[Balneological treatment of pruritus vulvae, kraurosis vulvae and leuloplakia vulvae].
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Adult↗
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Diseases of vulva. Classification and incidence of 877 patients seen consecutively in vulva clinic.
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Female↗
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↗
Abnormalities of lymphocyte transformations in women with intraepithelial carcinoma of the vulva.
Cellular immunity of the delayed type in women with intraepithelial carcinoma (carcinoma is situ) of the vulva was investigated by an in vitro assay of mitogen-induced lymphocyte transformations. Test results from 9 patients were compared to those of 23 age-matched control subjects. Lymphocyte transformation responses in counts per minute were significantly lower for women with carcinoma in situ of the vulva than for control subjects for phytohemagglutinin-P (at 50 microgram/ml) 6238 and 28,102 (P less than 0.0001); for phytohemagglutinin-P (at 165 microgram/ml 7222 and 21,417 (P less than 0.001); for concanavallin A, 14,988 and 41,888 (P less than 0.0001); and pokeweed mitogen, 20,861 and 49,601 (P less than 0.001). No significant differences in lymphocyte transformations were noted between these two groups to the specific antigens, Candida or streptokinase-streptodornase. Four patients with carcinoma in situ of the vulva were also found to have intraepithelial carcinoma of the cervix and/or vegina. The occurrence and clinical course of carcinoma in situ of the vulva in some women may be related to an underlying defect in cellular immunity. Immunosuppression may also explain the frequent association noted between carcinoma of the vulva and the development of other malignant neoplasms.
Adolescent↗
Quantitative microbiology of human vulva.
The microbial flora of the vulva is described and compared with the flora of the forearm by utilizing the detergent scrub method. Microbial counts were higher on the vulva (2.8 x 10(6)/cm2) than on the forearm (6.4 x 10(2)/cm2). Lipophilic diphtheroids, coagulase negative staphylococci, micrococci, non-lipophilic diphtheroids and lactobacilli formed the dominant flora of the vulva. Streptococci, Gram negative rods and yeasts were also noted. The highest incidence of S. aureus was noted on the vulva (67%) followed by perianal (30%), nose (30%), and the forearm (11%).
Adult↗
Adenosquamous carcinoma of skin appendages (adenoid squamous cell carcinoma, pseudoglandular squamous cell carcinoma, adenocanthoma of sweat gland of Lever) of the vulva: a clinical and ultrastructural study.
History and clinical findings of 18 cases of adenosquamous carcinoma of the skin appendages found among 135 cases of primary carcinoma of the vulva seen at the University of Minnesota Hospital between 1951 and 1970 were analyzed. In addition, two recent cases of this tumor were studied with conventional transmission electron microscopy. Adenosquamous carcinoma of the vulva showed poorer survival and a higher rate of lymph node metastases than squamous cell carcinoma of the corresponding stages (carcinoma in situ excluded). In four out of thirteen cases, the metastatic lesions in the lymph nodes retained glandular pattern. The ultrastructure showed mucin-producing columnar cells lining glandular lumina, and poorly differentiated squamous cells elsewhere; further, cells of the intermediate type between the two were present. This study indicates that adenosquamous carcinoma of the vulva is a distinctively separate entity from squamous cell carcinoma of the vulva, and possibly arises from mucin-producing cells of the skin appendages as suggested by Johnson and Helwig.
Adenocarcinoma↗
Scanning electron microscopic study of the vulva of some trichurids (Nematoda).
The structure of vulva of four Trichocephalus species has been studied using scanning electron microscopy (SEM). The shape of vulva and cuticular elements on vulval appendages is described and documented. The cuticular structures on the vulva have a characteristic shape specific for each species. It is suppossed that SEM can be successfully employed in a detailed study of vulval structure, which is an important taxonomic character for the differentiation of females of Trichocephalus species.
Animals↗
Granular-cell tumors of the vulva: a report of three cases.
Three black women were found to have granular-cell tumors on the vulva; in one, there were several additionally in other cutaneous sites. Although this benign neoplasm is uncommon on the vulva, it should be considered in the differential diagnosis of nodular lesions on the vulva. Granular-cell tumors in multiplicity occur frequently and are not a sign of metastatic disease. This lesion has predilection for blacks. Pseudocarcinomatous hyperplasia occurs typically in overlying squamous epithelium and may be misinterpreted as squamous-cell carcinoma.
Adult↗
Granular cell myoblastoma of the vulva.
The granular cell myoblastoma (granular cell tumor) is a rare lesion of mesodermal origin that occurs in many areas of the body, including the vulva in seven percent of cases. The exact origin of this tumor is still being investigated. However, nerve cell origin is generally accepted. Lesions of the vulva occur in any age group and must be biopsied to rule out carcinoma, hidradenomas, sebaceous cysts, and papillomas. The recurrence rate of incompletely excised lesions is 25 percent. The microscopic picture of the lesion may simulate carcinoma as a result of reactive hyperplasia of the overlying epidermis. Discovery of a mass on the vulva in any patient which on biopsy reveals a granular cell myoblastoma should lead the examiner to excise the lesion completely and also to search for other lesions at various sites of the body.
Adult↗
Erosions and ulcers of the vulva: diagnosis, incidence, and management.
In a study of 877 patients with disorders of the vulva seen at a vulva clinic, 375 (43%) presented with an erosion or ulceration or a condition in which an erosion or ulceration developed as a complicating feature. One hundred sixty-one of these patients had a sexually transmitted disease. This report identifies the conditions associated with erosions and ulcerations of the vulva by incidence and provides a simple clinical classification of them as an aid in diagnosis. Methods of study of this group of diseases and their management are discussed.
Adolescent↗
Management of carcinoma in situ of the vulva.
