Table of Contents
1
UI - 11815968
AU - Hefler LA; Concin N; Mincham D; Thompson J; Swarte NB; van Eijkeren MA;
TI -
Sie-Go DM; Hammond I; McCartney AJ; Tempfer CB; Speiser P
The prognostic value of immunohistochemically detected CD44v3 and CD44v6
expression in patients with surgically staged vulvar carcinoma: a
multicenter study.
SO - Cancer 2002 Jan 1;94(1):125-30
AD - Department of Gynecology & Obstetrics, University of Vienna Medical
School, Vienna, Austria. l_hefler@hotmail.com
BACKGROUND: Isoforms of the adhesion molecule CD44 are involved in
carcinogenesis and the metastatic cascade of tumor cells by increasing
the affinity of malignant cells to their extracellular matrix.
Preliminary data with respect to the prognostic value of the CD44
isoforms CD44v3 and CD44v6 in patients with vulvar carcinoma showed
promising results. The current multicenter study aimed to determine the
prognostic value of CD44v3 and CD44v6 in patients with surgically staged
vulvar carcinoma. METHODS: Expression of CD44v3 and CD44v6 in vulvar
carcinoma tissue was assessed by immunohistochemistry.
Immunohistochemical staining was performed according to established
protocols. Results were correlated to clinical data. RESULTS: A positive
CD44v3 and CD44v6 staining was detected in 33.3% (33 out of 99) and
39.4% (39 out of 99) of the tumor samples, respectively. Overexpression
of CD44v6 was associated with an impaired prognosis with respect to
disease-free survival (P = 0.01) and overall survival (P = 0.04).
Multivariate analysis showed that CD44v6 provided prognostic information
with respect to disease-free survival (P = 0.001) and overall survival
(P = 0.005) independently of the two established prognosticators, tumor
stage and groin lymph node involvement. Overexpression of CD44v3 had no
impact on patient survival. CONCLUSIONS: The current multicenter study,
involving a large series of patients with surgically staged vulvar
carcinoma, allowed for multivariate survival analysis and showed that
CD44v6 confers prognostic information in addition to that provided by
the established clinicopathologic parameters of tumor stage and lymph
node status. Copyright 2002 American Cancer Society.
2
UI - 11464136
AU - Kumar R; Kumar S; Hemal AK
TI -
Vaginal and omental metastasis from superficial bladder cancer.
SO - Urol Int 2001;67(1):117-8
AD - Department of Urology, All India Institute of Medical Sciences, Ansari
Nagar, New Delhi, India.
A 58-year-old lady, diagnosed as having superficial bladder cancer 6
years earlier presented to us with a vaginal nodule. Investigations and
biopsy revealed a metastatic transitional cell carcinoma in the pelvic
lymph nodes, omentum and vagina. Copyright 2001 S. Karger AG, Basel
3
UI - 11714112
AU - Hatch EE; Herbst AL; Hoover RN; Noller KL; Adam E; Kaufman RH; Palmer
TI -
JR; Titus-Ernstoff L; Hyer M; Hartge P; Robboy SJ
Incidence of squamous neoplasia of the cervix and vagina in women
exposed prenatally to diethylstilbestrol (United States).
SO - Cancer Causes Control 2001 Nov;12(9):837-45
AD - Division of Cancer Epidemiology and Genetics, National Cancer Institute,
Bethesda, MD, USA. eehatch@bu.edu
OBJECTIVES: Women exposed prenatally to diethylstibestrol (DES) have an
excess risk of clear-cell adenocarcinoma of the vagina and cervix, but
the effect on the incidence of squamous neoplasia is uncertain. The
purpose of the current study was to evaluate the long-term risk of
developing high-grade squamous neoplasia of the genital tract among
women exposed prenatally to DES. METHODS: A cohort comprising 3,899
DES-exposed and 1,374 unexposed daughters was followed for 13 years
(1982 1995) for pathology-confirmed diagnoses of high-grade squamous
intraepithelial neoplasia (HSIL) of the genital tract. Poisson
regression analysis was used to compute relative risks (RR) and 95%
confidence intervals (95% CI), adjusting for age, calendar year, and
other covariates. RESULTS: The RR (95% CI) among DES-exposed versus
unexposed, based on 111 cases of high-grade disease, was 2.1 (1.2-3.8).
