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Abramson Cancer CenterNCI CANCERLIT® Search: Vaginal and Vulvar Cancer - April 2002
National Cancer Institute®
Last Modified: April 1, 2002
Table of Contents
1
UI - 11725728
AU - Molpus KL; Kelley MC; Johnson JE; Martin WH; Jones HW 3rd
TI -
Sentinel lymph node detection and microstaging in vulvar carcinoma.
SO - J Reprod Med 2001 Oct;46(10):863-9
AD - Department of Obstetrics and Gynecology, University of Nebraska Medical
Center, Omaha, NE 68198-3255, USA. kmolpus@unmc.edu
OBJECTIVE: To determine the efficacy of using complementary techniques
for detecting sentinel lymph nodes (SLNs) in vulvar carcinoma and to
evaluate the utility of microstaging techniques. STUDY DESIGN: Patients
with invasive vulvar carcinoma underwent sentinel lymph node detection
(SLND) using preoperative lymphoscintigraphy, intraoperative isosulfan
blue dye injection and an intraoperative hand-held gamma-detecting
probe. Eleven patients were included and a total of 16 groins evaluated.
Sentinel nodes identified were excised, bisected and examined in
surgical pathology using hematoxylin and eosin (H&E) staining.
Pathologically negative SLNs were subjected to additional microstaging
via serial sectioning and immunohistochemical staining for cytokeratin.
Surgical management of the vulvar cancer and extent of inguinal-femoral
lymphadenectomy were individualized based on clinicopathologic
parameters, including depth of invasion, location of the tumor and
patient performance status. RESULTS: Lymphoscintigraphy, dye and
gamma-detector methods led to the total detection of 16, 19 and 17 SLNs,
respectively. In two cases the isosulfan blue dye assisted in the
isolation of an additional sentinel node over that of the gamma probe.
Each method individually identified SLNs in 10/11 patients (91%). A
total of 19 sentinel nodes were isolated. One SLN (5%) was positive for
metastatic disease using H&E staining. Of the 18 negative SLNs, 2 (11%)
had micrometastases (< 0.2 mm) upon serial sectioning and
immunohistochemical staining. CONCLUSION: Combined-modality mapping
enhances detection of SLNs in vulvar carcinoma. Histologic microstaging
improves the detection of micrometastases within SLNs.
2
UI - 11801875
AU - Joura EA
TI -
Epidemiology, diagnosis and treatment of vulvar intraepithelial
neoplasia.
SO - Curr Opin Obstet Gynecol 2002 Feb;14(1):39-43
AD - Department of Gynecology and Obstetrics, University of Vienna, Vienna,
Austria. elmar.joura@akh-wien.ac.at
The incidence of human papilloma virus-related vulvar intraepithelial
neoplasia is increasing worldwide. This is associated with an increasing
incidence of invasive vulvar cancer in young women. Undifferentiated
vulvar intraepithelial neoplasia has an invasive potential; a subset of
very young patients with pigmented lesions and spontaneous regression
has been described. Differentiated vulvar intraepithelial neoplasia is
human papilloma virus negative and affects older women, who are at risk
of invasive cancer. Chromosomal changes and angiogenesis may play a role
in carcinogenesis. Immunocompromised women bear a substantial risk of
vulvar intraepithelial neoplasia. These facts demand the awareness of
both women and physicians, because there is evidence of diagnostic
delays in patients with vulvar cancer. The standard treatment is
surgical excision, which may be combined with laser treatment in
extensive disease. Preliminary results of topical antiviral agents and
photodynamic therapy are available, but remain to be confirmed by
prospective, placebo-controlled studies.
3
UI - 11875739
AU - Reddy A; Yuille M; Sullivan A; Repellin C; Bell A; Tidy JA; Evans DJ;
TI -
Farrell PJ; Gusterson B; Gasco M; Crook T
Analysis of CHK2 in vulval neoplasia.
SO - Br J Cancer 2002 Mar 4;86(5):756-60
AD - Ludwig Institute for Cancer Research, Imperial College Faculty of
Medicine, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
Structure and expression of the Rad53 homologue CHK2 were studied in
vulval neoplasia. We identified the previously described silent
polymorphism at codon 84 (A>G at nucleotide 252) in the germ-line of six
out of 72, and somatic mutations in two out of 40 cases of vulval
squamous cell carcinomas and none of 32 cases of vulval intraepithelial
neoplasia. One mutation introduced a premature stop codon in the kinase
domain of CHK2, whereas the second resulted in an amino acid
substitution in the kinase domain. The two squamous cell carcinomas with
mutations in CHK2 also expressed mutant p53. A CpG island was identified
close to the putative CHK2 transcriptional start site, but
methylation-specific PCR did not detect methylation in any of 40 vulval
squamous cell carcinomas, irrespective of human papillomavirus or p53
status. Consistent with this observation, no cancer exhibited loss of
CHK2 expression at mRNA or protein level. Taken together, these
observations reveal that genetic but not epigenetic changes in CHK2
occur in a small proportion of vulval squamous cell carcinomas.
