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Results for “Vulvar Neoplasms”

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PubMed1977

[Vulvar neoplasms and preoperative lymphography].

20 patients with histologically verified carcinoma of the vulva fulfilled the following conditions: general operability, preoperative lymphography, radical vulvectomy with inguinal lymph node resection and histological examination of all lymph nodes. It was studied how far the preoperative lymphography plays a role for the strategy of operative treatment of carcinoma of the vulva and eventually in the limitation of risks of operative treatment. A survey of the lymphatic drainage of the vulva underlines the importance of the knowledge of the lymphatic pathways for the operation and for the lymphography as performed in this hospital since 1972. The results suggest that lymphography shows an unacceptable high number of false-negative results in cases of metastatic involvement of the inguinal nodes (7 out of 10 cases), whereas it is reliable for the judgment of the iliac and paraaortal nodes. For this reason the resection of the inguinal nodes remains a necessary part of radical vulvectomy. The additional removal of intrapelvic lymph nodes has been restricted to patients with lymphographic signs of positive nodes. In our opinion preoperative lymphography is of considerable value to minimize the operative risk for patients with carcinoma of the vulva by means of a more precise preoperative diagnosis, stage-oriented therapy and postoperative control.

Aged↗
PubMed1995

[Radiosensitivity of hyperpentaploid cell clones in vulvar neoplasms].

INTRODUCTION: Intension of our examination is to investigate changes in ploidy during radiotherapy and to find out radiosensitive cloni of tumors. PATIENT AND METHODS: In November 1993 a 83-year old patient with a carcinoma of the vulva was introduced to the Strahlenklinik der Städtischen Kliniken Offenbach. It was a stage T3N0M0 tumor (UICC 1990). We performed daily smears of the tumor surface during radiotherapy. The smears became air-dried before fixation in PBS/formaldehyde and staining with the Feulgen procedure. The DNA-analyse took place at an image-analysis-system (Ahrens Cytometry Analyse System). RESULTS: Nine and 16 weeks after radiotherapy the patient showed clinically complete remission. Macroscopically and histopathologically there was no tumor found. The ploidy-analysis shows the take off of the hyperpentaploid cells on radiotherapy. Nine and 16 weeks after finished therapy there are no more hyperpentaploid cells detectable. CONCLUSIONS: The DNA-determination is a senseful completition to estimate the success of therapy. It is possible to earn informations about the behaviour of different tumor cell populations during the course of radiotherapy. The hyperpentaploid cells are a radiosensitive part of the tumor. For being able to judge about the route of this cells, if they are proliferating cells of a peritriploid tumor population, or if they proliferate themselves, are some more examinations and additional investigations necessary.

Aged↗
PubMed2005

[Vulvar intraepithelial neoplasm].

BACKGROUND: Vulvar intraepithelial neoplasia is a challenge for the physician as it is asymptomatic and it can evolve to malignant disease. A high suspicion index, as well as some biopsies are necessary, provided an early invasive disease can exist. OBJECTIVE: To establish the patient's characteristics with vulvar intraepithelial neoplasia, seen at the Clinica de Especialidades de la Mujer, SEDENA. PATIENTS AND METHODS: An observational and retrospective analysis was done from February 1st, 1990 to December 31st, 2004. We used the data base of the Hospital Central Militar and of the Clinica de Especialidades de la Mujer, SEDENA. We identified patients with vulvar intraepithelial neoplasia or in situ vulvar cancer diagnosis. We assessed the following variables: patient's age, intraepithelial neoplasia or history of cervical cancer, acuminated vagina or condylomas, prescribed treatment and current health state. RESULTS: We identified 38 patients with ages between 49 and 82 years old. Patients with intraepithelial neoplasia I were the youngest, except one, whom at the moment of the diagnosis had 58 years old. The histopathological diagnosis was of intraepithelial neoplasia type I (koilocytotic atypia) in 10 cases, type II in 10 more, and type III in 18 of them. CONCLUSIONS: Treatment should be individual for each patient. In most of the cases and due to the high recurrence rates we prefer the conservative treatments.

Aged↗
PubMed1991

Conservative surgery in vulvar-vaginal neoplasias and fertility. 3 clinical cases.

In this article we present three clinical cases of patients affected by vulvar neoplasm. Since the patients were very young when the disease was diagnosed, we decided for a conservative treatment. All patients underwent a surgical non-mutilant therapy which guaranteed a surgical radicality and, at the same time allowed them a normal reproductive life. Later all patients conceived and their pregnancies developed physiologically till the end. One patient died 23 years later; the two other are still alive and disease-free.

Adenocarcinoma↗
PubMed1998

[Bowen's disease: one of the types of vulvar intraepithelial neoplasm (VIN) III (four case reports)].

Vulvar intraepithelial neoplasia has been considered a problem of postmenopausal years, but its frequency appears to be increasing among younger women. Bowen's disease is a form of VIN III carcinoma in situ, that may appear clinically as pigmented lesions. This pathology mostly concerns younger women, and is probably connected with human papilloma virus (HPV) infection. The incidence rate is very rare. During the last 15 years only four cases of Bowen's disease have been diagnosed and treated in Division of Gynecological Oncology in Poznań. In this paper we presented symptoms, diagnostic procedures, results of clinical and histopathologic evaluation as well as managements methods. Also the results of treatment and reports on follow-up visits have been discussed.

