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National Cancer Institute®
Ultima Vez Modificado: 1 de julio del 2002
UI - 11908149
AU - Renaud-Vilmer C; Dehen L
TI - [Single erythroplastic vulvar lesion in a 70-year-old woman: Bowen disease]
SO - Ann Dermatol Venereol 2001 Dec;128(12):1361-2
AD - Institut de Recherche sur la Peau, Service de Dermatologie du Professeur L. Dubertret, Hopital Saint-Louis, 1, avenue Claude Vellefaux, 75475 Paris, France.
UI - 11827426
AU - Santos LD; Currie BG; Killingsworth MC
TI - Case report: plexiform schwannoma of the vulva.
SO - Pathology 2001 Nov;33(4):526-31
AD - Department of Anatomical Pathology, Liverpool Hospital, NSW, Australia.
We describe a case of plexiform schwannoma, a benign tumour of the peripheral nerve sheath, arising in the labia of a 5-year-old girl who presented with a mass in the vulva. Light and electron microscopy, special stains and immunohistochemistry studies were done on the excised specimen. A Medline search revealed a single case of vulvar plexiform schwannoma which was reported in 1983.
UI - 11550003
AU - Bilenchi R; Andreassi A; Santopietro R; Miracco C; Biagioli M; Cardone
TI - C; Andreassi L Vulvar Paget disease. Two cases with cytokeratin 7 and 20 expression.
SO - Minerva Ginecol 2001 Oct;53(5):363-6
AD - Department of Dermatology, University of Siena, Italy. email@example.com
Two cases of vulvar Paget's disease are described in two women aged 75 and 60 years, with onset several years earlier as eczema-like manifestations, and evolving into erosive, slightly infiltrative lesions. In both cases immunohistochemical examination revealed positivity for cytokeratins CK7 and CK20. This finding suggested the diagnosis of primitive vulvar Paget's disease, a relatively benign form, unlike the aggressive and rapidly progressive secondary vulvar Paget's disease.
UI - 12090585
AU - Lerma E; Matias-Guiu X; Lee SJ; Prat J
TI - Squamous cell carcinoma of the vulva: study of ploidy, HPV, p53, and pRb.
SO - Int J Gynecol Pathol 1999 Jul;18(3):191-7
AD - Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain.
Seventy-one cases of invasive squamous cell carcinoma (ISCC) of the vulva were compared with 18 cases of vulvar intraepithelial neoplasia (VIN) and 21 cases of lichen sclerosus. Ploidy was studied by image analysis, HPV-DNA by PCR, and p53 and pRb by immunohistochemistry. Univariate and multivariate statistical analyses were performed. The mean age of the patients with ISCC was 70.6 years; only 8.5% were < 60 (range, 43-89) years. For the 43 patients with follow-up, FIGO surgical stages were I in 16.2%, II in 48.8%, III in 27.9%, and IV in 6.9%. The 5-year survival was 90% for the patients with curative surgery (vulvectomy and lymphadenectomy) and 32% for those with tumors in stages III to IV. Previous history of nonneoplastic epithelial alterations was recorded in 54%. Vascular invasion was detected in 4.3% and perineural invasion in 21.4%. Inguinal lymph node metastases were present in 34.9% of the cases. Fifty-one (72%) ISCCs were aneuploid, HPV-DNA-16 was detected in 7 (12.3%) cases, overexpression of p53 was found in 40 (56%), and pRb expression was negative in 15 (21.4%). Fifteen cases (80%) of VIN were aneuploid, 5 (27.7%) contained HPV-DNA, 11 (61%) were positive for p53, and all immunoreacted for pRb. All lichen sclerosus cases were diploid, did not contain HPV-DNA, failed to stain for p53, and were positive for pRb. Our study confirmed the prognostic value of conventional pathological features: stage, lymph node metastasis, histological grade, and vascular and perineural invasion; all were statistically significant for survival in the univariate analysis. Also, ploidy was significant in patients with stages I and II tumors. The only significant variable in the multivariate analysis was stage. p53 overexpression appears as a late event in vulvar carcinogenesis, but it may occur before tumor invasion. Lack of pRb expression can occur in vulvar neoplasia, but it does not seem to play any role in the initiation or prognosis of vulvar ISCC.