Copyright 2002 Cancer Research UK
4
UI - 11891200
AU - Regauer S; Reich O; Beham-Schmid C
TI -
Monoclonal gamma-T-cell receptor rearrangement in vulvar lichen
sclerosus and squamous cell carcinomas.
SO - Am J Pathol 2002 Mar;160(3):1035-45
AD - Institute of Pathology and Departmentof Obstetrics and Gynecology,
University of Graz, Graz, Austria. sigrid.regauer@kfunigraz.ac.at
Risk factors for vulvar squamous cell carcinoma (SCC) are human
papilloma virus (HPV) infections and lichen sclerosus (LS). The
significance of monoclonal gamma-T-cell receptor (gamma-TCR)
rearrangement in the lymphoid infiltrate of LS and the consequence for
vulvar carcinogenesis is unknown. One hundred sixty-one biopsies of
vulvar LS and SCC, with and without LS, were examined for monoclonal
gamma-TCR rearrangement and HPV16 expression, and for the expression of
B- and T-cell markers and fascin. Monoclonal gamma-TCR rearrangement was
identified in 8 of 17 patients with LS and 11 of 21 patients with SCC
arising in LS with only occasional HPV16 DNA detection. None of the 19
SCC without LS showed monoclonal gamma-TCR rearrangement, but 14 of 19
patients had strong HPV16 detection. The lichenoid infiltrate of LS with
germline configuration consisted predominantly of T cells (CD8 > CD4),
along with numerous B cells. However, in biopsies with monoclonally
rearranged gamma-TCR, CD4-positive T cells dominated along with B cells
and fascin-positive cells in the lichenoid infiltrate and in deeply
located lymphocyte aggregates (LAs). These LAs additionally contained
fascin-positive dendritic cells with only individual CD8, CD57, and
granzyme-positive cells. LAs in biopsies with germline configuration
demonstrated numerous T cells (CD8 >CD4), but only single peripheral B
cells, CD57, and fascin-positive lymphocytes. Our data suggest that
monoclonal gamma-TCR rearrangement is characteristic for and limited to
LS and SCC arising in LS, raising the question for a LS-associated
antigen. We interpret B cells, CD4-positive T cells, and
fascin-expressing dendritic cells within LS as a cellular immune
response to antigen or proliferating T-cell clones. The resulting local
immune dysregulation in LS may provide a permissive environment for the
development of a SCC.
5
UI - 11905414
AU - de Hullu JA; Hollema H; Hoekstra HJ; Piers do A; Mourits MJ; Aalders JG;
TI -
van der Zee AG
Vulvar melanoma: is there a role for sentinel lymph node biopsy?
SO - Cancer 2002 Jan 15;94(2):486-91
AD - Department of Gynecologic Oncology, University Hospital Groningen, The
Netherlands. j.a.de.hullu@og.azg.nl
BACKGROUND: The objective of this study was to evaluate the author's
recent, preliminary experience with the sentinel lymph node procedure in
patients with vulvar melanoma and to compare this experience with
treatment and follow-up of patients with vulvar melanomas who were
treated previously at their institution. METHODS: From 1997, sentinel
lymph node procedure with the combined technique (99mTechnetium-labeled
nanocolloid and Patente Blue-V) was performed as a standard staging
procedure for patients with vulvar melanoma with a thickness > 1 mm and
no clinically suspicious inguinofemoral lymph nodes. For the current
study, clinicopathologic data from all 33 patients with vulvar melanoma
who were treated between 1978 and 2000 at the University Hospital
all nine patients who were referred for treatment of vulvar melanoma.
Three patients underwent subsequent complete inguinofemoral
lymphadenectomy because of metastatic sentinel lymph nodes. In
follow-up, groin recurrences (in-transit metastases) occurred in two of
nine patients, both 12 months after primary treatment. Both patients had
melanomas with a thickness > 4 mm and previously had negative sentinel
lymph nodes. There was a trend toward more frequent groin recurrences in
patients after undergoing the sentinel lymph node procedure (2 of 9
patients) compared with 24 historic control patients (0 of 24 patients;
P = 0.06). Five of 33 patients developed local recurrences: Two patients
had groin recurrences, and 11 patients developed distant metastases.
