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PubMed1998

Combined use of intraoperative lymphatic mapping and lymphoscintigraphy in the management of squamous cell cancer of the vulva.

BACKGROUND: The standard care of the patient with squamous cell cancer of the vulva is radical vulvectomy along with inguinal-femoral node dissection. We explored the feasibility of sentinel lymphadenectomy in patients with squamous cell cancer of the vulva. METHODS: Patients with biopsy proven squamous cell cancer of the vulva were studied with preoperative lymphoscintigraphy, intraoperative lymphatic mapping with isosulfan blue combined with intraoperative lymphoscintigraphy utilizing a hand-held gamma counter. RESULTS: Five patients with invasive squamous cell cancer were studied. Sentinel nodes were identified in six lymphatic basins. One lymphatic basins had two sentinel nodes. Six of seven sentinel nodes were blue and all retained radioactivity at a ratio of at least 3:1 above the background levels in the regional node basin. One patient was found to have metastatic tumor which was confined to a sentinel lymph node. There was minimal morbidity associated with the procedure. CONCLUSIONS: Lymphatic mapping is feasible in patients with squamous cell cancer of the vulva. These initial results suggests further study is warranted.

Carcinoma, Squamous Cell↗
PubMed1995

Carcinoma of the vulva in young women.

OBJECTIVE: To determine if young women with carcinoma of the vulva have a different risk factor history and outcome compared with older women. METHODS: We conducted a retrospective review of the medical records of 78 women treated at the Medical College of Georgia for squamous carcinoma of the vulva during 1979-1993. Women younger than 45 years were compared with those 45 and over for historic risk factors, treatment modality, and outcome. RESULTS: Over the study interval, the average presenting age of these patients decreased from 69 to 55 years. Women under 45 were found to have a stronger history of condyloma (P < .001, 95% confidence interval [CI] 3.69-87.96). There was no significant difference by age in the duration of symptoms before presentation, smoking history, or tumor size. Women 45 and over were more likely to have advanced-stage disease (International Federation of Gynecology and Obstetrics [FIGO] stage III or IV) (P = .03, 95% CI 0.43-0.91). Treatment did not differ significantly with age. In a univariate analysis, advanced FIGO stage, presence of metastases, and tumor size were associated with shorter survival. There was no detected difference in survival for women in either age group. CONCLUSION: There appears to be a trend in our patient population toward younger women presenting with squamous carcinoma of the vulva. Human papillomavirus infection appears to be more common in younger women with vulvar carcinoma. There may be a difference in the etiologies producing squamous carcinomas of the vulva. Education encouraging the early detection and prevention of sexually transmitted diseases might alter the rising incidence of this disease in younger women.

Adult↗
PubMed1985

Adhesion of Corynebacterium renale and Corynebacterium pilosum to the epithelial cells of various parts of the bovine urinary tract from the renal pelvis to vulva.

The various parts of the bovine urinary tract, the renal pelvis, the ureter, the urinary bladder, the urethra, the vaginal vestibule and the vulva, were examined for the capacity of the epithelial cells to bind Corynebacterium renale and C. pilosum. C. renale adhered best to the epithelial cells of the vulva, and then to those of the ureter and renal pelvis. C. pilosum also adhered best to the epithelial cells of the vulva, followed by those of the vaginal vestibule. The results indicate that the most important target tissue for these bacteria may be the vulva, and the results correlate with the fact that C. renale frequently causes pyelonephritis and ureteritis, while C. pilosum causes the same diseases less frequently and behaves like normal flora of the vaginal vestibule.

Adhesiveness↗
PubMed2004

Pristionchus pacificus vulva formation: polarized division, cell migration, cell fusion, and evolution of invagination.

