• The roles of estrogen and progesterone in breast and genital cancer.

• Complications of systemic oral contraceptive therapy: neoplasm - breast, uterus, cervix and vagina.

• Most clinicians feel DES exposure does not contraindicate OC use.

• DES exposure: implications for childbearing.

• Observations on the psychological impact of diethylstilbestrol exposure and suggestions on management.

• Diethylstilbestrol-exposed monozygotic twins discordant for cervicovaginal clear cell adenocarcinoma.

• Role of hormones including diethylstibestrol (DES) in the pathogenesis of cervical and vaginal intraepithelial neoplasia.

• The current status of the DES-exposed population.

• Prenatal diethylstilbestrol (DES) exposure. Recommendations of the Diethylstilbestrol-Adenosis (DESAD) Project for the identification and

• Preservation of reproductive potential in diethylstilbestrol-related vaginal adenocarcinoma.

• Colposcopic and pathologic features in two cases of DES-related vaginal clear-cell adenocarcinoma.

• Carbon dioxide laser treatment of vaginal adenosis in DES-exposed offspring: a prospective study.

• Diethylstilboestrol (DES) exposure in utero.

• [Sentinel lymph nodes in gynecologic cancers]

• [Vaginal leiomyosarcoma. Apropos of 2 cases and review of the literature]

• Premalignant vulval disorders.

• Trichofolliculoma of the vulva associated with vulvar intraepithelial neoplasia: report of three cases and review of the literature.

• [Imaging of the cervix and the vagina]

• [Treatment of dystrophy, dysplasia and initial stages of vulvar carcinoma in virus infections]

• [Large condylomatous lesions of the vulva and their malignant transformation]

• Concordant p53 and mdm-2 protein expression in vulvar squamous cell carcinoma and adjacent lichen sclerosus.

• Vaginal leiomyoma--an imitator of prolapse.

• Adenoid cystic carcinoma of the vulva: conservative surgery using a de-epithelized rhomboid flap.

• Stage of gestation of intrauterine exposure to diethylstilbestrol.

1
UI - 12332236
AU - Wilson RA
TI - The roles of estrogen and progesterone in breast and genital cancer.
SO - J Am Med Assoc 1962 October 27;182(4):327-31

2
UI - 12333972
AU - Sperling MA
TI - Complications of systemic oral contraceptive therapy: neoplasm - breast, uterus, cervix and vagina.
SO - West J Med Surg 1975 January;122(1):42-9

3
UI - 12341549
AU - Anonymous
TI - Most clinicians feel DES exposure does not contraindicate OC use.
SO - Contracept Technol Update 1987 Oct;8(10):127-9

4
UI - 12286762
AU - Milhan D
TI - DES exposure: implications for childbearing.
SO - Int J Childbirth Educ 1992 Nov-Dec;7(4):21-8

5
UI - 7373597
AU - Burke L; Apfel RJ; Fisher S; Shaw J
TI - Observations on the psychological impact of diethylstilbestrol exposure and suggestions on management.
SO - J Reprod Med 1980 Mar;24(3):99-102
The emotional impact of diethylstilbestrol (DES) exposure is described in a series of 50 mothers and daughters interviewed by psychiatrists. Patterns of response to this trauma and methods of resolution are discussed, and opportunities for preventive intervention by gynecologists are suggested. Specific, open dialogue about DES with the patient as a colleage can minimize the emotional sequelae of the experience.

6
UI - 7189642
AU - Sandberg EC; Christian JC
TI - Diethylstilbestrol-exposed monozygotic twins discordant for cervicovaginal clear cell adenocarcinoma.
SO - Am J Obstet Gynecol 1980 May 15;137(2):220-8
Monozygotic, 17-year-old, female twins exposed to diethylstilbestrol (DES) in utero and discordant for cervicovaginal clear cell adenocarcinoma are reported. Benign teratologic changes were present in both. The twin with cancer was treated by extensive operation and postoperative irradiation. No tumor has appeared in either twin in the 4 years subsequent to therapy. Discordance for cervicovaginal clear cell adenocarcinoma in this situation suggests that factors other than embryonic exposure to DES, extrauterine in location and nongenetic in character, were operative in tumorigenesis. The twins were compared in regard to lifetime radiation exposure and evidence of previous viral disease. The only substantial difference was an elevated titer of antibody in the twin with cancer to the capsid antigen of the Epstein-Barr virus, a herpesvirus with oncogenic capability.