Twelve patients died of vulvar melanoma. Seventeen patients with a
median follow-up of 66 months (range, 9-123 months) are currently alive
(overall survival rate, 52%). CONCLUSIONS: Although the numbers were
small, this study showed that the sentinel lymph node procedure is
capable of identifying patients who have occult lymph node metastases
and who may benefit from lymphadenectomy for locoregional control and
prevention of distant metastases. However, the data also suggest that
the sentinel lymph node procedure may increase the risk of locoregional
recurrences (in-transit metastases), especially in patients with thick
melanomas. The potential role of the sentinel lymph node procedure as an
alternative method of lymph node staging in patients with vulvar
melanoma needs further investigation only within the protection of
clinical trials and probably should be restricted to patients with
melanomas with intermediate thickness (1-4 mm).
6
UI - 11917588
AU - Hale JL; Schwenk GR Jr; Wilson DB; Moriarty AT; Crabtree WN
TI -
Diagnosis of a vulvar granular cell tumor by fine needle aspiration
biopsy. A case report.
SO - Acta Cytol 2002 Mar-Apr;46(2):373-6
AD - Department of Cytopathology, Methodist Clinical Laboratory, Clarian
Health, AmeriPath of Indiana, Department of Pathology, Laboratory
Medicine, Indiana University School of Medicine, Indianapolis, Indiana,
USA.
BACKGROUND: Granular cell tumor (GCT) (granular cell "myoblastoma") is
an uncommon neoplasm that may mimic carcinoma both clinically and
morphologically. Fine needle aspiration diagnosis of vulvar GNT has been
described on only one prior occasion. CASE: A 74-year-old, black female
presented with a mass in the left labia. Fine needle aspiration biopsy
revealed rare intact cells; abundant, granular, cytoplasmic fragments;
and bland, ovoid, stripped nuclei. The intact cells were arranged in
loose aggregates. Each sampling was exquisitely painful to the patient
despite the use of local anesthesia. CONCLUSION: Cytologists should be
aware of the distinctive clinical and morphologic appearance of GCT. The
cytologic findings of vulvar, GCT are identical to those described at
other body sites. Definitive diagnosis before extirpation permits
definitive therapy.
7
UI - 11917602
AU - Ng WK
TI -
Non-small cell carcinoma of the lung metastatic to the lower female
genital tract and mimicking glassy cell carcinoma.
SO - Acta Cytol 2002 Mar-Apr;46(2):438-40
8
UI - 11902101
AU - Unterweger M; Caduff R; Ochsenbein-Imhof N; Kubik-Huch RA
TI -
[Vaginal granulocytic sarcoma: CT and MR imaging]
SO - Schweiz Rundsch Med Prax 2002 Feb 27;91(9):367-70
AD - Institut fur Diagnostische Radiologie, Universitatsspital Zurich,
Schweiz. munterweger@uhbs.ch
A 30-year-old female patient with vaginal bleeding was referred to the
gynecological unit of our hospital. Speculum examination showed a
lobulated tumor, 5 cm in size, at the vaginal fornix. MRI demonstrated a
tumor encompassing the ventral part of the vagina and the entire cervix.
Computed tomography diagnosed pathologically enlarged mediastinal lymph
nodes. Subsequent examinations revealed an acute myeloic leukemia,
synchronous histopathological examination of the vaginal tumor led to
the rare diagnosis of a granulocytic sarcoma.
9
UI - 11896620
AU - Gasco M; Sullivan A; Repellin C; Brooks L; Farrell PJ; Tidy JA; Dunne B;
TI -
Gusterson B; Evans DJ; Crook T
Coincident inactivation of 14-3-3sigma and p16INK4a is an early event in
vulval squamous neoplasia.
SO - Oncogene 2002 Mar 14;21(12):1876-81
AD - UO Oncologia Medica, Azienda Ospedaliera S Croce e Carle, Via Coppino
26, 12100 Cuneo, Italy.
The structure and expression of 14-3-3 sigma(sigma) was analysed in
squamous carcinomas (SCC) of the vulva and in the vulval pre-malignant
lesion vulval intraepithelial neoplasia (VIN). Sequence analysis of the
sigma coding region did not detect mutations in any case of SCC or VIN
III and loss of heterozygosity (LOH) occurred in only 2 out of 27
informative cases. In contrast to the absence of genetic change,
methylation-specific PCR (MSP) analysis revealed dense CpG methylation
within the sigma gene in approximately 60% of cases of vulval SCC, but
methylation was not detected in matched, normal epithelial tissue.
Methylation was associated in all cases with reduced or absent
expression of sigma mRNA. There was no correlation between sigma
methylation and HPV or p53 status. Analysis of pre-malignant vulval
intraepithelial neoplasia (VIN) revealed that sigma methylation was
detectable early in neoplastic development. Co-incident methylation,
accompanied by loss of expression, of sigma and p16INK4a was commonly
detected in both SCC and VIN III, suggesting that epigenetic silencing
of these two genes is an early and important event in vulval neoplasia.
