[Lichen sclerosus et atrophicus (kraufosis) vulvae. Complications of lichen sclerosus et atrophicus of the vulva)].
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Adult↗
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Vulva formation in Pristionchus pacificus relies on continuous gonadal induction.
One of the best known features of vulva development in Caenorhabditis elegans is the induction of vulval precursor cells by the gonadal anchor cell. Induction is crucial for the initiation of pattern formation within the C. elegans vulva equivalence group, and it is therefore surprising to find that this aspect of vulva formation, in particular, varies greatly among nematodes. In some species which form vulvae in the posterior body region, no gonadal signal is necessary for vulva induction. In other nematodes, such as Panagrolaimus, Oscheius, and Rhabditella, vulva formation depends on two temporally distinct gonadal inductions which specify the different cell fates. Here we report our analysis of vulva induction in Pristionchus pacificus, a species which has recently been used as a genetic system to analyze the evolution of vulva development. Cell ablation studies in P. pacificus show that another mode of vulva induction exists. P. pacificus vulva formation depends on a continuous gonadal induction that starts several hours after hatching and continues until the birth of the anchor cell, some 20 h later. Mutations defective in gonadal induction result in the absence of vulva differentiation, suggesting that only one signaling system is involved in the gonadal-epidermal interaction. This new mode adds further to the great variety of gonadal inductions among nematode species.
Animals↗
Long-term impact of postoperative radiotherapy in carcinoma of the vulva FIGO I/II.
PURPOSE: Between 1953 and 1978, postoperative radiotherapy was used as an adjuvant therapy for carcinoma of the vulva that had not been treated with radical vulvectomy. We evaluated long-term results and possible prognostic factors. METHODS AND MATERIALS: Ninety-two patients were treated. Surgical procedures were simple vulvectomy, electrocoagulation, or local excision. Radiotherapy doses to the vulva ranged from 0 to 90 Gy. All patients received radiotherapy to the inguinal lymph nodes, ranging from 30 to 60 Gy. Thirty-year retrospective follow-up was done evaluating the records and statistical survival rates. RESULTS: Five-year actuarial survival rates in T1 patients were 71% (77% cause-specific survival rate), for T2 patients 43% (48% cause-specific survival rate). The difference between T1 and T2 patients was significant (p < 0.05). Patients with tumors of the labia minora had a significantly higher survival rate than those with different sites affected. Doses of 45 Gy or more to the vulva were sufficient to increase the 5-year cause-specific survival rate from 55% to 88%. The results in three subgroups were analyzed, group 1 having received electrocoagulation, but no radiotherapy of the vulva; group 2, local excision and doses of 40 Gy to the vulva; group 3, local excision and doses of 60 Gy to the vulva. There was a significant effect on 10-year cause-specific survival rates: 48% in group 1, 11% in group 2, and 88% in group 3. In multivariate analysis, the significant independent factors were T classification, tumor sites and-with only marginal significance-radiation doses to the vulva. CONCLUSIONS: The prognosis in early vulva carcinoma after nonradical surgery primarily depends on T classification and the site of the primary tumor. With univariate analyses, the dose has a significant effect on survival. In multivariate analyses the dose is a marginal independent factor in the whole group of patients. After nonradical surgery of early vulva carcinoma, the vulva should be irradiated resulting in better long-term survival.
Adult↗
HAIRY-like transcription factors and the evolution of the nematode vulva equivalence group.