Tube formation is a widespread process during organogenesis. Specific cellular behaviors participate in the invagination of epithelial monolayers that form tubes. However, little is known about the evolutionary mechanisms of cell assembly into tubes during development. In Caenorhabditis elegans, the detailed step-to-step process of vulva formation has been studied in wild type and in several mutants. Here we show that cellular processes during vulva development, which involve toroidal cell formation and stacking of rings, are conserved between C. elegans and Pristionchus pacificus, two species of nematodes that diverged approximately 100 million years ago. These cellular behaviors are divided into phases of cell proliferation, short-range migration, and cell fusion that are temporally distinct in C. elegans but not in P. pacificus. Thus, we identify heterochronic changes in the cellular events of vulva development between these two species. We find that alterations in the division axes of two equivalent vulval cells from Left-Right cleavage in C. elegans to Anterior-Posterior division in P. pacificus can cause the formation of an additional eighth ring. Thus, orthogonal changes in cell division axes with alterations in the number and sequence of cell fusion events result in dramatic differences in vulval shape and in the number of rings in the species studied. Our characterization of vulva formation in P. pacificus compared to C. elegans provides an evolutionary-developmental foundation for molecular genetic analyses of organogenesis in different species within the phylum Nematoda.

Adherens Junctions↗
PubMed2003

Apocrine carcinoma of the vulva in a band-like arrangement with inflammatory and telangiectatic metastasis via local lymphatic channels.

BACKGROUND: Primary adenocarcinomas of the vulva have been classified as sweat gland carcinomas, extramammary Paget's disease, and primary breast carcinomas of the vulva. They share some common histopathologic features. METHODS: We describe a 72-year-old Japanese woman with apocrine carcinoma of the vulva and local lymphatic metastasis. RESULTS: The patient presented with a bruise on her inguinal area. Physical examination revealed a 4 cm x 7 cm, dark-red, irregularly elevated tumor on the left labium majora. Dome-shaped, flesh-colored, small papulovesicles were scattered on the abdomen, accompanied by erythema and induration. The lesion showed a band-like arrangement. General examination revealed multiple bone metastases, particularly in the spine. Microscopic examination revealed a moderately differentiated adenocarcinoma with signet ring cells. A few pagetoid clear cells were present in the hypertrophic epidermis. The peripheral papulovesicles demonstrated the same histopathologic view as in inflammatory and telangiectatic, metastatic breast carcinoma. Tumor cells were positive for various ductal and glandular markers. Estrogen and progesterone receptors were not expressed. Ultrastructural findings suggested differentiation towards apocrine or mammary glands because of the presence of an apocrine process and electron-dense mucous granules. The patient died in spite of combination chemotherapy and irradiation therapy. CONCLUSIONS: We report a rare case of apocrine carcinoma of the vulva in a band-like arrangement with local lymphatic metastasis which showed the clinical and histopathologic characteristics of inflammatory and telangiectatic carcinoma.

Adenocarcinoma↗
PubMed2005

The vulva is relatively insensitive to menses-induced irritation.

Skin patch testing of menses and venous blood on the vulva (labia majora) and the upper arm was performed to assess the potential contribution of these biological fluids to vulvar irritation during menstruation. After 24 and 48 hours of occlusive exposure, the skin of the labia majora was relatively unaffected by these fluids compared to the skin of the upper arm: no significant irritation was observed on the labia at either exposure time, but discernible irritation was elicited on the upper arm after 48 hours of exposure. Pre-treatment of the upper arm with a petrolatum-based emollient attenuated the upper arm response. Semi-occlusive conditions also reduced the degree of upper-arm irritation elicited test materials and an irritant control, sodium lauryl sulfate. The relative insensitivity of the vulva to irritation by menses or blood was not predictable a priori because some irritants elicit heightened responses on the vulva relative to the arm (3). These results suggest that the vulva (labia majora) may be adapted to be less sensitive to menses-induced skin irritation than other anatomical sites.

Journal Article↗
PubMed1982

Microinvasive carcinoma of the vulva.