7
UI - 7030882
AU - Robboy SJ; Truslow GY; Anton J; Richart RM
TI - Role of hormones including diethylstibestrol (DES) in the pathogenesis of cervical and vaginal intraepithelial neoplasia.
SO - Gynecol Oncol 1981 Oct;12(2 Pt 2):S98-110

8
UI - 7024873
AU - Herbst AL
TI - The current status of the DES-exposed population.
SO - Obstet Gynecol Annu 1981;10():267-78

9
UI - 6822019
AU - Anonymous
TI - Prenatal diethylstilbestrol (DES) exposure. Recommendations of the Diethylstilbestrol-Adenosis (DESAD) Project for the identification and management of exposed individuals.
SO - Clin Pediatr (Phila) 1983 Feb;22(2):139-43

10
UI - 6824026
AU - Hudson CN; Crandon AJ; Baird PJ; Willcocks D
TI - Preservation of reproductive potential in diethylstilbestrol-related vaginal adenocarcinoma.
SO - Am J Obstet Gynecol 1983 Feb 1;145(3):375-77

11
UI - 6834354
AU - Blythe JG; Michael H; Hodel KA
TI - Colposcopic and pathologic features in two cases of DES-related vaginal clear-cell adenocarcinoma.
SO - J Reprod Med 1983 Feb;28(2):137-46
Two cases of vaginal clear-cell adenocarcinoma occurred as a result of maternal ingestion of diethylstilbestrol during pregnancy. The first case was diagnosed during the patient's first office visit. The second patient was first seen by the authors in 1976 and was followed at six-month intervals during the ensuing six years; the adenocarcinoma developed during this interval. Colposcopy and cytology were important in the diagnosis of both cases.

12
UI - 6633131
AU - Bellina JH; Ross LF; Hemmings R; Voros JI; Moorehead M
TI - Carbon dioxide laser treatment of vaginal adenosis in DES-exposed offspring: a prospective study.
SO - Lasers Surg Med 1983;3(1):23-8
Seventy-nine patients with history and physical findings characteristic of antenatal DES exposure were randomly divided into two groups. Fourty-four DES-exposed offspring had their vaginal adenosis treated with the carbon dioxide laser (group I), and the remaining 35 DES-exposed offspring (group II) did not receive any specific treatment for this condition. Additionally, the 79 DES-exposed offspring were compared to an age-matched control population (group III). Treatment of vaginal adenosis with the carbon dioxide laser did not significantly reduce the incidence of development of new dysplasia in the DES-exposed offspring. This study also showed no statistical difference (p less than or equal to 0.05) in the incidence of dysplasia in DES-exposed offspring as compared to a control population.

13
UI - 6482793
AU - Chanen W; Pagano R
TI - Diethylstilboestrol (DES) exposure in utero.
SO - Med J Aust 1984 Oct 13;141(8):491-3
A clinical review of the first 200 patients who attended the DES Referral Clinic at The Royal Women's Hospital, Melbourne, has been undertaken. To date, clear-cell adenocarcinoma has not been detected in patients attending the Clinic. Fifteen per cent of patients who allegedly were exposed in utero to diethylstilboestrol (DES) showed no clinical stigmata. Vaginal adenosis was found in 41% of patients. On its own, cytological examination of vaginal smears was found to be unreliable as routine screening for detection of adenosis. Painting of the cervix and vagina with Lugol's iodine proved to be a more reliable screening test. Colposcopy is recommended in all patients who are suspected of having been exposed in utero to DES.