UI - 12051887
AU - Mulayim N; Foster Silver D; Tolgay Ocal I; Babalola E
TI - Vulvar basal cell carcinoma: two unusual presentations and review of the literature.
SO - Gynecol Oncol 2002 Jun;85(3):532-7
AD - Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520, USA. firstname.lastname@example.org
BACKGROUND: Basal cell carcinoma (BCC) of the vulva comprises 2-4% of all vulvar cancers. In general, vulvar BCCs tend to grow at slow rates. Nonetheless, they may be locally invasive and destructive if they are neglected. Eight cases of vulvar BCC metastatic to regional lymph nodes have been documented in the literature. CASES: Two unusual cases of vulvar BCC are presented. Case 1 is an 86-year-old white woman who presented with vulvar BCC metastatic to the femoral head. This is the first report of hematogeneous metastasis of vulvar BCC. The patient was treated with palliative vulvar resection and radiation to the femoral metastasis. At 6 months, she progressed with multiple bony and intraperitoneal metastases and died with disease. Case 2 is vulvar BCC in a 90-year-old African-American woman. She was managed by wide local excision and remains disease free to date. CONCLUSION: Vulvar BCCs are rare tumors with an unclear etiology. They can be aggressive and are capable of causing significant morbidity and occasional mortality if they are neglected or improperly treated. Hematogeneous metastasis at presentation appears to result in rapidly progressive disease. The literature regarding the pathogenesis, biologic behavior, and treatment of vulvar BCC is reviewed.
UI - 12057054
AU - Hensley ML
TI - Uterine/female genital sarcomas.
SO - Curr Treat Options Oncol 2000 Jun;1(2):161-8
AD - Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Choosing the best management of uterine and vulvo-vaginal sarcomas depends on careful histologic review of the pathologic specimen. Prognosis and treatment vary greatly depending on specific histology, grade, and tumor stage. The initial approach to sarcomas of the female genital tract, with the occasional exception of vulvo-vaginal rhabdomyosarcoma, is surgery. Adjuvant radiation decreases local recurrence rates for uterine sarcomas, but has not been clearly shown to improve overall survival. It is frequently used as adjuvant therapy for resected high-grade or margin-positive vulvo-vaginal sarcomas, and for endometrial stromal sarcomas. Adjuvant chemotherapy has not been demonstrated to improve survival in vulvo-vaginal sarcomas, with the exception of vulvo-vaginal rhabdomyosarcomas, nor has it been demonstrated to improve survival in uterine sarcomas. Chemotherapy may be used for recurrent or persistent disease. The choice of agent depends on the histologic type of sarcoma.
UI - 12057056
AU - Coleman RL; Santoso JT
TI - Vulvar carcinoma.
SO - Curr Treat Options Oncol 2000 Jun;1(2):177-90
AD - University of Texas, Southwestern Medical Center, Division of Gynecologic Oncology, 5323 Harry Hines Blvd., J7.124, Dallas, TX 75235-9032, USA.
Carcinoma of the vulva is an uncommon gynecologic malignancy primarily affecting postmenopausal women. The lesion is most commonly associated with HPV DNA, although, for many, a defined preinvasive to invasive connection is not readily apparent. Most patients experience symptoms of pruritus, irritation, and even pain for weeks or months before the diagnostic biopsy is performed. Patient embarrassment and unfamiliarity and reluctance on the part of the physician to fully evaluate these symptoms add to the delay. Vulvar carcinoma is staged surgically following resection. A concerted effort to conserve as much normal tissue as possible has been the focus of recent investigation. Separate incision resection of the vulvar mass and groin has improved wound healing and quality of life for many patients. The effect these conservative procedures have on long-term survival is currently being evaluated. Increased use of radiation therapy or chemoradiation has allowed organ preservation in many otherwise exenterative cases. In some instances, this neoadjuvant therapy has provided an opportunity to surgically clear otherwise unresectable lesions. Current radiotherapy techniques might also be as effective as groin dissection in certain low-risk patients. Adjuvant radiation and chemoradiation improve local control and reduce groin recurrence risk. In addition, patients with histologically positive groins enjoy longer survival when the pelvis is also treated. Selected use of multimodality therapy will likely extend the lives of women with vulvar cancer.