10
UI - 10986677
AU - Joura EA; Losch A; Haider-Angeler MG; Breitenecker G; Leodolter S
TI -
Trends in vulvar neoplasia. Increasing incidence of vulvar
intraepithelial neoplasia and squamous cell carcinoma of the vulva in
young women.
SO - J Reprod Med 2000 Aug;45(8):613-5
AD - Department of Gynecology and Obstetrics, University of Vienna, Austria.
elmar.joura@akh-wien.ac.at
OBJECTIVE: To determine trends in the epidemiology of vulvar
intraepithelial neoplasia (VIN) and squamous cell carcinoma (SCC) of the
vulva in a Central European sample during the last decade. STUDY DESIGN:
A total of 366 women with VIN 2 and 3 (n = 128) or vulvar SCC (n = 238)
presented within two four-year periods separated by one decade
(1985-1988 and 1994-1997). We performed a retrospective analysis of the
clinicopathologic records of the cohorts. RESULTS: The number of women
with high grade VIN (n = 29 vs. 99) tripled during the last decade,
while the incidence of vulvar SCC remained stable. In women < or = 50
years old, the incidence of high grade VIN increased by 392% (n = 12 vs.
59) and of invasive vulvar cancer by 157% (n = 7 vs. 18). In the earlier
cohort there were 7/126 (5%) women with invasive vulvar SCC under the
age of 50 and, in the latter cohort, 18/112 (16%, P < .01). CONCLUSION:
Over the past decade a striking increase occurred in the incidence of
VIN and an increase in invasive vulvar SCC in young women.
11
UI - 10986685
AU - Heller DS; Cracchiolo B; Hameed M; May T
TI -
Pregnancy-associated invasive squamous cell carcinoma of the vulva in a
28-year-old, HIV-negative woman. A case report.
SO - J Reprod Med 2000 Aug;45(8):659-61
AD - Department of Pathology, University of Medicine and Dentistry of New
Jersey-New Jersey Medical School, Newark 07103, USA. hellerds@umdnj.edu
BACKGROUND: The incidence of invasive squamous cell carcinoma of the
vulva in women under 40 years of age has been increasing, particularly
in association with human papillomavirus. Invasive vulvar carcinoma is
rare in women under 30, as is an association with pregnancy. We report
on a 28-year-old woman who was diagnosed with invasive squamous cell
carcinoma of the vulva during pregnancy. CASE: The patient, gravida 5,
para 4105, HIV negative, presented to the emergency room with vulvar
pain. She had delivered a term infant three months earlier at another
institution and was diagnosed with squamous cell carcinoma of the vulva
at that time. At this admission, a 4.0-cm, ulcerated lesion involving
the left labium minus was noted. The patient underwent examination under
anesthesia with bilateral inguinal lymph node dissection, cone biopsy,
radical vulvectomy and excision of perianal lesions. CONCLUSION: This
case demonstrates the need to biopsy all suspicious vulvar lesions, even
in young and pregnant women.
12
UI - 11354848
AU - Jones RW
TI -
Vulvar intraepithelial neoplasia and squamous cell carcinoma of the
vulva in young women.
SO - J Reprod Med 2001 Apr;46(4):408
13
UI - 11818193
AU - Isoda H; Kurokawa H; Kuroda M; Asakura T; Akai M; Sawada S; Nakagawa M;
TI -
Shikata N
Fibroma of the vulva.
SO - Comput Med Imaging Graph 2002 Mar-Apr;26(2):139-42
AD - Department of Radiology, Kansai Medical University, 10-15, Fumizono-cho,
Moriguchi, 570-8506, Osaka, Japan.
We describe a patient with fibroma of the vulva. The tumor had areas of
marked hypointensity consistent with fibrosis on T1 and T2 weighted
magnetic resonance (MR) images. The presence of abundant fibrous tissues
on MR images enabled us to make a preoperative diagnosis of fibroma.
14
UI - 10989637
AU - Wada H; Enomoto T; Yoshino K; Ozaki K; Kurachi H; Nomura T; Murata Y;
TI -
Kim N; Weinrich S; Lea-Chou E; Lopez-Uribe D; Shroyer KR
Immunohistochemical localization of telomerase hTERT protein and
analysis of clonality in multifocal vulvar intraepithelial neoplasia.
SO - Am J Clin Pathol 2000 Sep;114(3):371-9
AD - Department of Obstetrics and Gynecology, Osaka University Faculty of
Medicine, Japan.
