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NCI CANCERLIT^® Search: Vaginal and Vulvar Cancer - August 2002

Imprima English

National Cancer Institute^®
Ultima Vez Modificado: 1 de agosto del 2002

Treatment of high-grade vaginal intraepithelial neoplasia with imiquimod cream.
Supra-additive effect with concurrent paclitaxel and cisplatin in vulvar squamous cell carcinoma in vitro.
CO(2) laser therapy of vulval lymphangiectasia and lymphangioma circumscriptum.
Vulval intraepithelial neoplasia: current perspectives.
[Contact isolation]
New perspectives on therapy for vaginal endodermal sinus tumors.
Terminology for vulvar cytology based on the Bethesda System.
The role of p53 and Ki67 in Paget's disease of the vulva and the breast.
Expression of topoisomerase IIalpha, Ki-67, proliferating cell nuclear antigen, p53, and argyrophilic nucleolar organizer regions in vulvar

Table of Contents

1
UI - 12151484
AU - Diakomanolis E; Haidopoulos D; Stefanidis K
TI - Treatment of high-grade vaginal intraepithelial neoplasia with imiquimod cream.
SO - N Engl J Med 2002 Aug 1;347(5):374

2
UI - 12115575
AU - Raitanen M; Rantanen V; Kulmala J; Helenius H; Grenman R; Grenman S
TI - Supra-additive effect with concurrent paclitaxel and cisplatin in vulvar squamous cell carcinoma in vitro.
SO - Int J Cancer 2002 Jul 10;100(2):238-43
AD - Department of Obstetrics and Gynecology, Turku University Central Hospital, Turku, Finland.
The effect of concurrent paclitaxel and cisplatin was tested in vitro in 5 vulvar squamous cell carcinoma (SCC) cell lines (UM-SCV-1A, -2, -4 and -7 and UT-SCV-3). Chemosensitivity was tested using the 96-well plate clonogenic assay. Paclitaxel concentrations used varied between 0.4 and 1.6 nM, and cisplatin concentrations varied between 0.1 and 0.9 microg/ml. These drug concentrations are clinically achievable. Survival data were fitted to the LQ model, and the area under the curve (AUC) value was obtained with numerical integration. The type of interaction was determined by comparing the AUC ratio of the 2 drugs with the survival fraction (SF) of paclitaxel alone. With all cell lines tested the growth-inhibitory effect of simultaneous paclitaxel and cisplatin was at least additive. The effect of the tested combination on the UM-SCV-1A and UT-SCV-3 cell lines was clearly supra-additive with all paclitaxel concentrations tested, and the UM-SCV-4 and UM-SCV-7 cell lines exhibited a supra-additive effect with increasing paclitaxel concentrations. The degree of supra-additivity was dose-dependent in the UM-SCV-7 cell line with increasing synergy at higher paclitaxel doses. In the current study the combination of paclitaxel and cisplatin had a clear additive or supra-additive cytotoxic effect on the vulvar SCC cell lines, and it has been successfully used in other gynecologic malignancies; therefore concurrent paclitaxel and cisplatin also deserves further testing in clinical settings in advanced-stage vulvar carcinoma, which has a poor prognosis. Copyright 2002 Wiley-Liss, Inc.

3
UI - 12135508
AU - Huilgol SC; Neill S; Barlow RJ
TI - CO(2) laser therapy of vulval lymphangiectasia and lymphangioma circumscriptum.
SO - Dermatol Surg 2002 Jul;28(7):575-7
AD - St. Thomas' Hospital, London, United Kingdom.
BACKGROUND: Lymphangiectasia is a disorder of superficial lymphatics resulting from obstruction of previously normal deep lymphatics, while lymphangioma circumscriptum describes a deep dermal and subcutaneous lymphatic malformation with secondary superficial ectatic changes. Previous case reports have suggested the effectiveness of CO2 laser treatment. OBJECTIVE: To assess CO2 laser therapy for vulval involvement by these lymphatic disorders. METHODS: A retrospective case review at St. John's Institute of Dermatology from 1996 to 1999 identified three women with vulval lymphangiectasia and two with vulval lymphangioma circumscriptum treated with the CO2 laser. RESULTS: Patient tolerance of the procedure was good. Healing was complete within 1 month and occurred without change in skin texture. All patients reported considerable improvement in symptoms (mean follow-up 22 months, median 24 months, range 10-33 months). Focal recurrence and an area of localized persistence were noted in the two patients with lymphangioma circumscriptum. CONCLUSION: CO2 laser therapy of vulval lymphangiectasia and lymphangioma circumscription is effective and well-tolerated; the latter may possibly be more resistant to treatment than the former.