Concern about multicentricity and occult invasion has led authorities to recommend total vulvectomy in the management of carcinoma in situ of the vulva (VCIS). Of these considerations, only occult invasion has sufficient import to contraindicate a more conservative therapeutic approach. VCIS is being diagnosed with increasing frequency in young women for whom the deforming and sexually crippling effects of vulvectomy are especially repugnant. Because of its distinctive success in localizing preinvasive and early invasive squamous neoplasia of the cervix, colposcopy and directed biopsy were employed in evaluating all patients seen in our vulva clinic since 1971. Of 27 consecutive patients considered to have VCIS, 24 were treated either by local excision, skinning vulvectomy, topical 5-fluorouracil (5-FU), or cryosurgery. In no instance was occult invasion missed on pretreatment evaluation, and only one patient has developed a new in-situ lesion following conservative surgical therapy. Topical 5-FU therapy was unsuccessful in six of six cases. These results demonstrate that total vulvectomy for VCIS can be replaced successfully with more conservative operations.
Adult↗
Preoperative radiation therapy in the management of squamous cell carcinoma of the vulva: preliminary report.
Fourteen cases of squamous cell carcinoma of the vulva treated preoperatively by use of cobalt-60 irradiation directed to the vulva and inguinal areas are reviewed. Toral dose varied from 3,600 to 5,500 rads according to reaction and tolerance. No treatments had to be interrupted due to excessive radiation effects. Surgical procedures were performed six weeks after irradiation. Histologic investigation of the surgical specimen showed no sign of tumor in five cases, almost complete regression in three, and a substantial reduction of the lesion in the remainder of the cases. In situ lesions surrounding the invasive tumors were cleared in three cases. Lymph node involvement was found in only two patients, one of whom did not receive preoperative radiation to in inguinal areas. Only one local recurrence was encountered and this was in the abdominal skin outside of the irradiated area. The healing process does not seem to be impaired after radiation treatment in spite of the fact that in many patients a very extensive type of surgical procedure was carried out.
Aged↗
[Colposcopy, histology, cytology and HPV findings in patients with condylomata of the vulva].
The presence of vulvar condylomata acuminata shows evidence HPV infection of the vulva. 49 patients with such lesions came to our hospital for laser treatment. At that time, none of the patients were aware of their cervical disease. Colposcopy and biopsy of the cervix revealed in eight (16%) of the 49 patients CIN I and CIN II in one patient (2%). Condylomata or other HPV-associated lesions were found in seven patients (14%) and cervicitis in two (4%). HPV were detected in the cervix in 23 patients (46%). HPV types 16 and 18 were found in seven patients (14%) and HPV types 31, 33 and 35 in four patients (8%). It is concluded, that patients with condylomata acuminata of the vulva have a high risk of developing CIN and should undergo colposcopy.
Biopsy↗
Urogenital sinus origin of mucinous and ciliated cysts of the vulva.
The origin of mucinous and ciliated cells in the vulva and the pathogenesis of cysts lined by these epithelia were investigated. Small mucinous glands numbering from one to more than a hundred were encountered in 9 of 19 vulvas (53%) that were consecutively examined at autopsy. Eleven other cysts were encountered clinically. Six were lined by mucinous epithelium, three by pseudostratified cells with cilia plus small foci of mucinous epithelium, and two by ciliated epithelium only. Four of the cysts with ciliated epithelium were otherwise typical Bartholin's gland cysts. It is concluded that glands lined by either mucinous or ciliated epithelia are normal constituents of the vulvar vestibule, are derived from urogenital sinus, and develop into cysts when the neck leading to the vulvar surface becomes inflamed and obstructed.
Adult↗
Treatment of pruritus vulvae by multiple intradermal injections of alcohol. A double-blind study.
A double blind study is described in which 17 patients with intractable pruritus vulvae were treated by multiple intradermal injections of absolute alcohol. In each patient half the vulva was treated with alcohol whilst the other half was injected with water. Treatment with alcohol was significantly better than treatment with water (p less than 0.001).
Adult↗
Angiokeratoma of vulva.
A female of 66 who presented with long-standing pruritus vulvae showed angiokeratoma of the vulva as an incidental finding. This benign tumour is uncommon and in a survey of 150 patients over 50 years old (mean age 76.9), no further example was found.
Aged↗
[The surgical treatment and results in patients with leukoplakia vulvae].
For period from 1976 to 1988 in the Clinic of Gynecology were treated 78 patients (women--31-74 years old) with leukoplakia vulvae. 61 patients (77.2%) were subjected to classical simple vulvectomy. 18 patients (22.8%) were subjected to simple vulvectomy according to Abitbol. Per primam was closed operative sore at 12 patients, operated by classical vulvectomy and at 8 patients, operated according to Abitbol. Per secundam was closed operative sore at 49 women from first group and at 10 from second group. Stenosis vulvae was shown at 4 women (5%) and at 7 (8.9%) was developed recurrence, who was applied to accomplish a repeated treatment. Good results were educated from vulvectomy according to Abitbol. This vulvectomy was recommended from authors.
Adult↗
[Examination of the vulva of small girls. A too often neglected examination].
After a description of the methods of examination of the vulva, the authors discuss the most important findings. Among the organic diseases, are congenital abnormalities, vulvar coalescence, imperforate hymen, polyps, cysts and above all, trauma. Among the infections, one may note vulvitis or vulvovaginitis but also inclusions, of the clitoridian smaegma, and meatitis. Among the functional disorders, examination of the vulva is necessary for precocius puberty, amenorrhoea, and late puberty. Finally, it permits one to solve a certain number of false problems ; it is however often neglected and should form part of all complete pediatric examinations.
Amenorrhea↗