Vulvar intraepithelial neoplasias (VINs) are potentially premalignant
lesions of the squamous mucosa. The immunohistochemical distribution of
the catalytic protein subunit of telomerase (hTERT) and the patterns of
X chromosome inactivation were investigated as markers of neoplasia in
samples from a patient with multifocal and diffuse VIN. hTERT nuclear
staining in VIN correlated with squamous maturation and the degree of
nuclear atypia. Normal mucosa revealed faint nuclear staining of
parabasal cells and lower intermediate layer squamous cells. Monoclonal
composition was demonstrated in 0 of 3 samples of VIN1, 2 of 3 samples
of VIN2, and 13 of 13 samples of VIN3. The patterns of X chromosome
inactivation indicated intramucosal extension and multifocal origin of
individual lesions. Five samples of histologically normal vulvar
squamous epithelium revealed a random pattern of X chromosome
inactivation, consistent with polyclonal composition. All 19 samples
from 9 lesions contained human papillomavirus (HPV)-16 sequences.
Neither mutations in the p53 tumor suppressor gene or K-ras oncogenes
nor loss of heterozygosity at 7 chromosomal loci were detected in any of
the 19 samples of VIN. These results demonstrate that HPV-associated VIN
may result from multifocal and diffuse 2-dimensional intraepithelial
expansion of an immortalized monoclonal cell population.
15
UI - 10908532
AU - van Der Velden J; Ansink A
TI -
Primary groin irradiation vs primary groin surgery for early vulvar
cancer.
SO - Cochrane Database Syst Rev 2000;(3):CD002224
AD - Division of Obstetrics and Gynaecology, Academic Medical Centre,
Meibergdreef 9, P O Box 22660, Amsterdam, Netherlands.
j.vandervelden@amc.uva.nl
BACKGROUND: Despite changes in technique, morbidity after surgical
treatment for vulvar cancer is considerable and mainly related to the
groin dissection. Primary radiotherapy to the groin is expected to
result in lower morbidity. However, studies on the efficacy of primary
radiotherapy for the groins in terms of groin recurrences and survival
show conflicting results. OBJECTIVES: To determine whether the
effectiveness and safety of primary radiotherapy to the inguino-femoral
lymph nodes is comparable with surgery SEARCH STRATEGY: The literature
search was carried out using the criteria set by the Cochrane
Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh
Heading 'vulvar neoplasms' and textword 'vulva' was performed.
Publications on the effectiveness of primary radiotherapy treatment of
early squamous cell carcinoma of the vulva were selected. SELECTION
CRITERIA: Type of study: Randomized clinical trials, case-control and
observational studies of primary radiotherapy of the groin Type of
participants: Patients with early squamous cell cancer of the vulva Type
of interventions: inguino-femoral lymph node dissection and primary
radiotherapy of the inguino-femoral lymph nodes. Type of outcome
measurements: incidence of groin recurrences, survival and morbidity
DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed study
quality and extracted results MAIN RESULTS: Out of nine reviewed papers
only three met the selection criteria. From these studies, (one
randomised controlled trial RCT one case-control and one observational
study) it became clear from the RCT that the incidence of groin
recurrences after primary radiotherapy is higher compared with surgery.
survival was also worse in the radiotherapy group. The other two studies
showed a higher than expected number of groin recurrences after primary
radiotherapy. Morbidity after primary radiotherapy was lower compared
with surgery. The conclusion of the RCT was criticized on the grounds of
the depth of the radiotherapy administered. The depth of 3 cm used in
the RCT, is too shallow to administer an optimal dose to the deeper
groin nodes. REVIEWER'S CONCLUSIONS: As shown in an RCT, primary
radiotherapy to the groin results in less morbidity but also in a higher
number of groin recurrences compared with surgery. Although the
technique of radiotherapy in the RCT was criticized, other uncontrolled
data do not give evidence for a similar or better groin control for
radiotherapy when compared to surgery. This means that surgery is still
to be considered the cornerstone of therapy for the groin nodes in women
with vulvar cancer. Individual patients not fit enough to withstand
surgery can be treated with primary radiotherapy.
16
UI - 11687151
AU - van der Velden K; Ansink A
TI -
Primary groin irradiation vs primary groin surgery for early vulvar
cancer.
SO - Cochrane Database Syst Rev 2001;(4):CD002224
AD - Division of Obstetrics and Gynaecology, Academic Medical Centre,
Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
j.vandervelden@amc.uva.nl
BACKGROUND: Despite changes in technique, morbidity after surgical
treatment for vulvar cancer is considerable and mainly related to the
groin dissection. Primary radiotherapy to the groin is expected to
result in lower morbidity. However, studies on the efficacy of primary
radiotherapy for the groins in terms of groin recurrences and survival
show conflicting results. OBJECTIVES: To determine whether the
effectiveness and safety of primary radiotherapy to the inguino-femoral
lymph nodes is comparable with surgery SEARCH STRATEGY: The literature
search was carried out using the criteria set by the Cochrane
Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh
Heading 'vulvar neoplasms' and textword 'vulva' was performed.