BACKGROUND: Nematode vulva formation provides a paradigm to study the evolution of pattern formation and cell-fate specification. The Caenorhabditis elegans vulva is generated from three of six equipotent cells that form the so-called vulva equivalence group. During evolution, the size of the vulva equivalence group has changed: Panagrellus redivivus has eight, C. elegans six, and Pristionchus pacificus only three cells that are competent to form vulval tissue. In P. pacificus, programmed cell death of individual vulval precursor cells alters the size of the vulva equivalence group. RESULTS: We have identified the genes controlling this cell-death event and the molecular mechanism of the reduction of the vulva equivalence group. Mutations in Ppa-hairy, a gene that is unknown from C. elegans, result in the survival of two precursor cells, which expands the vulva equivalence group. Mutations in Ppa-groucho cause a similar phenotype. Ppa-HAIRY and Ppa-GROUCHO form a molecular module that represses the Hox gene Ppa-lin-39 and thereby reduces the size of the vulva equivalence group. The C. elegans genome does not encode a similar hairy-like gene, and no typical HAIRY/GROUCHO module exists. CONCLUSIONS: We conclude that the vulva equivalence group in Pristionchus is patterned by a HAIRY/GROUCHO module, which is absent in Caenorhabditis. Thus, changes in the number, structure, and function of nematode hairy-like transcription factors are involved in the evolutionary alteration of this equivalence group.
Amino Acid Sequence↗
[Investigation of the relationship between white lesion of vulva and human epidermal growth factor].
The levels of human epidermal growth factor (hEGF) were determined by radioimmunoassay (RIA) in dermal specimens taken from lesion skin and normal vulva skin in 30 patients with white lesions of the vulva as well as their urine specimens, and in another 29 vulva biopsy and 37 urine samples from healthy women without the disease as the control group. The results showed that the mean hEGF levels in lesion vulva skin, normal vulva skin of the patients and normal vulva skin of healthy women were 163.40 +/- 97.89 micrograms/L, 119.00 +/- 53.13 micrograms/L and 67.84 +/- 14.72 micrograms/L respectively. The level of hEGF in lesion skin was higher than that in the normal vulva skin of same patients (P < 0.05) and also higher than that in the normal skin of healthy women (P < 0.01). The hEGF level in normal skin of the patients was higher than that in healthy women (P < 0.01). The hEGF level in lesion skin had no relationship with pathological types. The hEGF levels in urine had no significant difference between the patients and healthy women. The results suggested that high levels of hEGF in local vulva lesions may play an important role in the pathogenesis of white lesions of the vulva.
Adult↗
[Steroid hormone receptors in normal, dystrophic, dysplastic and carcinomatous vulva tissues].
We employed the agar gel electrophoresis method to determine in 63 samples of vulva tissue the cytoplasmatic receptors for oestradiol, dihydrotestosterone and dexamethasone. Tissues with a binding capacity of more than 5 femtomol/mg (fmol = 10(-15) mol) cell proteins were considered receptor positive. The study comprised 17 normal tissues of the vulva, 13 vulva biopsies at the end of the pregnancy period, 7 dystrophically changed tissues, 11 premalignant changes of the vulva and 15 squamous cell carcinomas. In normal as well as in benign or malignantly changed vulva, specific receptors were found for all the four steroids (ER, PR, DHTR, DExaR). Receptors were most frequent in normal vulva tissue (ER = 94%, PR = 54%, DHTR = 38%, DexaR = 83%) with binding-capacities of 8-650 fmol/mg cell proteins. ER levels were higher during the postmenopausal period than during the premenopausal period. In dystrophia the receptor pattern was almost the same as in healthy tissue. Biopsies conducted at the end of the pregnancy period showed in all cases despite the high endogenous oestrogen levels positive ER values up to 875 fmol/mg cell proteins, whereas PR and DTHR were present in only 20% or 25% with low binding capacities. Loss of receptors, particularly of PR, was seen in premalignant changes (dysplasia of vulva, carcinoma in situ) and in case of squamous cell carcinomas. On comparing the receptor distribution of clinically changed vulva tissue with healthy tissue we found only differences by degree but no fundamental differences in principle.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
Recurrent squamous cell carcinoma of the vulva: a study of 73 cases.
