National Cancer Institute®
Last Modified: April 1, 2002
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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
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. email@example.com
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.
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. firstname.lastname@example.org
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).
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.
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. email@example.com
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.
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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.
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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. email@example.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.
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. firstname.lastname@example.org
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.
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.
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.
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. email@example.com
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.
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
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.
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.
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