14
UI - 12206981
AU - Atallah D; Rouzier R; Camatte S; Pautier P; Pomel C; Lhomme C;
TI - Haie-Meder C; Duvillard P; Castaigne D; Morice P [Sentinel lymph nodes in gynecologic cancers]
SO - Bull Cancer 2002 Jul-Aug;89(7-8):681-8
AD - Departement de chirurgie oncologique, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France.
The detection of the sentinel lymph node is one of the most significant surgical advance in cancer research. This technique allow to decrease the morbidity of a surgical gesture which can be noxious in itself even without bringing a profit in survival. In the gynaecological cancers the detection of the sentinel lymph node is still at the stage of feasibility. An evaluation of the technique and the applicability in these cancers is mandatory in view of the prognostic value of the nodal involvement in these patients.

15
UI - 12199042
AU - Benchakroun N; Tahri A; Tawfiq N; Acharki A; Sahraoui S; Benider A;
TI - Kahlain A [Vaginal leiomyosarcoma. Apropos of 2 cases and review of the literature]
SO - Gynecol Obstet Fertil 2002 Jul-Aug;30(7-8):592-5
AD - Centre d'oncologie Ibn Rochd, Casablanca, Maroc. nadia_benchakroun@caramail.com
The leiomyosarcoma of the vagina is extremely rare. This paper reports two observations treated at the Ibn Rochd oncology center of Casablanca. The first patient was 32 years old, and presented a tumor of 15 cm to the detriment of the posterior wall of the vagina. The treatment consisted of a large exeresis of the tumor followed by postoperative radiotherapy. After 50 months, she is still alive. The second patient who was 42 years old, had a 10 cm tumor of the posterior wall of the vagina. A tumorectomy was realized and then the patient was not heard of. The evolution was marked by the appearance of pulmonary metastasis and a palliative chemotherapy was prescribed. This patient is deceased after 31 months. Seventy-five cases only are described in the literature. The surgery is the basic treatment whereas radiotherapy is still discussed. The prognosis of these tumors remains linked especially to the histological rank.

16
UI - 12230784
AU - Murphy D; Redman C; Thomas E
TI - Premalignant vulval disorders.
SO - Clin Evid 2002 Jun;(7):1733-8
AD - Department of Obstetrics and Gynaecology, New Cross Hospital, Wolverhampton, UK.

17
UI - 12068167
AU - Peterdy GA; Huettner PC; Rajaram V; Lind AC
TI - Trichofolliculoma of the vulva associated with vulvar intraepithelial neoplasia: report of three cases and review of the literature.
SO - Int J Gynecol Pathol 2002 Jul;21(3):224-30
AD - Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, Missouri 63110, USA.
Trichofolliculoma is an uncommon, benign cutaneous adnexal neoplasm most commonly occurring on the head and neck. Trichofolliculoma of the vulva has not been previously reported. The juxtaposition of a trichofolliculoma in an excisional biopsy specimen performed for vulvar intraepithelial neoplasia (VIN III) created a diagnostic dilemma and prompted a review of our files from 1989 to 2000 for additional cases. A search for benign hair follicle tumors of the vulva identified two additional trichofolliculomas. All three vulvar trichofolliculomas were associated with VIN III. During this same period, 628 cases of vulvar intraepithelial neoplasia II and III were identified. The appearance of trichofolliculoma at this previously unreported site may present diagnostic difficulty.

18
UI - 11917654
AU - Rouanet JP; De Graef M; Teissier JM; Daclin PY; Kassem Z; Maubon A
TI - [Imaging of the cervix and the vagina]
SO - J Radiol 2001 Dec;82(12 Pt 2):1845-53
AD - CMC Beausoleil, 119, avenue de Lodeve, 34070 Montpellier.
US and MRI currently are the best imaging modalities to evaluate pathology of the uterine cervix and vagina. Carcinoma of the cervix is the most frequent indication for imaging. MRI allows preoperative staging of cervical carcinoma based on FIGO classification, and post treatment follow-up. Other uterine cervix diseases are less frequently imaged and include a wide range of entities that most frequently cause increased T2W signal at MR imaging. Pathology of the pelvic floor, vagina, vulva, and perineum also includes a wide range of entities that have seldom been described in the imaging literature.