Adjustment for screening history estimated by the number of years since
the last Pap smear had little effect. Risk estimates were higher with
earlier intrauterine exposure; the RR (95% CI) for exposure within 7
weeks of the last menstrual period was 2.8 (1.4-5.5). Only two cases of
invasive squamous cervical cancer occurred in total, precluding separate
analysis. CONCLUSIONS: The findings support an association between
in-utero DES exposure and high-grade squamous neoplasia, although a role
for more intensive screening among DES-exposed women in the production
of this excess could not be completely ruled out.
4
UI - 11720444
AU - O'Nions J; Brooks LA; Sullivan A; Bell A; Dunne B; Rozycka M; Reddy A;
TI -
Tidy JA; Evans D; Farrell PJ; Evans A; Gasco M; Gusterson B; Crook T
p73 is over-expressed in vulval cancer principally as the Delta 2
isoform.
SO - Br J Cancer 2001 Nov 16;85(10):1551-6
AD - Ludwig Institute for Cancer Research, St Mary's Hospital Medical School,
Norfolk Place, London W2 1PG .
p73 was studied in squamous cancers and precursor lesions of the vulva.
Over-expression of p73 occurred commonly in both human papillomavirus
(HPV)-positive and -negative squamous cell cancers (SCC) and high-grade
premalignant lesions. Whereas expression in normal vulval epithelium was
detected only in the basal and supra-basal layers, expression in
neoplastic epithelium increased with grade of neoplasia, being maximal
at both protein and RNA levels in SCC. p73 Delta 2 was the principal
over-expressed isoform in the majority of cases of vulval SCC and often
the sole form expressed in SCC. Over-expression of p73 was associated
with expression of HPV-encoded E7 or with hypermethylation or mutation
of p16(INK4a) in HPV-negative cases. There was a close correlation
between expression of p73 and p14(ARF) in cancers with loss of p53
function. The frequent over-expression of p73 Delta 2 in neoplastic but
not normal vulval epithelium, and its co-ordinate deregulation with
other E2F-1 responsive genes suggests a role in the oncogenic process.
5
UI - 11603227
AU - McCluggage WG; Price JH; Dobbs SP
TI -
Primary adenocarcinoma of the vagina arising in endocervicosis.
SO - Int J Gynecol Pathol 2001 Oct;20(4):399-402
AD - Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road,
Belfast, BT12 6BL, Northern Ireland. glenn.mccluggage@bll.n-i.nhs.uk
Endocervicosis is a rare condition, being one of the triad of
non-neoplastic secondary mullerian lesions. This report describes a
primary vaginal adenocarcinoma arising in endocervicosis. Histologic
examination showed a mucin-secreting adenocarcinoma admixed with benign
mucin-containing endocervical-type glands with a transition from
dysplastic glands to obvious adenocarcinoma. There were bilateral groin
lymph node metastases at presentation and the tumor recurred locally 9
and 12 months after treatment. This is the second reported case of
vaginal endocervicosis and the first documented report of adenocarcinoma
arising in endocervicosis at any site.
6
UI - 11702099
AU - Tavares MG; Sapienza MT; Galeb NA Jr; Belfort FA; Costa RR; Osorio CA;
TI -
Goes JC; Endo IS; Soares J Jr; Lewin S; Marone MM
The use of 99mTc-phytate for sentinel node mapping in melanoma, breast
cancer and vulvar cancer: a study of 100 cases.