Thirty cases of microinvasive squamous cell carcinoma of the vulva were seen from 1972 to 1978 inclusive. They comprised 37.7% of 77 cases of squamous carcinoma of the vulva seen during this period of time. The results of analysis of multiple factors, including tumor depth and pattern of invasion, nuclear and histologic grade, volume, inflammatory response, presence of vascular invasion, and depth of invasion as compared to the depth of adjacent skin appendages and rete ridges are presented. Two patients were found to have inguinal lymph node metastasis: in one of these patients the tumor was deeper than the adjacent deepest skin appendages while in the second patient skin appendages were not adjacent to the tumor. These tumors measured 2.25 and 1.8 mm in depth, respectively. In both patients the tumor was of high nuclear grade and had a diffuse pattern of infiltration. No nodal metastases were found in patients whose tumors did not invade deeper than 1.5 mm or deeper than the adjacent deepest skin appendage. Tumors measuring 1.5 mm in depth had tumor volumes under 1,000 mm3. The only death from tumor that occurred in this series occurred in a woman who had a second primary tumor of the vulva following a local excision for her microinvasive carcinoma. The definition and measurements of microinvasive carcinoma of the vulva are discussed and an improved method of measurement is proposed.

Adult↗
PubMed2005

Association between invasive squamous cell carcinoma of the vulva and ABO blood group.

OBJECTIVE: To determine whether the distribution of ABO blood group among women with invasive squamous cell carcinoma (SCC) of the vulva is different from that among a population of women treated for nonneoplastic gynecologic disease. METHODS: A retrospective analysis of pathology reports and blood bank records from January 1996 through September 2003 was performed. The distribution of ABO blood group for 33 women diagnosed with invasive SCC of the vulva was determined. ABO blood group was also recorded for 100 female patients (controls) who underwent a gynecologic procedure for a nonneoplastic process during the period January 2003 through November 2003. The blood group phenotype distribution for the study groups and the controls was compared by an incidence ratio. RESULTS: Statistical analysis gave an incidence ratio for blood group types A and O of 1.55 (p < .20) when the patients with invasive SCC of the vulva were compared with the controls. The p value was not significant. Similarly, the incidence ratio for blood group types B and O equaled 0.386 (p = 1). Again the p value was not significant. In fact, none of the incidence ratios calculated were statistically significant. Although not statistically significant, the incidence ratio for the invasive vulvar SCC group was >1. This may indicate that there is a trend for women with invasive SCC of the vulva to have blood group type A. CONCLUSIONS: Results of this study do not suggest an association between blood group type A, or any other blood group, and vulvar SCC. This study was similar in patient size to another study (33 patients with vulvar SCC vs. 39 patients with vulvar SCC, respectively). The disparity of the results in determining the significance of blood group type A as an associated factor for vulvar SCC in this and the other study may be due to the limited size of the study populations. Additional investigation is needed to further evaluate this issue.

ABO Blood-Group System↗
PubMed1987

Multifocal invasive carcinoma of the vulva in a 25-year-old woman with Bowenoid papulosis.

This case report documents malignant progression associated with wart virus infection of the vulva in a 25-year-old female. The initial condition of Bowenoid papulosis and carcinoma in situ of the vulva was diagnosed on colposcopic biopsies performed to investigate chronic pruritus and superficial dyspareunia. This condition failed to resolve with local ablative therapy and progressed over a period of 8 months to multifocal invasive carcinoma of the vulva requiring radical surgery. Deoxyribonucleic acid hybridization studies on the operative specimen revealed the presence of human papilloma virus type 16. The role of human papilloma virus in the aetiology of Bowenoid papulosis and neoplasia of the vulva is discussed.

Adult↗
PubMedDate not supplied

A rare association of synchronous intraductal carcinoma of the breast and invasive carcinoma of ectopic breast tissue of the vulva: case report and literature review.