19
UI - 11944391
AU - Tkachuk TIe
TI - [Treatment of dystrophy, dysplasia and initial stages of vulvar carcinoma in virus infections]
SO - Lik Sprava 2002;(1):80-4
Overall sixty-seven patients with distrophy, dysplasia and valvular carcinoma presenting with human papilloma virus- and herpes simplex-2 virus infections underwent a complex treatment intended for background, precancerous affections of the vulva and for valvular carcinoma, involving the use of antiviral drug preparations laferon, zovirax, lovir (both on the systemic and local basis), and an immunomodulator (decaris). Efficacy of the above treatment option has been shown to be 98.5%.

20
UI - 12145975
AU - Ivanov S; Ivanov S
TI - [Large condylomatous lesions of the vulva and their malignant transformation]
SO - Akush Ginekol (Sofiia) 2002;41(3):28-31
For the period of 1987 till 2001 were examined 23 women with big condilomatous lesions of the vulva. There were examined the diagnostic and the therapeutical approach and in the last few years the type of HPV in some of these patients. Our aim was to study and reveal the potential for malignant transformation of the big condimatous lesions of the vulva. Different histological types squamous cell cancer of the vulva were found in 18 women (78.26%): condilomatous cancers--9, verucous--7 and basaloid types--2 vulvar cancer. HPV type 16 was found in 6 cases (4 condilomatous and 2 basaloid cancers). HPV type 6 was revealed in 6 cases with verucous cancer, type 11 in 1 case with verucous and 1 case with condilomatous cancer. In 1 case with condilomatous cancer we found HPV type 18. We used mostly radical vulvectomy with bilateral inguinofemoral lymph dissection a modo Ducuing. This kind of operation was performed in all women with the exception of the benign lesions with negative lymph nodes, where simple vulvectomy was mostly used. Wide local excision was used in 1 woman with verucous cancer and in 1 patient with basaloid cancer hemivulvectomy was performed.

21
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.

22
UI - 11484748
AU - Leron E; Stanton SL
TI - Vaginal leiomyoma--an imitator of prolapse.
SO - Int Urogynecol J Pelvic Floor Dysfunct 2000 Jun;11(3):196-8
AD - St. George's Hospital Medical School, London, UK.
Vaginal leiomyoma is a rare tumor with a variable clinical presentation and broad differential diagnosis that can lead to preoperative misdiagnosis. We present a case of vaginal leiomyoma with a symptom complex of prolapse, urinary urgency and urge incontinence. A 50-year-old woman presented with a 4-year history of deteriorating sensation of prolapse, significant complex urinary complaints and prolonged vaginal bleeding. Clinical examination revealed a mobile 6 x 8 cm mass arising from the anterior vaginal wall. She underwent hysteroscopy, curettage, urethrocystoscopy (normal findings) and mass enucleation through a vertical incision. Histology showed a benign leiomyoma. Ultrasonography, MRI, positive-pressure urethrography and urethrocystoscopy should be considered in the evaluation of an anterior wall vaginal mass. Surgical enucleation via a vaginal approach is the treatment of choice. If this surgical procedure results in skeletonization of the urethral and bladder support, a colporrhaphy/pubourethral ligament plication is required.

23
UI - 11766748
AU - Balat O; Tercan M; Bekerecioglu M; Aydin A; Karakok M; Kutlar I
TI - Adenoid cystic carcinoma of the vulva: conservative surgery using a de-epithelized rhomboid flap.
SO - Eur J Gynaecol Oncol 2001;22(5):387-8
AD - Department of Obstetrics and Gynecology, University of Gaziantep, Sahin Bey Medical Center, Gaziantep, Turkey.
Adenoid cystic carcinoma of the vulva is a very rare entity manifested by an indolent clinical course, late recurrence and a propensity for perineural and local invasion. A 41-year-old women underwent radical local excision and ipsilateral superficial lymph-node dissection using a de-epithelized rhomboid flap for adenoid cystic carcinoma of the left vulva. On follow-up after two years the patient is alive and well with no evidence of disease. In this report we present the first case of adenoid cystic carcinoma of the vulva using a de-epithelized rhomboid flap.

24
UI - 7219945
AU - Kirkhope TG
TI - Stage of gestation of intrauterine exposure to diethylstilbestrol.
SO - Ohio State Med J 1981 Apr;77(4):247-50

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