Table of Contents
1
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.
2
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.
3
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. donnellanr@med.und.ac.za
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.
4
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. tgfb@ukl.uni-freiburg.de
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.
5
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.
6
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.
7
UI - 21469906
AU - Lebrecht A; Hefler L; Schneeberger C; Koelbl H
TI -
Serum leptin in patients with vulvar cancer.
SO - Gynecol Oncol 2001 Oct;83(1):164-5
8
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.
gmeniru@hotmail.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.
9
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.
10
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.
11
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.
12
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. gatschar@mskcc.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.
13
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.
14
UI - 21485115
AU - Ilancheran A
TI -
Vulvar cancer--(r)evolution in management.
SO - Singapore Med J 2001 Jul;42(7):290-1
15
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. sham@kkh.com.sg
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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