UI - 12094381
AU - Brown HM; Wilkinson EJ
TI - Uroplakin-III to distinguish primary vulvar Paget disease from Paget disease secondary to urothelial carcinoma.
SO - Hum Pathol 2002 May;33(5):545-8
AD - Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville 32610, USA.
Paget disease of the vulva can be mimicked by several disease entities histopathologically, but most of these entities can be clinically distinguished from vulvar Paget disease. However, vulvar Paget disease is in itself a heterogeneous group of epithelial neoplasms that can be similar both clinically and histopathologically. The subtypes of vulvar Paget disease include primary Paget disease arising from a pluripotent stem cell within the epithelium of the vulva, and secondary Paget disease of the vulva. Secondary vulvar Paget disease results from spread of an internal malignancy, most commonly from an anorectal adenocarcinoma or urothelial carcinoma of the bladder or urethra, to the vulvar epithelium. We have recently proposed that these lesions be classified as primary (of cutaneous origin) or secondary (of extracutaneous origin). These subtypes can present similarly as eczematoid skin lesions and may appear similar on routine hematoxylin and eosin-stained slides. Immunohistochemical studies can help differentiate between them. Our current study includes 17 patients with a pathologic diagnosis of vulvar Paget disease. We performed a panel of immunohistochemical stains, including cytokeratin (CK) 7 and 20, carcinoembryonic antigen (CEA), gross cystic disease fluid protein-15 (GCDFP-15), and uroplakin-III (UP-III). Of these 17 patients, 14 (80%) had primary intraepithelial cutaneous Paget disease, 13 without invasion and 1 with associated invasion. Three patients had urothelial carcinoma with spread to the vulva, manifesting as secondary vulvar Paget disease. Immunohistochemically, primary vulvar Paget disease is immunoreactive for CK 7 and GCDFP-15, but uncommonly for CK 20. Vulvar Paget disease secondary to anorectal carcinoma demonstrates CK 20 immunoreactivity but is usually nonreactive for CK 7 and consistently nonimmunoreactive for GCDFP-15. Vulvar Paget disease secondary to urothelial carcinoma is immunoreactive for CK 7 and CK 20 but nonimmunoreactive for GCDFP-15. In addition, we propose the use of a new, commercially available antibody, UP-III, which is specific for urothelium and, in our experience, is immunoreactive in secondary vulvar Paget disease of urothelial origin. The distinction between these 3 types of Paget and Paget-like lesions is essential in that the specific diagnosis has a significant influence on current treatment. The difference in surgical approach to the subtypes of vulvar Paget disease justifies classifying them into distinct lesions, which may be aided by the use of immunohistochemistry, including UP-III. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 12094382
AU - Wilkinson EJ; Brown HM
TI - Vulvar Paget disease of urothelial origin: a report of three cases and a proposed classification of vulvar Paget disease.
SO - Hum Pathol 2002 May;33(5):549-54
AD - Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Extramammary Paget disease is generally considered a distinct entity that can involve the genital tract skin and may be associated with underlying adenocarcinoma. Evidence is presented that vulvar Paget disease represents a heterogeneous group of epithelial neoplasms that can be similar both clinically and histopathologically. Three cases of vulvar Paget-like disease that were manifestations of urothelial carcinoma are investigated. Vulvar Paget disease can be classified based on the origin of the neoplastic Paget cells as either primary (of cutaneous origin) or secondary (of noncutaneous origin). Each classification has 3 subtypes: primary, intraepithelial cutaneous Paget disease of the usual type; intraepithelial cutaneous Paget disease with invasion, and intraepithelial cutaneous Paget disease as a manifestation of underlying skin appendage adenocarcinoma; secondary, Paget disease of anorectal origin, Paget disease of urothelial origin, and Paget disease of other origin. This subclassification is based on a review of the literature and the current study of 3 patients with Paget-like disease of urothelial neoplastic origin. The 3 subtypes of vulvar Paget disease studied here can present similarly as eczematoid skin or vulvar mucosal lesions and may appear similar on routine hematoxylin and eosin-stained slides. Immunohistochemical studies can be used to help differentiate them. The distinction between these 3 types of Paget-like lesions is essential in that the specific diagnosis has a significant influence on current treatment. The difference in surgical approach to the subtypes of vulvar Paget disease justifies classifying them into distinct lesions to avoid potential confusion and unnecessary surgery. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 11840573
AU - de Hullu JA; Ansink AC; Tymstra T; van der Zee AG
TI - What doctors and patients think about false-negative sentinel lymph nodes in vulvar cancer.
