PCR (HPV type 6/11, 16, 18) was applied to formalin fixed, paraffin embedded sections. RESULTS: There were 54 cases of cervical carcinoma and 33 cases of vulvar carcinoma in the 87 cases of target DNA qualified samples. The HPV detection rate in cervical carcinoma was 83.3%. HPV16 (55.6%) and HPV 18(24.4%) were the predominant types. In vulvar carcinoma, HPVs, mainly HPV 16(70%, 7/10), were detected in basaloid (83.3%, 5/6) and warty carcinoma (83.3%, 5/6), but none in conventional type of keratinized squamous cell carcinoma (0.0%, 0/21). Three of the 6 women with basaloid carcinoma were associated with cervical squamous neoplasia, and the same HPV type was found in both lesions in 2 of the 3 patients with two primary tumors. Four patients with basaloid carcinoma recurred after simple vulvectomy or local excision, but no lymph node metastasis occurred and all were still alive at last follow-up, with a median follow-up of 6.3 years. In contrast, the majority of the women with keratinized squamous cell carcinoma were over 65 years of age, with histologic extensive keratinization and poorer prognosis. CONCLUSIONS: A high detection rate of HPV 16 and 18 was found in cervical carcinoma. However, the sensitivity of HPV in vulvar carcinoma seems to be more related to histologic type.
UI - 11733955
AU - Irvin WP Jr; Legallo RL; Stoler MH; Rice LW; Taylor PT Jr; Andersen WA
TI - Vulvar melanoma: a retrospective analysis and literature review.
SO - Gynecol Oncol 2001 Dec;83(3):457-65
AD - Division of Gynecologic Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA. firstname.lastname@example.org
OBJECTIVE: This review focuses on current directions in the staging and treatment of melanoma of the vulva. METHODS: All women treated for invasive melanoma of the vulva at the University of Virginia Health Sciences Center from 1980 through 2000 were identified through a retrospective review of the records of the Division of Gynecologic Oncology. Their treatments and outcomes were then analyzed and presented. RESULTS: Over the 20-year study period, 14 cases of melanoma of the vulva were identified. Of the 14 patients treated with curative intent, 6 developed recurrences following the completion of primary therapy, and all are dead from their disease. The mean duration from completion of therapy to recurrence was 7.5 months; the mean survival following recurrence was 17 months. CONCLUSION: One-centimeter skin margins appear adequate for vulvar melanomas <1 mm thick, and 2-cm margins appear adequate for intermediate-thickness melanomas (1-4 mm). In all cases it is necessary to include at least a 1-cm-deep margin extending through the subcutaneous fat to the muscular fascia below. Elective node dissection seems to offer no additional advantage in superficial lesions <0.76 mm thick, and its role in deeper lesions is still uncertain. (c)2001 Elsevier Science.
UI - 11745496
AU - Rosenthal AN; Ryan A; Hopster D; Surentheran T; Jacobs IJ
TI - High frequency of loss of heterozygosity in vulval intraepithelial neoplasia (VIN) is associated with invasive vulval squamous cell carcinoma (VSCC).
SO - Int J Cancer 2001 Dec 15;94(6):896-900
AD - The Gynaecological Oncology Unit, St. Bartholomew's and the Royal London Hospitals Medical College, Queen Mary and Westfield College, London, United Kingdom.
Vulval intraepithelial neoplasia (VIN) is thought to be the premalignant phase of human papillomavirus (HPV)-associated vulval squamous cell carcinoma (VSCC). Various molecular events have been suggested as markers for progression from VIN to VSCC, but loss of heterozygosity (LOH) in vulval neoplasia has rarely been studied in this context. We performed LOH analysis by polymerase chain reaction (PCR) amplification of polymorphic microsatellite markers at 6 chromosomal loci (17p13-p53, 9p21-p16, 3p25, 4q21, 5p14 and 11p15). The presence of HPV was assessed using consensus PCR primers and DNA sequencing. To examine any association between LOH and the presence of invasive disease, we analyzed 43 cases of lone VIN III, 42 cases of lone VSCC and 21 cases of VIN with concurrent VSCC. HPV DNA was detected in 95% of lone VIN III samples and 71% of lone VSCC samples. Fractional regional allelic loss (FRL) in VIN associated with VSCC was higher than in lone VIN (mean FRL 0.43 vs. 0.21, p < 0.005). LOH at 3p25 occurred significantly more frequently in HPV-negative VSCC than in HPV-positive VSCC (58% vs. 22%, p < 0.04). These data suggest that genetic instability in VIN, reflected by LOH, may increase the risk of invasion. In addition, molecular events differ in HPV-positive and -negative VSCC and 3p25 may be the site of a tumor suppressor gene involved in HPV-independent vulval carcinogenesis. Copyright 2001 Wiley-Liss, Inc.
UI - 11722509
AU - Levine TS; Rolfe KJ; Crow J; Styles S; Perrett CW; Maclean AB; Reid WM
TI - The use of cytospin monolayer technique in the cytological diagnosis of vulval and anal disease.