Publications on the effectiveness of primary radiotherapy treatment of
early squamous cell carcinoma of the vulva were selected. SELECTION
CRITERIA: Type of study: Randomized clinical trials, case-control and
observational studies of primary radiotherapy of the groin Type of
participants: Patients with early squamous cell cancer of the vulva Type
of interventions: inguino-femoral lymph node dissection and primary
radiotherapy of the inguino-femoral lymph nodes. Type of outcome
measurements: incidence of groin recurrences, survival and morbidity
DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed study
quality and extracted results MAIN RESULTS: Out of nine reviewed papers
only three met the selection criteria. From these studies, (one
randomised controlled trial [RCT] one case-control and one observational
study) it became clear from the RCT that the incidence of groin
recurrences after primary radiotherapy is higher compared with surgery.
survival was also worse in the radiotherapy group. The other two studies
showed a higher than expected number of groin recurrences after primary
radiotherapy. Morbidity after primary radiotherapy was lower compared
with surgery. The conclusion of the RCT was criticized on the grounds of
the depth of the radiotherapy administered. The depth of 3 cm used in
the RCT, is too shallow to administer an optimal dose to the deeper
groin nodes. REVIEWER'S CONCLUSIONS: As shown in an RCT, primary
radiotherapy to the groin results in less morbidity but also in a higher
number of groin recurrences compared with surgery. Although the
technique of radiotherapy in the RCT was criticized, other uncontrolled
data do not give evidence for a similar or better groin control for
radiotherapy when compared to surgery. This means that surgery is still
to be considered the cornerstone of therapy for the groin nodes in women
with vulvar cancer. Individual patients not fit enough to withstand
surgery can be treated with primary radiotherapy.
17
UI - 11766145
AU - Cardosi RJ; Bomalaski JJ; Hoffman MS
TI -
Diagnosis and management of vulvar and vaginal intraepithelial
neoplasia.
SO - Obstet Gynecol Clin North Am 2001 Dec;28(4):685-702
AD - Department of Obstetrics and Gynecology, University of South Florida,
Tampa 33606, USA. rcardosi@tampabay.rr.com
Vulvar intraepithelial neoplasia and VAIN present unique challenges to
the practicing gynecologist. VIN may produce distressing symptoms and
undergo malignant conversion. A high index of suspicion and liberal use
of biopsy are required to make the diagnosis. The approach to therapy
for VIN has been reviewed. Treatment should be tailored to each
individual patient and may include a period of expectant observation.
Variations and combinations are used whenever necessary to preserve
normal function and anatomy. Frequent surveillance is a must because
recurrence rates are high, especially with multifocal disease in young
women. Although VAIN accounts for less than 0.5% of lower genital tract
neoplasia, the frequency of its detection is increasing, especially in
younger patients. These lesions are most commonly found in the upper
third of the vagina and are often multifocal in nature. The close
proximity of the upper vagina to the rectum, bladder, and ureters makes
treatment difficult. The occult invasion rate may be as high as 28%, and
a wide variety of therapies are available. As is true for VIN,
recurrence is not uncommon.
18
UI - 11766152
AU - Hopkins MP; Nemunaitis-Keller J
TI -
Carcinoma of the vulva.
SO - Obstet Gynecol Clin North Am 2001 Dec;28(4):791-804
AD - Department of Obstetrics and Gynecology, Aultman Hospital, Northeastern
Ohio University College of Medicine, Canton 44710, USA.
bschmaltz@aultman.com
Vulvar cancer will probably become a more common disease as the
population ages. It is primarily a disease of the elderly. Fortunately,
most vulvar cancers remain localized for extended periods of time and
can be treated adequately with radical surgery.
19
UI - 11906556
AU - Narayansingh GV; Cumming GP; Dighe S; Parkin DE; Millar I
TI -
Invasive adenocarcinoma of the vagina following surgery for
adenocarcinoma in situ of the cervix--recurrence or implantation?
SO - Int J Gynecol Cancer 2001 Nov-Dec;11(6):493-5
AD - Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary,
Foresterhill, Scotland. gordonvn@tstt.net.tt
A 51-year-old woman underwent cervical conization for severe glandular
abnormal cells. Histology noted adenocarcinoma in situ (AIS) with
incomplete excision margins. Four months later, hysterectomy revealed no
residual disease. Six months subsequently she developed invasive
adenocarcinoma of the upper vagina. This report documents the unusual
behavior of AIS and its management difficulties.