SO - J Psychosom Obstet Gynaecol 2001 Dec;22(4):199-203
AD - Department of Gynecologic Oncology, Groningen University Hospital, Groningen, Hanzeplein 1, PO Box 30001, 9700RB Groningen, The Netherlands. email@example.com
The sentinel lymph node procedure is a relatively new, minimally-invasive method for the assessment of nodal status in malignancies such as breast cancer, cutaneous melanoma and vulvar cancer. Although highly accurate, this new method is inevitably associated with a certain false-negative rate, possibly leading to worse survival in a small subset of patients. The clinical implementation of the sentinel lymph node procedure is therefore a matter of ongoing debate, especially among doctors. The aim of this study was to assess opinions on the acceptable false-negative rate of the sentinel lymph node procedure in patients with vulvar cancer, who in the past had undergone standard routine radical vulvectomy and complete inguinofemoral lymphadenectomy (and frequently experienced complications), and in gynecologists treating patients with vulvar cancer. Structured questionnaires were sent to both patients and gynecologists. The patients had been treated for vulvar cancer between 1985 and 1993, and were all in complete remission with a median follow-up of 118 months (range: 76-185). Questions to the patients dealt with experienced side-effects of the standard treatment and opinion on the acceptable false-negative rate of the sentinel lymph node procedure. The response rate among patients was 91% (106/117). Forty per cent of the patients experienced one or more infections in the legs (cellulitis) and 49% of the patients still experience either severe pain and/or severe lymphedema in the legs. Sixty-six per cent of the patients preferred complete inguinofemoral lymphadenectomy in preference to a 5% false-negative rate of the sentinel lymph node procedure of 5%. Their preference was not related to age or the side-effects they had experienced. The response rate among gynecologists was 80% (80/100), of whom 60% were willing to accept a 5-20% false-negative rate of the sentinel lymph node procedure. While gynecologists may consider the sentinel lymph node procedure to be a promising diagnostic tool, the majority of vulvar cancer patients, who have undergone complete inguinofemoral lymphadenectomy in the past and have frequently experienced complications, would not advise introduction of this technique because they do not want to take any risk of missing a lymph node metastasis.
UI - 12079308
AU - Tamussino KF; Bader AA; Lax SF; Aigner RM; Winter R
TI - Groin recurrence after micrometastasis in a sentinel lymph node in a patient with vulvar cancer.
SO - Gynecol Oncol 2002 Jul;86(1):99-101
AD - Department of Obstetrics and Gynecology, University of Graz, Austria. firstname.lastname@example.org
BACKGROUND: The sentinel lymph node concept is attractive in vulvar cancer because of the potential to avoid the morbidity associated with formal groin dissection. CASE: An 84-year-old patient with a T2 carcinoma of the anterior vulva underwent surgery including bilateral sentinel node excision after identification with technetium-labeled nanocolloid. Frozen section histology showed a tumor deposit <1 mm in diameter in a left groin node whereas four nodes in the right groin were apparently negative. Completion lymphadenectomy was performed only for the left groin. Final histology including serial sectioning showed a micrometastasis in one of seven nodes from the right groin; no further treatment was given. Sixteen months postoperatively the patient developed a recurrence in the right groin; the left groin was free of tumor. CONCLUSION: This case indicates that groins with a micrometastasis detected by sentinel lymph node excision require further treatment. (c) 2002 Elsevier Science (USA).
UI - 12118657
AU - Thorpe-Beeston JG; Sebire NJ
TI - Spontaneous expulsion of submucous fibroid after preterm labour.
SO - BJOG 2002 Jun;109(6):726-7
AD - Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK.
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