SO - Cytopathology 2001 Oct;12(5):297-305
AD - Department of Histopathology and Cytopathology, The Royal Free Hospital NHS Trust, London, UK. Tanya.Levine@rfh.nthames.nhs.uk
This pilot study investigated the use of the non-invasive cytospin monolayer technique in the diagnosis and screening of neoplastic and non-neoplastic vulval disease. Twenty-three patients (age range 34-86 years) attending a vulval disease clinic had brush cytology performed. The samples were prepared with a cytospin monolayer technique and the slides Papanicolaou-stained. Subsequent cytological interpretation and diagnosis were performed without knowledge of the clinical history and correlated with follow-up biopsy histopathology from each patient. Twenty-eight cytospin samples were analysed in total, of which 11 (39%) contained dyskaryotic cells which were assessed and a predicted VIN/AIN grade given. Ten of 11 samples (91%) reported as dyskaryotic had VIN/AIN on biopsy histology. One of 11 samples (9%) was reported as containing occasional squamous cells with borderline nuclear features and, although the corresponding biopsy did not show VIN, basal atypia was reported. One patient had features suggesting invasive carcinoma on cytology which was verified on subsequent biopsy. The 15 cases in which no dyskaryotic cells were identified did not show VIN or AIN on subsequent histology. Two cases were acellular and considered inadequate for cytological interpretation. The cytospin monolayer technique allows the diagnosis of neoplastic from non-neoplastic vulval disease. It is a quick, inexpensive and non-invasive method that may have a role in diagnosis, screening and surveillance of patients.
UI - 10739696
AU - Abang Mohammed DK; Uberoi R; de B Lopes A; Monaghan JM
TI - Inguinal node status by ultrasound in vulva cancer.
SO - Gynecol Oncol 2000 Apr;77(1):93-6
AD - Gynaecological Oncology Centre/Radiology Department, Queen Elizabeth Hospital, Gateshead, NE9 6SX, United Kingdom.
OBJECTIVE: The objective of this study was to determine the value of ultrasound in preoperative assessment of groin node status in vulva cancer. MATERIALS AND METHODS: Women with clinically uninvolved groins who were undergoing groin node dissection for vulva cancer in our department over an 18-month period were recruited into the study. A preoperative scan of each groin to be dissected was performed to identify any suspicious lymph nodes containing metastases. Suspicious nodes were defined by two sonographic criteria: short axis diameter (>8 mm) and a long axis/short axis ratio (L/S = 2). Each suspicious node was sampled by ultrasound-guided fine-needle aspiration (FNA). RESULTS: Twenty women, with an average age of 70 years, consented to the study. Seventeen had bilateral groin node dissection and three had unilateral groin node dissection. Six (16%) of the seventeen dissected groins contained metastases. Short axis had a better overall accuracy (89%) but failed to detect a singular micrometastasis. The L/S ratio identified all positive groins but had a high false-positive rate (62%) and an overall accuracy of 67%. The combination of both criteria did not improve the overall accuracy when compared with the individual criterion. FNA was not diagnostic in three, representative in two, and falsely negative in one. CONCLUSION: Although L/S ratio has a lower overall accuracy, it correctly identified all groins with metastases. This has a great impact on treatment and prognosis. Its high false-positive rate may be improved by more diagnostic FNA. These sonographic criteria show good potential for segregating those with groin metastases requiring surgical treatment from those with uninvolved nodes. This experience has to be expanded to prove its clinical effectiveness. Copyright 2000 Academic Press.
UI - 11729219
AU - McCluggage WG
TI - Lymphoepithelioma-like carcinoma of the vagina.
SO - J Clin Pathol 2001 Dec;54(12):964-5
AD - Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT12 6BL, Northern Ireland. email@example.com
This report describes a lymphoepithelioma-like carcinoma of the vagina. Although such tumours are well described in the cervix this is only the second report of such a neoplasm at this site. Histology showed a well circumscribed lesion composed of syncytial sheets of epithelioid tumour cells with an intense inflammatory infiltrate, largely consisting of T lymphoid cells. In situ hybridisation and immunohistochemistry for Epstein-Barr virus were negative. A review of the literature reveals that such neoplasms appear to be extremely rare within the female genital tract outside of the cervix.
UI - 11491368
AU - Paraskevaidis E; Zioga C; Chouliara S; Koliopoulos G; Tzioras S; Lolis D
TI - Adenoid cystic carcinoma of Bartholin's gland: a case report.
SO - Clin Exp Obstet Gynecol 2001;28(2):109-10
AD - Department of Obstetrics and Gynecology, Ioannina University Hospital, Greece.
Adenoid cystic carcinoma is an uncommon histological type of the already rare carcinoma of Bartholin's gland with 51 cases described in the literature. We present a case of a 66-year-old woman who was admitted with severe pelvic pain. In an examination under anesthesia a 10x5 cm apparently fixed mass at the left vaginal wall originating from the area of Bartholin's gland was found. and biopsy indicated carcinoma. The patient underwent wide local excision. Although clinically inoperable, the tumor did not infiltrate the bony pelvis and no evidence of metastasis was found. Pathology examination revealed adenoid cystic carcinoma of Bartholin's gland. PCR did not detect human papillomavirus DNA in the specimen. The patient has been treated with adjuvant radiotherapy, and is alive with no evidence of disease after ten months.
UI - 11759499
AU - Ahsan A; Zaidi SM; Sadiq MS
TI - Endodermal sinus tumor of the vagina--a rare entity treated exclusively with chemotherapy.
SO - J Pak Med Assoc 2001 Apr;51(4):158-9
AD - Department of Obstetrics and Gynaecology, Liaquat National Hospital, Karachi.
UI - 11757483
AU - Olejek A; Mazurek U; Orchel J; Rzempoluch J; Wilczok T
TI - [The assessment of expression of kininogen and bradykinin receptors genes in different vulvar pathologies by QPCR (TaqMan).]
SO - Ginekol Pol 2001 Sep;72(9):717-22
AD - Oddzialu Klinicznego Poloznictwa i Ginekologii w Bytomiu Sl.A.M. w Katowicach.
OBJECTIVES: In different vulvar path
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