In a study of 73 patients, diagnosed with recurrent squamous cell carcinoma of the vulva between 1975 and 1990, the effect of clinical variables on the outcome was evaluated. The overall 5-year survival rate was 35.2%. Of the 73 patients, 33 (45.2%) originally had Stage I or II disease and 40 (54.8%) Stage III or IVA; 49 (67.1%) recurred less than 2 years and 24 (32.9%) more than 2 years after initial surgery; and 39 (53.4%) recurred on the vulva only, while 34 (46.6%) recurred beyond the vulva. Of 59 patients who had groin lymph node dissection at initial surgery, 26 (44%) had negative and 33 (56%) had positive nodes. By means of univariate analyses, a significant worsening in outcome was demonstrated with advancing original stage of disease (P < 0.001), positivity of groin lymph nodes (P < 0.01), shortening of recurrence-free interval (P < 0.001), and extension of recurrence beyond the vulva (P < 0.001). In a multivariate analysis (Cox proportional hazards model) recurrence site was the strongest and the only significant predictor of survival. The death risk showed a 3.7-fold increase (95% confidence intervals: 1.6 to 8.7, P = 0.002) for recurrence beyond the vulva over recurrence on the vulva only. For patients who recurred in the vulva only, wide radical local excision provided acceptable survival results, while for all other patients, regardless of type of treatment, the outcome was poor.
Adult↗
Karyotypic findings in tumors of the vulva and vagina.
Neoplasms of the vulva and vagina together account for less than 5% of all female genital tract cancers, and very few cases have been analyzed using chromosome banding techniques. We report the karyotypic findings in a consecutive series of ten tumors of the vulva and vagina; in addition to five squamous cell carcinomas of the vulva, we present the first cytogenetic analysis of two malignant melanomas and a Paget disease of the vulva, as well as an adenocarcinoma and a squamous cell hyperplasia of the vagina. Whereas no clonal karyotypic changes were found in the squamous cell hyperplasia of the vagina, the remaining nine malignant tumors showed clonal chromosome abnormalities. An inverse correlation was found between the degree of histologic differentiation and karyotypic complexity in the squamous cell carcinomas of the vulva. The malignant melanomas had chromosomal aberrations that have previously been described in malignant melanomas occurring elsewhere, but were less karyotypically complex. Cytogenetically unrelated clones were detected in the Paget disease of the vulva but not in any of the other tumors; this finding is consonant with the interpretation that at least a proportion of Paget disease of the vulva arises multicentrically within the epidermis from pluripotent stem cells.
Adenocarcinoma↗
[Cytologic cancer prevention in the vulva. Morphologic study of an extensive case material].
464 patients, 286 healthy patients and 178 patients with lesions of the vulva had cytological and/or histologic examinations of the vulva. The normal vulva sheds in approximately 50% of the cases anucleate squames and in approximately 50% of the cases parakeratotic cells. In benign lesions of the vulva, in 1/3 of the cases each one finds either and anucleate squames, parakeratotic cells or mildly dyskariotic cells. In premalignant lesions 1/2 of the cases exfoliate mildly dyskariotic cells and the other 1/2 severely dyskariotic cells. In carcinoma of the vulva cytologic evidence of cancer is found in approximately 60% of the cases whereas 34% of the cases only show severely dyskariotic cells and 6% only mildly dyskariotic cells. Ulcers and defects do not increase the yield of exfoliated tumour cells. Exfoliative cytology of the vulva is considered to be an important part of the early diagnosis of cancer of the vulva.
Carcinoma in Situ↗
Relation of lichen sclerosus et atrophicus of the vulva to development of carcinoma.
One hundred and seven patients with lichen sclerosus et atrophicus (LS&A) of the vulva were studies to determine the malignant potential of the LS&A. Five patients had coexisting invasive carcinoma of the vulva or perineum with the LS&A, and 1 patient had coexisting intraepithelial vulvar carcinoma on the clitoris. None of these, however, was known to have LS&A prior to the biopsy for carcinoma of the vulva. The high association of carcinoma and LS*A is probably a result of selection of 2 unusual lesions sent for consultation and evaluation. Squamous hyperplasia in the vulva occurred in association with LS&A in 37 (35%) patients, but only 6 patients had areas of dysplasia coexisting with LS&A. These areas of dysplasia, like the 5 invasive carcinomas, occurred in an area of the vulva where the LS&A was minimal or absent. Follow-up data were obtained on 92 patients with LS&A. Only 1 developed carcinoma of the vulva, which occurred 12 years after identification of the LS&A. When carcinoma arises in the vulva in a patient with vulvar LS&A, it tends to arise in areas of minomal LS&A or isolated areas of relatively normal vulvar skin. This study did not provide evidence of carcinoma arising from LS&A. Five of the 92 patients developed 6 malignant neoplasms in other sites, including carcinoma of the endometrium (3 patients), lung (1 patient), and simultaneous carcinomas of the colon and cervix (1 patient).