20
UI - 11942894
AU - Turkistani I; Ghourab S; Al-Rikabi A; Al-Sheikh AE; Al-Orainy I
TI -
Large paravaginal solitary fibrous tumor with secondary schistosoma
hematobium infestation.
SO - Acta Obstet Gynecol Scand 2002 Jan;81(1):88-90
AD - Department of Obstetrics and Gynecology, King Khalid University
Hospital, Riyadh 11461, Kingdom of Saudi Arabia.
21
UI - 10920128
AU - de Hullu JA; Hollema H; Piers DA; Verheijen RH; van Diest PJ; Mourits
TI -
MJ; Aalders JG; van Der Zee AG
Sentinel lymph node procedure is highly accurate in squamous cell
carcinoma of the vulva.
SO - J Clin Oncol 2000 Aug;18(15):2811-6
AD - Departments of Gynecologic Oncology, Pathology, and Nuclear Medicine,
University Hospital Groningen, Groningen, The Netherlands.
PURPOSE: To determine the diagnostic accuracy of the sentinel lymph node
procedure in patients with squamous cell carcinoma of the vulva and to
investigate whether step sectioning and immunohistochemistry of sentinel
lymph nodes increase the sensitivity for detection of metastases.
primary vulvar cancer were entered onto a two-center prospective study.
All patients underwent sentinel lymph node procedure with the combined
technique (preoperative lymphoscintigraphy with technetium-99m-labeled
nanocolloid and intraoperative blue dye). Radical excision of the
primary tumor with uni- or bilateral inguinofemoral lymphadenectomy was
performed subsequently. Sentinel lymph nodes and lymphadenectomy
specimens were sent for histopathologic examination separately. Sentinel
lymph nodes, negative at the time of routine pathologic examination,
were re-examined with step sectioning and immunohistochemistry. RESULTS:
In 59 patients, 107 inguinofemoral lymphadenectomies were performed (11
unilateral and 48 bilateral). All sentinel lymph nodes, as observed on
preoperative lymphoscintigram, were identified successfully
intraoperatively. Routine histopathologic examination showed lymph node
metastases in 27 groins, all of which were detected by the sentinel
lymph node procedure. The negative predictive value for a negative
sentinel lymph node was 100% (97.5% confidence interval [CI], 95% to
100%). Step sectioning and immunohistochemistry showed four additional
metastases in 102 sentinel lymph nodes (4%; 95% CI, 1% to 9%) that were
negative at the time of routine histopathologic examination. CONCLUSION:
Sentinel lymph node procedure with the combined technique is highly
accurate in predicting the inguinofemoral lymph node status in patients
with early-stage vulvar cancer. Future trials should focus on the safe
clinical implementation of the sentinel lymph node procedure in these
patients. Step sectioning and immunohistochemistry slightly increase the
sensitivity of detecting metastases in sentinel lymph nodes and should
be included in these trials.
22
UI - 11352972
AU - Penson RT; Fuller AF Jr
TI -
Nodal metastasis is highly consistent in squamous cell carcinoma of the
vulva.
SO - J Clin Oncol 2001 May 15;19(10):2767-8
23
UI - 11841521
AU - Reis-Filho JS; Milanezi F; Soares MF; Fillus-Neto J; Schmitt FC
TI -
Intradermal spindle cell/pleomorphic lipoma of the vulva: case report
and review of the literature.
SO - J Cutan Pathol 2002 Jan;29(1):59-62
AD - Institute of Molecular Pathology and Immunology (IPATIMUP), University
of Porto, Porto, Portugal. jreis@ipatimup.pt
BACKGROUND: Spindle cell/pleomorphic lipoma (SC/PL) is a benign adipose
tissue tumor that usually affects the subcutaneous tissues of shoulders,
backs, and neck region of middle-aged male patients. Histologically, it
is characterized by the presence of primitive CD34-positive spindle
cells arranged in short fascicles, bizarre floret-like multinucleated
giant cells, mature adipocytes, and a small number of lipoblasts.
Recently, an intradermal subset has been described, which mainly affects
female patients and presents a wider antomical distribution when
compared to the classical variant of SC/PL. METHODS: We report a case of
intradermal SC/PL affecting the labium majus of a 56-year-old female
patient. RESULTS: The histological examination disclosed the typical
histological features, however the lesion showed poorly demarcated and
infiltrative borders, as well as involvement of dermal nerves. The
immunohistochemical analysis according to streptovidin-biotin-peroxidase
technique showed immunoreactivity for CD34 and vimentin in the spindle
cells, as well as S100 protein and vimentin in the adipocytic cells.