SO - Eur J Nucl Med 2001 Nov;28(11):1597-604
AD - UDDO - Nuclear Medicine Department, Avenida Alcantara Machado 2576,
Mooca 03102-000, Sao Paulo, SP, Brazil. uddo.ibcc@uol.com.br
Sentinel node mapping reduces surgical morbidity and allows the use of
more accurate tumour staging techniques. Radionuclide studies are
preferentially performed using small colloids, which have limited
availability in our country. The possibility of using phytate for
sentinel node mapping was raised because of the similarity between its
biodistribution and that of nanocolloids in the reticulo-endothelial
system. In this paper we evaluated the use of 99mTc-phytate for sentinel
node mapping, correlating the histopathological results with the status
of the rest of the lymph node chain in different malignant tumours. A
total of 100 patients were studied. group 1 consisted of 62 patients
with breast cancer, group 2 of 20 patients with melanoma and group 3 of
18 patients with vulvar carcinoma. Lymph node scintigraphy was carried
out after injecting 99mTc-phytate subdermally, and the sentinel node
projection was marked on the skin. After 18-24 h, intraoperative
sentinel node localisation was performed using a gamma probe (combined
with visual localisation using patent blue dye) in 75 patients, and
lymph node dissection was then carried out. Radionuclide scintigraphy
identified the sentinel node in 98% of all studies. Intraoperative
detection using the gamma probe was equally efficient: group 1=93%
(38/41), group 2=95% (18/19) and group 3=100% (15/15). The sentinel node
was involved in 41%, 31% and 20% of cases in groups 1, 2 and 3,
respectively. Among the patients with positive nodes, the sentinel node
was the only one affected in 53% of group 1, 50% of group 2 and 67% of
group 3 cases. The method's negative predictive value was 91% in group 1
and 100% in the other groups. One false-negative study occurred in a
patient who had a multifocal tumour and an intraparenchymatous lymph
node; another occurred in a patient with a macroscopically affected node
found during surgery. There were no side-effects related to the
99mTc-phytate. It is concluded that scintigraphic and intraoperative
sentinel node identification was satisfactorily performed using
99mTc-phytate. The results were comparable to those previously described
in the literature using other radiopharmaceuticals. Easy availability
and low cost justify the use of phytate in our practice.
7
UI - 11793194
AU - Wu X; Xin Y; Yao J; Hasui K; Tsuyama S; Yonezawa S; Murata F
TI -
Expression of epithelial growth factor receptor and its two ligands,
transforming growth factor-alpha and epithelial growth factor, in normal
and neoplastic squamous cells in the vulva: an immunohistochemical
study.
SO - Med Electron Microsc 2001 Sep;34(3):179-84
AD - Department of Gynecology, The First Clinical College, China Medical
University, Shenyang, China.
Epithelial growth factor receptor (EGFR) sends signals to the
proliferation signal transduction system, receiving two ligands:
epithelial growth factor (EGF) and transforming growth factor-alpha
(TGF-alpha). This immunohistochemical study examined the roles of EGFR
and its ligands in the proliferation of normal and neoplastic vulvar
squamous cells in 25 patients with vulvar squamous cell carcinoma
(VSCC), 10 patients with vulvar condyloma acuminata (VCA), 15 patients
with vulvar intra-epithelial neoplasm I-II or III (VIN I-II or III), and
5 subjects with vulvar normal squamous cells (VNSC). EGFR was detected
in a few basal cells in 40% of the VNSC, in highly dysplastic cells in
40% of the VIN III, in many neoplastic cells in 80% of the VCA, and in
some malignant cells in 64% of the VSCC. EGF was seen in the cytoplasm
in 20% of the VIN I-II, 100% of the VIN III, 100% of the VCA, and 100%
of the VSCC. Diffuse TGF-alpha was weakly expressed in the cytoplasm in
100% of the VNSC, more intensely in 100% of the VIN and 100% of the VCA,
and intensely in 100% of the VSCC. These findings led to the suggestion
that the TGF-alpha-EGFR system maintains the growth of normal squamous
cells and, in part, maintains the growth of dysplastic and neoplastic
squamous cells in the vulva. EGF expression was an early sign of
neoplasia. The expression of EGFR with overexpression of its two ligands
contributed to the proliferation of dysplastic and neoplastic squamous
cells in VIN III and VCA. EGFR expression appeared to contribute to
essential neoplastic abnormalities in 64% of the VSCC.
8
UI - 11804896
AU - Sohaib SA; Richards PS; Ind T; Jeyarajah AR; Shepherd JH; Jacobs IJ;
TI -
Reznek RH
MR imaging of carcinoma of the vulva.
SO - AJR Am J Roentgenol 2002 Feb;178(2):373-7
AD - Department of Diagnostic Imaging, St. Bartholomew's Hospital, West
Smithfield, London, EC1A 7BE, United Kingdom.