Adolescent↗
Non-Hodgkin's lymphoma involving the vulva.
Non-Hodgkin's lymphomas (NHL) involving the vulva are rare. We report the clinicopathologic and immunohistochemical findings of six cases of vulvar NHL. The age of the patients ranged from 43 to 71 years (mean 60 years), and 5 presented with a vulvar mass. Two patients had neoplasms localized to the vulva, and two patients had a history of NHL that secondarily involved the vulva; in another patient the stage was unknown, and the sixth patient had stage IVA mycosis fungoides/Sezary syndrome involving the vulva. Each tumor was classified according to the revised European-American classification of lymphoid neoplasms: four were diffuse large B-cell lymphoma, one was peripheral T-cell lymphoma, and one was mycosis fungoides/Sezary syndrome. Two patients were treated with chemotherapy and radiotherapy, one patient received chemotherapy and phototherapy, one patient was treated with chemotherapy, and in two patients the treatment is unknown. Clinical follow-up, available for 4 cases, ranged from 7 months to 5 years. One patient with low-stage NHL responded to therapy, but relapsed and died of disease 2 years later. Two patients with generalized NHL that secondarily involved the vulva died of disease 7 months and 5 years, respectively, after the diagnosis of vulvar involvement was established. The patient with mycosis fungoides/Sezary syndrome is alive with disease at 4 years. The three patients in this study who died and our review of the literature indicate that NHL involving the vulva is usually an aggressive disease.
Aged↗
The nematode even-skipped homolog vab-7 regulates gonad and vulva position in Pristionchus pacificus.
In free-living nematodes, developmental processes like the formation of the vulva, can be studied at a cellular level. Cell lineage and ablation studies have been carried out in various nematode species and multiple changes in vulval patterning have been identified. In Pristionchus pacificus, vulva formation differs from Caenorhabditis elegans with respect to several autonomous and conditional aspects of cell fate specification. To understand the molecular basis of these evolutionary changes, we have performed a genetic analysis of vulva formation in P. pacificus. Here, we describe two mutants where the vulva is shifted posteriorly, affecting which precursor cells will form vulval tissue in P. pacificus. Mutant animals show a concomitant posterior displacement of the gonadal anchor cell, indicating that the gonad and the vulva are affected in a similar way. We show that mutations in the even-skipped homolog of nematodes, vab-7, cause these posterior displacements. In addition, cell ablation studies in the vab-7 mutant indicate that the altered position of the gonad not only changes the cell fate pattern but also the developmental competence of vulval precursor cells. Investigation of Cel-vab-7 mutant animals showed a similar but weaker vulva defective phenotype to the one described for Ppa-vab-7.
Amino Acid Sequence↗
Human papillomavirus coinfections of the vulva and uterine cervix.
DNA filter in situ hybridisation (FISH) was used to determine the presence of human papillomavirus (HPV) genotypes 6/11, 16/18, and 31/33 in cell scrapes of the cervix and vulva of 128 women who had precancerous lesions and/or HPV infection of the cervix diagnosed by cytology, colposcopy, and histology. HPV-DNA was found in 87 (68%) vulval and 95 (74%) cervical cell scrapes, and in both the vulval and cervical scrapes of 73 (57%) women, but not in either the vulva or the cervix of 19 women (15%). Of the HPV-DNA-positive smears, the prevalence of the HPV types was 61% HPV 16/18, 14% HPV 6/11, 3% HPV 31/33, and 22% HPV 6/11 and 16/18. By contrast, HPV-DNA was not detected in the cervical smears of a control group of 35 women who were assessed to be free of cervical abnormalities by colposcopy and cytology. The epithelial response of the vulva and the cervix to application of 5% acetic acid was assessed by colposcopy and the results correlated with the presence of HPV genotypes. A possible or definite disorder of the cervix and vulva was detected by colposcopy in 95 (74%) and 96 (75%) of the 128 cases, respectively. The colposcopic assessment of the vulva was inconclusive in ten cases (8%), and only eight women (6%) were found to be free of both a vulval and cervical disorder. This study shows subclinical papillomavirus infections of the vulva frequently coexist with HPV infections and precancerous lesions of the cervix.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The role of vascular endothelial growth factor-A (VEGF-A) and platelet-derived endothelial cell growth factor/thymidine phosphorylase (PD-ECGF/TP) in Paget's disease of the vulva and breast.