CONCLUSIONS: To the best of our knowledge, this is the first case of
intradermal SC/PL affecting the vulvar region. Care must be taken not to
misdiagnosis this rare tumor as well-differentiated liposarcoma,
cellular angiofibroma, solitary fibrous tumor, and cutaneous
neurofibroma.
24
UI - 11953825
AU - Allen DG; Hutchins AM; Hammet F; White DJ; Scurry JP; Tabrizi SN;
TI -
Garland SM; Armes JE
Genetic aberrations detected by comparative genomic hybridisation in
vulvar cancers.
SO - Br J Cancer 2002 Mar 18;86(6):924-8
AD - Department of Gynecologic Oncology, Mercy Hospital for Women, Melbourne,
Australia.
Squamous cell carcinoma of the vulva is a disease of significant
clinical importance, which arises in the presence or absence of human
papillomavirus. We used comparative genomic hybridisation to document
non-random chromosomal gains and losses within human papillomavirus
positive and negative vulvar cancers. Gain of 3q was significantly more
common in human papillomavirus-positive cancers compared to human
papillomavirus-negative cancers. The smallest area of gain was 3q22-25,
a chromosome region which is frequently gained in other human
papillomavirus-related cancers. Chromosome 8q was more commonly gained
in human papillomavirus-negative compared to human
papillomavirus-positive cancers. 8q21 was the smallest region of gain,
which has been identified in other, non-human papillomavirus-related
cancers. Chromosome arms 3p and 11q were lost in both categories of
vulvar cancer. This study has demonstrated chromosome locations
important in the development of vulvar squamous cell carcinoma.
Additionally, taken together with previous studies of human
papillomavirus-positive cancers of other anogenital sites, the data
indicate that one or more oncogenes important in the development and
progression of human papillomavirus-induced carcinomas are located on
3q. The different genetic changes seen in human papillomavirus-positive
and negative vulvar squamous cell carcinomas support the
clinicopathological data indicating that these are different cancer
types. Copyright 2002 Cancer Research UK
25
UI - 11860544
AU - Nordstrom B; Einhorn N; Silfversward C; Sjovall K; Tryggvason K; Auer G
TI -
Laminin-5 gamma 2 chain as an invasivity marker for uni- and multifocal
lesions in the lower anogenital tract.
SO - Int J Gynecol Cancer 2002 Jan-Feb;12(1):105-9
AD - Department of Oncology and Pathology, Karolinska Institute and Hospital,
S-171 76 Stockholm, Sweden. Britta.Nordstrom@ks.se
During recent decades it has become apparent that there are two types of
vulvar disease: the classic type found in elderly women with unicentric
and unifocal lesions, and the type found in younger women, in which
precancerous and invasive changes develop in the anogenital lower tract
in a multicentric and multifocal fashion, often over a long period of
observation.The laminin-5 gamma 2 chain is an extracellular protein that
is a component of the basement membrane. Recently its expression has
been recognized as a marker in cervical cancer that permits
identification of invasive capacity.The aim of our study was to
determine if laminin-5 gamma 2 chain antibody can act as a sensitivity
marker of invasive capacity in precancerous and invasive carcinoma in
women with uni- and multifocal changes in the anogenital tract. The
result showed that all patients in the older group of women with
invasive carcinoma of the vulva had moderate to high positive expression
of the laminin-5 gamma 2 chain. In the group of younger patients with
multifocal precancerous changes observed over long periods, most of the
patients with vulva intraepithelial neoplasia (VIN) 3 showed laminin-5
gamma 2 chain positivity already in the precancerous changes, and all of
them developed invasivity during the period of observation. Normal
epithelium without atypia was mostly negative or of low immunoreactivity
of laminin-5. In conclusion, positive laminin-5 gamma 2 chain expression
seems to indicate the invasiveness potential of precancerous lesions and
is also expressed in all investigated invasive carcinomas of the
anogenital tract.
26
UI - 11187991
AU - Kostova P; K'rlov T; Zlatkov V; K'rlov A
TI -
[Cancer of the vulva: modern diagnostic and therapeutic principles]
SO - Akush Ginekol (Sofiia) 2000;39(3):26-9
In the presented methodical sceme, consicutively and systematically are
scrutinized the epidemiology. The risk factors, the etiopathogenesis,
the hostopathology and the clinical signs of the vulvar cancer. The
diagnostic possibilities, as well as the staging principles are pointed.
The current treatment tactics, therapeutic schemes according to the
stage and follow-up corresponding to the requirements of the oncological
doctrine are present.
27
UI - 11519227
AU - Sirakov M
TI -
[Genital hemorrhaging in children]
SO - Akush Ginekol (Sofiia) 2000;40 Suppl 3():3-5
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