OBJECTIVE: The aim of this study was to describe the MR imaging features
of cancer of the vulva and to determine the accuracy of MR imaging in
staging the disease. MATERIALS AND METHODS: We reviewed the MR images of
22 patients (range, 21-85 years; median, 74 years) with cancer of the
vulva who were treated at our institution between 1995 and 2000. Note
was made of the primary tumor size, site, signal characteristics,
enhancement, and local extension and of lymph node number, size, and
position. The MR imaging features were correlated with surgical and
pathologic findings. RESULTS: The tumors were isointense to muscle on
T1-weighted images and showed intermediate-to-high signal intensity on
T2-weighted scans. After IV gadolinium was administered to four
patients, tumor enhancement was seen in two (50%). MR imaging correctly
staged the primary site in 14 (70%) of the 20 patients. If superficial
inguinal nodes 10 mm or greater in short-axis diameter are considered
abnormal, then the sensitivity for detection of malignant nodes was 40%
and the specificity, 97%. If deep inguinal nodes 8 mm or greater in
short-axis diameter are considered abnormal, then the sensitivity for
detection of malignant nodes was 50% and the specificity, 100%.
CONCLUSION: MR imaging is highly specific for the detection of nodal
involvement in patients with cancer of the vulva but correlates only
moderately with clinicopathologic staging of the primary tumor.
9
UI - 11695804
AU - Chattopadhyay I; Cruickshan DJ; Packer M
TI -
Non diethylstilbesterol induced vaginal adenosis--a case series and
review of literature.
SO - Eur J Gynaecol Oncol 2001;22(4):260-2
AD - Specialist Registrar, Obstetrics and Gynaecology, Hartlepool General
Hospital, UK.
Non diethylstilbestrol induced vaginal adenosis has a reported incidence
of about 10% in adult women. Although in some, it may be an
insignificant coincidental finding, it is probably under-diagnosed even
in symptomatic women. Little is known about the aetiology, pathogenesis,
symptomatology and management of this poorly understood condition. Our
experience with the four cases of vaginal adenosis unrelated to
diethylstilbestrol (DES) exposure and a review of the literature will
probably shed some light on this, as it still remains an enigma in
gynaecological oncology.
10
UI - 11695815
AU - Kouvaris JR; Kouloulias VE; Loghis CD; Balafouta EJ; Miliadou AC; Vlahos
TI -
LJ
Minor prognostic factors in squamous cell vulvar carcinoma.
SO - Eur J Gynaecol Oncol 2001;22(4):305-8
AD - Department of Radiology-Radiotherapy, Aretaieion Hospital, University of
Athens, Greece.
PURPOSE OF THE STUDY: To evaluate minor prognostic factors in a patient
population with squamous cell vulvar carcinoma, with particular
attention to age, smoking, obesity and parity. METHODS: A total of 50
women with invasive squamous cell vulvar carcinoma were retrospectively
analyzed. Factors assessed for prognostic value included age, obesity,
diabetes, hypertension, smoking and parity. RESULTS: The log-rank test
and the univariate regression analysis revealed that all factors
decreased the overall survival. In the multivariate regression analysis
only age, obesity, smoking and parity were independent predictors for
survival. The relative risk of death for elderly and patients, obese
smokers, and patients with more than three deliveries was 1.008, 1.159,
1.411 and 2.532, respectively. Hypertension and diabetes seemed to be
questionable prognostic factors. CONCLUSION: Smokers, patients who had
more than three children, body mass index >27, and were older than 73
years had a poorer survival rate.
11
UI - 11547655
AU - Zahn CM; Kendall BS; Liang CY
TI -
Spindle cell lipoma of the female genital tract. A report of two cases.
SO - J Reprod Med 2001 Aug;46(8):769-72
AD - Department of Obstetrics and Gynecology, Uniformed Services University
of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799,
USA. czahn@usuhs.mil
BACKGROUND: Lipomas presenting in the female genital tract are most
commonly seen in the vulva or myometrium as a component of a leiomyoma.
These lesions have the gross appearance of a typical lipoma. CASES: Two
cases of spindle cell lipoma occurred, one incidentally encountered in
the cervix and the other presenting as a vulvar mass. Both lesions
demonstrated histologic features characteristic of spindle cell lipomas
normally found elsewhere, and the diagnosis was supported by
immunohistochemical staining patterns. CONCLUSION: This is the first
report of spindle cell lipomas diagnosed in the female genital tract.
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