Only 17 cases of breast carcinoma arising in vulvar ectopic mammary tissue have been reported. We present a unique case of synchronous pure intraductal carcinoma of the breast (DCIS) and invasive carcinoma of ectopic breast tissue of the vulva. A 53-year-old woman presented with a 2-cm nodule in left labium major of the vulva. A surgical biopsy revealed an invasive carcinoma of ectopic mammary tissue. The mammography showed irregular microcalcifications of the right breast. The patient underwent left hemivulvectomy, bilateral inguinal sentinel lymph node biopsy, and radioguided breast resection (radioguided occult lesion localization) of the microcalcifications. The definitive histology revealed negative inguinal sentinel nodes, no further residual tumor in the vulva, and a high-grade (grade 3) DCIS in the breast. The synchronous occurrence of primary breast carcinoma and ectopic breast tissue carcinoma in the vulva is an extremely rare finding, only once previously being reported and leading to unsolved problems of differential diagnosis. The presence of a pure DCIS of the breast makes this case really unique, definitively confirming the independent primary origin of both mammary tumors. The inguinal sentinel node biopsy avoided a bilateral inguinal dissection.

Breast↗
PubMed2002

Mucinous adenocarcinoma of ectopic breast tissue of the vulva.

Ectopic breast tissue has been described rarely in the vulva and is known to develop a variety of pathologic changes. Our review of the literature found a total of 11 reported cases of primary infiltrating ductal adenocarcinoma arising in ectopic breast tissue of the vulva. We report what we believe is the first case of primary mucinous adenocarcinoma arising in ectopic breast tissue of the vulva diagnosed by characteristic histopathologic features and immunohistochemical stain results. We discuss the criteria used in diagnosis of primary breast carcinoma of the vulva and review previously reported cases.

Adenocarcinoma, Mucinous↗
PubMed1990

[Koilocytosis in precancerous conditions and cancer of the vulva].

The incidences of combination of koilocytosis and dysplasias of squamous epithelium of skin-mucous integument of vulva in 120 patients with kraurosis and leukoplakia and 166 patients with carcinoma of external genitalia (at the distance of 3-4 cm from the tumour) are studied. Vulva tissue of 100 women of the same age dying from non-tumourous conditions served as control. The increase of the koilocytosis incidence was observed at various stages of carcinogenesis (slight dysplasia--mild dysplasia--severe dysplasia--preinvasive carcinoma). koilocytes are not found in the invasive carcinoma. It is suggested to consider koilocytosis as one of additional morphologic signs of the risk of vulva carcinoma. The disappearance of koilocytes which are markers of the viral cell alteration in invasive carcinomas allows one to regard a viral damage of the vulva epithelium as one of the cocarcinogenic influences responsible for the development of squamous cell carcinoma.

Epithelium↗
PubMed1988

Pre-neoplastic lesions of the vulva.

Preneoplastic lesions of the vulva have to be considered lesions "at risk" of facilitating the occurrence of invasive vulvar cancer. The Author examines the two categories of lesions commonly considered at risk for invasive epidermoid carcinoma of the vulva, carcinoma in situ and vulvar dystrophies. Carcinoma in situ of the vulva is characterized by an extreme clinical diversity contrasting with a remarkable uniformity of histologic pattern. The author describes two different clinical patterns, the young female type and the post-menopausal type. According to the new virologic progress, three conclusions may be drawn: 1) Oncogenic HPV is the common aetiology of all the carcinomas in situ of the vulva, whatever the clinical type; 2) Oncogenic HPV may directly induce any type of carcinoma in situ; 3) Oncogenic HPV possesses a very special carcinogenic effect with a long period of ascending trophism. Among the dystrophies, the hyperplastic one is the most at risk. The Author discusses the real autonomy of this entity. He concludes that hyperplastic dystrophy per se does not exist and it is always a mixed dystrophy.

Bowen's Disease↗
PubMed1985

[A clinicopathological study of 11 patients with Paget's disease of the vulva].

A clinicopathological analysis of 11 patients with Paget's disease of the vulva was reported. A close association of this disease with cancer was strongly suggested in the histological examination. Nine of 11 patients had wide primary lesion; 4 patients had coexisting undifferentiated carcinoma (one patient with in situ sweat gland carcinoma) and one patient had squamous cell carcinoma in other lesion of the vulva. Five patients had downward growth of the tumor from the epidermis proper. There were, thus, only two patients who had Paget's cells confined within the epidermis. Three patients died of generalized metastasis of carcinoma and two patients had vulvar recurrence. The results of staining for PAS, PAS diastase resistant reaction, alcian blue, mucicarmin and carcinoembryonic antigen (CEA) were all positive in specimens with similar stainings to coexisting undifferentiated carcinoma of the vulva and metastasized lesions. CEA staining was positive in cytoplasm of Paget's cells and basal cells widely in the epidermis. It could be considered that the Paget's cells of the vulva originated multifocally from primitive stratum germinativum, which gave rise to the surface epithelium as well as all of the dermal appendages.