4
UI - 11874067
AU - Jones RW
TI - Vulval intraepithelial neoplasia: current perspectives.
SO - Eur J Gynaecol Oncol 2001;22(6):393-402
AD - Department of Gynaecological Oncology, National Women's Hospital, Auckland New Zealand.
The heterogeneous clinical features of vulval intraepithelial neoplasia (VIN), its uncertain and variable natural history, difficulties in the management of certain cases and the frequency of recurrences provide a continuing challenge for gynaecologists. Patients with VIN present to a diverse range of physicians, all of whom provide differing perspectives on the multifarious issues relating to the condition. The importance of VIN relates principally to the symptoms it causes and its potential to progress to invasive vulval cancer. Both the International Society for the Study of Vulvovaginal Diseases and the International Society of Gynaecological Pathologists have stressed the importance of eliminating eponymous terminology and recommend only the term vulval intraepithelial neoplasia (VIN). This terminology includes both squamous and non-squamous varieties (Table 1). The latter includes both Paget's disease of the vulva and melanoma in situ. Non-squamous VIN will not be considered in this paper. Until 30 years ago VIN was an uncommon condition, seen principally in middle and later life. The incidence particularly in younger women has increased significantly since then [1-3]. Since that time the mean age in our unit has fallen from 52.7 years to 35.8 years (Figure 1) [2]. The increasing incidence of the condition parallels similar trends in cervical intraepithelial neoplasia (CIN) and relates at least in part to changing sexual mores, human papilloma virus (HPV) infection, and cigarette smoking.

5
UI - 11944159
AU - Kull C
TI - [Contact isolation]
SO - Krankenpfl Soins Infirm 2001 Mar;94(3):26-7

6
UI - 12131350
AU - Handel LN; Scott SM; Giller RH; Greffe BS; Lovell MA; Koyle MA
TI - New perspectives on therapy for vaginal endodermal sinus tumors.
SO - J Urol 2002 Aug;168(2):687-90
AD - Department of Pediatric Urology, The Children's Hospital and The University of Colorado School of Medicine, Denver, Colorado, USA.
PURPOSE: Malignant germ cell tumors account for 3% of childhood cancers. Endodermal sinus tumor, the most common malignant germ cell tumor, requires treatment primarily with chemotherapy and surgery is reserved as a last resort. It is rare for the vagina to be the primary site of endodermal sinus tumor, and we report on our experiences with this phenomenon at a single institution. MATERIALS AND METHODS: We retrospectively reviewed the clinical features, treatment and outcomes of 3 children with vaginal endodermal sinus tumor. RESULTS: Initial treatment was combination chemotherapy, in 2 patients. alpha-fetoprotein decreased rapidly and returned to normal in both. One patient is disease-free 7 years after chemotherapy and the other patient is currently disease-free with a normal alpha-fetoprotein 3 months after induction chemotherapy. In the remaining case progressive disease developed following initial chemotherapy and subsequent salvage surgery combined with radiation, chemotherapy and ultimately autologous bone marrow transplant was performed. The patient has remained disease-free for 6.5 years since completing this extensive therapy. CONCLUSIONS: Endodermal sinus tumor of the vagina is rare. All of our patients presented with painless bleeding of no obvious source. In such cases one must maintain a high index of suspicion for possible underlying pathological conditions even if ultrasound is negative. Evaluation must include endoscopic examination of the lower genitourinary tract. Bone marrow transplant should be considered as a last therapeutic resort in salvage cases of unresponsive vaginal endodermal sinus tumor.

7
UI - 12146024
AU - Jimenez-Ayala M; Jimenez-Ayala B
TI - Terminology for vulvar cytology based on the Bethesda System.
SO - Acta Cytol 2002 Jul-Aug;46(4):645-50
AD - Department of Pathology, Hospital Universitario Gregorio Maranon, Hospital Universitario de Getafe, Madrid, Spain.
OBJECTIVE: To present a new terminology for vulvar cytology based on the Bethesda System. STUDY DESIGN: Material for cytologic diagnosis was collected by scraping vulvar lesions with a scalpel blade. RESULTS: This terminology was presented for the first time at an International Academy of Cytology conference in Kamuela, Hawaii, in 1997. It is based on the Bethesda System (1994) and WHO system. We recommend the following elements for a vulvar cytologic report: adequacy of specimen, general categorization and descriptive diagnosis. The terminology of vulvar lesions includes benign cellular changes (vulvitis and reactive changes) and epithelial cell abnormalities. If epithelial cell abmormalities are found, the following diagnoses are made: atypical squamous cells of undetermined significance, LSIL, HSIL and vulvar tumors. The most common epithelial tumors are papillary hydradenoma, squamous cell carcinoma and Paget's disease. Five hundred and sixty-three patients with vulvar cytology were examined in our department over 11 years, including 132 with normal vulvas, 220 with vulvitis, 145 with VSIL and 56 with squamous cell carcinoma. Histologic examination of 147 patients (26.11%) showed a sensitivity of 97.70% for benignity and 98.21% for malignancy and 98.87% and 94.82% for specificity, respectively. CONCLUSION: Vulvar cytodiagnosis with the new terminology allows both reporting on the type of vulvar lesions and cancer detection.