Adult↗
PubMed1993

Second genital primary squamous neoplasms in vulvar carcinoma: viral and histopathologic correlates.

OBJECTIVE: To determine whether vulvar squamous cell carcinomas associated with certain morphologic features and/or human papillomavirus (HPV) nucleic acids were more likely to be associated with other genital primary squamous neoplasms. METHODS: We surveyed 169 invasive squamous cell carcinomas of the vulva and correlated associated vulvar intraepithelial neoplasia (VIN), invasive growth patterns resembling VIN (intraepithelial-like or basaloid), and the presence of HPV nucleic acids by in situ hybridization with a history of a second primary squamous neoplasm of the genital tract. RESULTS: Twenty-two patients (13%) had a history of a second primary. An intraepithelial growth pattern or an associated VIN correlated significantly with HPV, at P = .0005 and P = .007, respectively, and with a second primary, at P = .077 and P = .009, respectively. When HPV-positive, the same histologic variables correlated with a second primary at P = .099 and P = .25, respectively. Compared with cases lacking both these histologic features and HPV, they correlated with multifocal disease at P = .01 and P = .003. CONCLUSIONS: The findings of HPV nucleic acids, tumor growth patterns, and associated VIN are interrelated and confer risk of other genital primary neoplasms in women with vulvar carcinoma. This supports the concept that subsets of vulvar carcinoma may be distinguished not only by morphology and HPV DNA, but also by a distinctly different risk of a second genital primary neoplasm.

Aged↗
PubMed1996

Human papillomavirus is associated with the frequent detection of warty and basaloid high-grade neoplasia of the vulva and cervical neoplasia among immunocompromised women.

A total of 158 women who either HIV-infected or under iatrogenic immunosuppression were examined regularly during a 4-year period to evaluate if certain vulvar neoplasms and cervical neoplasia have similar associated risk factors. Patients with CIN were matched prospectively with immunocompetent controls with CIN. Forty-eight cervical lesions were detected among patients, including 2 invasive carcinoma and 15 CIN-3 lesions, compared to 11 vulvar lesions, including 2 invasive carcinoma and 7 VIN-3 lesions. Women who have more than five life-time partners were more likely to have HPV-DNA positive cervical swabs and vulvar scrapes as well as cervical and/or vulvar neoplasia. Compared to 2.7% of controls 15.2% of patients with CIN had coexisting high-grade lesions of the vulva. With 1 exception all patients with vulvar neoplasia either suffered from symptomatic immunodeficiency or received immunosuppressive drugs for more than 10 years. Except for 1 VIN-3 lesions, all vulvar neoplasms were associated with HPV-DNA types 16, 31, and/or 33. Six of nine patients as well as the 2 controls with coexisting vulvar and cervical neoplasia had the same HPV-type associated with both lesions. All vulvar lesions were classified as either "warty" or "basaloid". In conclusion cervical and bowenoid/basaloid vulvar neoplasia seem to have a similar HPV-related genesis. Malfunction of the cellular immune response appears to be a cofactor in the genesis of HPV-associated neoplasia at both sites.

Case-Control Studies↗
PubMed2000

Primary groin irradiation vs primary groin surgery for early vulvar cancer.

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.

Carcinoma, Squamous Cell↗
PubMed1988

The predominance of human papillomavirus type 16 in vulvar neoplasia.

Southern transfer analysis for human papillomavirus genomic sequences was conducted on 152 vulvar and vaginal tissue specimens obtained from 86 patients. Histopathologic diagnoses included condyloma acuminatum, intraepithelial neoplasia, and invasive cancer. In six patients, lesions of more than one pathologic type were identified. Vaginal lesions constituted less than 5% of tissues examined. Distribution of lesions was as follows: condyloma, 93 lesions from 57 patients; intraepithelial neoplasia, 47 lesions from 29 patients; and invasive carcinoma, 12 lesions from six patients. Seventy-five percent of the patients were white. The mean age of the patients increased from 25 years for condyloma to 38 years for vulvar intraepithelial neoplasia III to 56 years for invasive cancer. A viral diagnosis was made in 81% of condylomas, 84% of vulvar intraepithelial neoplasia III, and 58% of invasive carcinomas. Distribution of viral types differed markedly for the various histopathologies. Types 6/11 accounted for 77% of condylomas and 0% of vulvar intraepithelial neoplasia III. Type 16 was recovered from 12% of condylomas and 81% of vulvar intraepithelial neoplasia III. Type 18 was identified in a small proportion in both categories; type 31 was seen in a few vulvar intraepithelial neoplasia III lesions. In invasive carcinomas, type 16 was the predominantly identified virus. Papillomavirus type 16 emerges as the dominant oncogenic virus in vulvar neoplasms. Its presence in a large percentage of condylomas raises the issue of an "atypical condyloma" as a precursor of neoplasia.

Adult↗