Aged↗
PubMed1995

[Expression of p53 gene protein in squamous cell carcinoma and precancerous lesion of vulva].

OBJECTIVES: To investigate the relationship between p53 gene protein expression and vulvar carcinoma. METHODS: Expression of p53 gene mutative protein was determined by immunohistochemical technique in 17 specimens of vulva squamous cell carcinoma, 11 of atypical hyperplasia, 22 of lichen sclerosus et atrophicus, 34 of hyperplastic dystrophy, 48 of mixed dystrophy. Normal skin samples from abdomen and legs, and adjacent tissues of vulvar cancer were served as controls. RESULTS: All specimens of normal skin showed no p53 gene mutative protein expression. However, p53 protein positive rates were 52.9% (9/17) in carcinoma group, 54.5% (6/11) in atypical hyperplasia, 13.6% (3/22) in lichen sclerosus et atrophicus group, 20.8% (10/48) in mixed dystrophy, 14.7% (5/34) in hyperplastic dystrophy. CONCLUSIONS: p53 gene mutative protein had a higher expression rate in vulva squamous cell carcinoma and precancerous lesion than that in various types of vulva dystrophy (P < 0.01). These data suggested that overexpression of p53 gene mutative protein may be related to the oncogenesis of vulva malignancy.

Carcinoma, Squamous Cell↗
PubMed1997

[Sweat gland carcinoma of the vulva, report of 7 cases].

OBJECTIVES: To report the clinical and pathologic features and to evaluate the treatment results of 7 cases of sweat gland carcinoma of the vulva. METHODS: The clinical records of the 7 cases of sweat gland carcinoma of the vulva, admitted to our hospital for treatment between December, 1974 and December, 1994, were reviewed. The data including clinical and pathologic features, treatments and posttreatment follow-ups. Five of the 7 cases were referred from other hospitals, 4 followed by local resection and 1 with recurrence 7 years after surgery. RESULTS: 5/7 of the cases were alive for more than 5 years. One of the 5 cases recurred twice at 7 and 11 years after the initial treatment and each time remedied by radiotherapy, but eventually died of tumor with pulmonary metastasis at the 17th year. Two died within 5 years after treatment; one from cerebral hemorrhage and the other from extensive cancer metastasis 1 year and 9 months after surgery. CONCLUSIONS: The prognosis of sweat gland carcinoma of the vulva is fairly good. Wide local resection of the vulva or radical vulvectomy is the treatment of choice.

Adenocarcinoma↗
PubMed1998

Human papilloma virus in verrucus carcinoma of the vulva: an immunopathological study of three cases.

The pathological features of three cases of verrucus carcinoma of the vulva, examined in our laboratory during the last decade are presented. Verrucus carcinoma of the vulva is of special interest because of its rarity (6.5% of our cases of malignant lesions of the vulva), its special morphology and the problems in differential diagnosis that are encountered. There is also evidence that there is an association with HPV infection. We present the pathological features of three cases of verrucus carcinoma that we studied in the last decade in our Laboratory among 48 malignant lesions of the vulva. An immunohistochemical detection of HPV was performed by the streptavidine-viotine method and classification by in situ hybridization showed the presence of HPV 6/11 in all cases.

Aged↗
PubMed1986

A new technique for alcohol injection in the vulva.

The technique of alcohol injection in the vulva is reserved for the attempted relief of pruritus vulvae in patients who have failed to respond to a conscientious trial of medical therapy. The procedure is time-consuming, but the operative time can be shortened significantly if a transparent adhesive drape with a grid drawn on it is applied to the vulva before injection.

Adhesiveness↗