8
UI - 12144821
AU - Ellis PE; Fong LF; Rolfe KJ; Crow JC; Reid WM; Davidson T; MacLean AB;
TI - Perrett CW The role of p53 and Ki67 in Paget's disease of the vulva and the breast.
SO - Gynecol Oncol 2002 Aug;86(2):150-6
AD - Department of Obstetrics and Gynaecology, Royal Free & University College Medical School (Royal Free Campus), London, United Kingdom.
OBJECTIVE: Paget's disease of the vulva (PDV) and Paget's disease of the breast (PDB) are uncommon diseases, accounting for approximately 1% of all vulval neoplasms and 0.5-4% of all breast cancers, respectively. In 10-30% of vulval cases an invasive adenocarcinoma is present. In such cases the disease is often aggressive and recurrence rate is high. This is in contrast to PDB where the general consensus is that almost all cases are associated with an in situ or invasive ductal carcinoma. Our aim was to examine the presence of the tumor suppressor protein p53 and the proliferation marker Ki67 in PDV and PDB and correlate any differences in the expression of these two proteins with the presence of an underlying carcinoma. METHODS: Immunohistochemistry was performed on 52 archival cases of PDV, which included 10 with associated invasive adenocarcinoma of the vulva, and on 37 archival cases of PDB, including 26 with available associated ductal carcinoma in situ (DCIS) or invasive carcinoma of the breast. All cases were formalin-fixed and paraffin wax-embedded. Monoclonal antibodies were used with microwave antigen retrieval. Streptavidin-biotin-horseradish peroxidase and 3,3'-diaminobenzidine detection methods were employed to visualize antibody binding and staining. A section was scored positive for p53 if more than 10% of cell nuclei were stained brown and Ki67 was expressed as a percentage of positive cells to the nearest 5% of cells showing nuclear positivity (Ki67 staining index). RESULTS: p53 was expressed in 15 of 52 (29%) PDV cases and 5 of 37 (13%) cases of PDB. Four of the ten cases (40%) of PDV associated with invasive disease expressed p53 compared with 11 of 42 (26%) cases without invasive disease. The mean Ki67 staining index for PDV associated with invasion was 19%, and for that without invasion, 16%. In the breast cases, the mean staining index was 11%. CONCLUSION: Our data suggest that p53 may have a role to play in PDV progression, and may be a late event in some cases, especially those associated with invasive disease. Ki67 has no apparent prognostic role in PDV as there was no significant difference between those cases associated with and those without invasive disease. Neither p53 nor Ki67 appears to have a prognostic role to play in PDB.

9
UI - 12144828
AU - Brustmann H; Naude S
TI - Expression of topoisomerase IIalpha, Ki-67, proliferating cell nuclear antigen, p53, and argyrophilic nucleolar organizer regions in vulvar squamous lesions.
SO - Gynecol Oncol 2002 Aug;86(2):192-9
AD - Department of Pathology, Landeskrankenhaus, Moedling/Vienna, Austria.
OBJECTIVE: It was the aim of this study to investigate the expression of topoisomerase IIalpha (topo IIalpha), Ki-67, proliferating cell nuclear antigen (PCNA), p53, and argyrophilic nucleolar organizer region (AgNOR) staining in normal vulvar epithelia (NE, N = 10), vulvar condylomas (VC, N = 24), vulvar intraepithelial neoplasia (VIN, N = 26), as well as squamous cell carcinomas (SCC, N = 22) of the vulva. METHODS: Formalin-fixed, paraffin-embedded archival tissue sections were immunostained with monoclonal antibodies against topo IIalpha, p53, and PCNA, as well as an affinity-isolated prediluted ready-to-use Ki-67 antibody using a standard immunohistochemical method, and stained with a colloid silver solution for AgNORs. Immunostaining was quantitated by determining the percentage of positively staining nuclei in each sample to express the labeling indices (LIs) by counting the immunoreactive nuclei in 1000 epithelial cells per case for each antibody. In each specimen 200 nuclei were examined using a x100 oil emersion lens, and the mean number of AgNORs per nucleus (AC) was calculated. RESULTS: The LIs for topo IIalpha, Ki-67, and PCNA as well as ACs increased stepwise from NE to VCs, VIN lesions, and SCCs. In contrast to PCNA LIs and ACs, a consistent correlation in all four groups was found for Ki-67 and topo IIalpha, suggesting that the latter is a proliferation-associated marker in these tissues. p53 expression was seen 8.3% of VCs, 30.8% of VIN lesions, and 54.45% of SCCs. p53 LIs were not correlated with LIs for topo IIalpha or Ki-67 in SCCs. The LIs for topo IIalpha, Ki-67, PCNA, p53, and ACs were not related to tumor progression, FIGO stage, or tumor grade in SCCs. CONCLUSIONS: This study presents topo IIalpha and Ki-67 as useful proliferation-associated markers of vulvar epithelia.

The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.

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