Table of Contents
1
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.
2
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.
3
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.
4
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.
5
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.
6
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.
7
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.
8
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.
9
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.
10
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.
11
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.
clevenba@mdanderson.org
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.
12
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.
13
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.
14
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
15
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.
16
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.
akimunef@iwate-med.ac.jp
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.
17
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.
18
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.
19
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.
20
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.
21
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.
takeshima@gyn.jfcr.or.jp
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.
22
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.
23
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.
24
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.
wpi9d@hscmail.mcc.virginia.edu
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.
25
UI - 11737317
AU - Cohen M; Pedemonte L; Drut R
TI -
Pigmented mullerian papilloma of the vagina.
SO - Histopathology 2001 Nov;39(5):541-3
26
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.
27
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.
28
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 29
UI - 11277664
AU - Moskovic E
TI -
Response to "Inguinal node status by ultrasound in vulva cancer" (Abang
Mohammed et al. Gynecol Oncol 2000;77:93-6).
SO - Gynecol Oncol 2001 Apr;81(1):123-4
30
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. glenn.mccluggage@bll.n-i.nhs.uk
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.
31
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.
32
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.
33
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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