BACKGROUND: Paget's disease of the vulva and the breast are uncommon conditions. The pathogenesis underlying these diseases is still unclear. Vascular endothelial growth factor-A (VEGF-A), a potent angiogenic factor, has been demonstrated in a variety of tumour cell types and is thought to be involved in tumour expansion. Platelet-derived endothelial cell growth factor/thymidine phosphorylase (PD-ECGF/TP) has also been shown to stimulate angiogenesis. MATERIALS AND METHODS: Fifty-four cases of Paget's disease of the vulva, including 10 with an associated invasive adenocarcinoma, and 38 cases of Paget's disease of the breast, including 26 with available associated ductal carcinoma in situ (DCIS) and/or invasive carcinoma of the breast, were evaluated immunohistochemically for the expression of VEGF-A and PD-ECGF/TP. RESULTS: VEGF-A was not expressed in Paget's disease of the vulva or breast. PD-ECGF/TP was expressed in 22 out of 54 (41%) cases of Paget's disease of the vulva. Four of the cases associated with invasive disease (40%) expressed PD-ECGF/TP. Twenty-one out of 38 (55%) cases of Paget's disease of the breast were positive for PD-ECGF/TP. CONCLUSION: Our data suggest that PD-ECGF/TP may have a role to play in the pathogenesis of Paget's disease of the vulva and the breast. The role of VEGF-A in Paget's disease of the vulva and the breast remains to be fully elucidated.
Breast Neoplasms↗
PAR-1 is required for morphogenesis of the Caenorhabditis elegans vulva.
The Caenorhabditis elegans vulva provides a simple model for the genetic analysis of pattern formation and organ morphogenesis during metazoan development. We have discovered an essential role for the polarity protein PAR-1 in the development of the vulva. Postembryonic RNA interference of PAR-1 causes a protruding vulva phenotype. We found that depleting PAR-1 during the development of the vulva has no detectable effect on fate specification or precursor proliferation, but instead seems to specifically alter morphogenesis. Using an apical junction-associated GFP marker, we discovered that PAR-1 depletion causes a failure of the two mirror-symmetric halves of the vulva to join into a single, coherent organ. The cells that normally form the ventral vulval rings fail to make contact or adhere and consequently form incomplete toroids, and dorsal rings adopt variably abnormal morphologies. We also found that PAR-1 undergoes a redistribution from apical junctions to basolateral domains during morphogenesis. Despite a known role for PAR-1 in cell polarity, we have observed no detectable differences in the distribution of various markers of epithelial cell polarity. We propose that PAR-1 activity at the cell cortex is critical for mediating cell shape changes, cell surface composition, or cell signaling during vulval morphogenesis.
Animals↗
Lifetime changes in the vulva and vagina.
The morphology and physiology of the vulva and vagina change over a lifetime. The most salient changes are linked to puberty, the menstrual cycle, pregnancy, and menopause. The cutaneous epithelia of the mons pubis, labia, and clitoris originate from the embryonic ectoderm and exhibit a keratinized, stratified structure similar to the skin at other sites. The mucosa of the vulvar vestibule, which originates from the embryonic endoderm, is non-keratinized. The vagina, derived from the embryonic mesoderm, is responsive to estrogen cycling. At birth, the vulva and vagina exhibit the effects of residual maternal estrogens. During puberty, the vulva and vagina acquire mature characteristics in a sequential fashion in response to adrenal and gonadal maturation. A trend to earlier pubertal onset has been observed in Western developed countries. In women of reproductive age, the vaginal mucosa responds to steroid hormone cycling, exhibiting maximal thickness and intracellular glycogen content at mid-cycle. Vulvar skin thickness remains unchanged but menstrual cycle-associated changes in ortho- and parakeratosis occur at the cytological level. The vulva and vagina further adapt to the needs of pregnancy and delivery. After menopause, tissue atrophy ensues. Post-menopausal changes in skin barrier function, skin hydration, and irritant susceptibility have been observed on exposed skin but not on the vulva. Nevertheless, older women with incontinence are at increased risk for developing incontinence dermatitis. A combination of factors, such as tissue atrophy, slower dissipation of excess skin hydration, shear forces associated with limited mobility, and lower tissue regeneration capacity increase the risk of morbidity from incontinence dermatitis in older women.
Aging↗
Apoptosis and change of competence limit the size of the vulva equivalence group in Pristionchus pacificus: a genetic analysis.
BACKGROUND: To understand how alterations in the molecular mechanisms underlying developmental processes generate a diversity of biological forms, comparative developmental biology can be combined with genetic analysis. The formation of the nematode vulva is one tractable system for such evolutionary developmental analysis, as much is understood about its development in Caenorhabditis elegans. In Caenorhabditis, six of twelve ventral epidermal cells form the 'vulva equivalence group'; although all six cells are competent to adopt vulval cell fates in response to an inductive signal, only three of these cells are induced to form vulval tissue. RESULTS: In some species of the nematode families Rhabditidae, Neodiplogastridae and Panagrolaimidae, the number of cells in the vulva equivalence group is limited by apoptosis and decreased responsiveness to inductive signals (competence). We have initiated a genetic analysis in one of these species, Pristionchus pacificus, to understand the evolution of the specification of ventral epidermal cells that are competent to generate the vulva. A ped-4 mutation restores competence to an incompetent cell. Mutation of either of two other genes of Pristionchus cause two anterior cells that die in wild-type to survive. A ped-5 mutation causes these cells to be competent to respond to inductive signals, expanding the equivalence group. A ped-6 mutation causes these cells to form ectopic, anterior vulva-like invaginations. CONCLUSIONS: During nematode evolution, apoptosis and change of competence alter the number and potency of ventral epidermal cells. The phenotypes of Pristionchus mutants suggest that alterations in homeotic gene control of anteroposterior patterning is involved in creating this cellular diversity.
Animals↗
Conservation and diversification of Wnt signaling function during the evolution of nematode vulva development.
Cell-fate specification and cell-cell signaling have been well studied during vulva development in Caenorhabditis elegans and provide a paradigm in evolutionary developmental biology. Pristionchus pacificus has been developed as a 'satellite' organism with an integrated physical and genetic map that allows detailed comparisons to C. elegans. A common aspect of vulva formation in both species is the polarization of the P7.p lineage, which is responsible for vulval symmetry. In C. elegans, Wnt signaling is crucial for P7.p cell-fate patterning; nothing is known about vulval symmetry in P. pacificus. We isolated mutations that disrupt polarization of the P7.p lineage in P. pacificus and found that the corresponding gene encodes a Frizzled-like molecule. In addition, mutations in Ppa-lin-17 (encoding Frizzled) and morpholino knock-down of Ppa-lin-44 (encoding Wnt), Ppa-egl-20 (encoding Wnt), Ppa-mig-5 (encoding Dsh), Ppa-apr-1 (encoding APC) and Ppa-bar-1 (encoding beta-catenin) results in gonad-independent vulva differentiation, indicating that these genes have a role in a negative signaling process. In contrast, in C. elegans, Wnt signaling has a positive role in vulva induction, and mutations in bar-1 result in a hypoinduced phenotype. Therefore, whereas the molecular mechanisms that generate vulval symmetry are conserved, the genetic control of vulva induction diversified during evolution.
Amino Acid Sequence↗