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Stevens-Johnson syndrome with vulvar involvement: A case report and literature review. Case Rep Womens Health 2022; 34:e00404. [PMID: 35340779 PMCID: PMC8942816 DOI: 10.1016/j.crwh.2022.e00404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023] Open
Abstract
Stevens-Johnson syndrome is a rare, life-threatening mucocutaneous condition causing necrosis and detachment of the epidermis. Vulvovaginal involvement, seen in up to 70% of affected women, can lead to painful chronic conditions such as adenosis, hematocolpos, and chronic pelvic pain. To date, there is no consensus regarding the optimal treatment of vulvovaginal involvement. In this case report, one case of Stevens-Johnson syndrome with vulvar and vaginal involvement is described, and the treatment options for this rare condition are reviewed. Up to 70% of patients with Stevens-Johnson syndrome may have vulvar involvement. The management of vulvar Stevens-Johnson syndrome should include high-potency topical steroids. Vaginal strictures may develop, in which case the use of vaginal dilators may be considered. Rolled gauze may be used to encourage labial separation when agglutination is seen.
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Magone MT, Maiberger M, Clayton J, Pasieka H. Vulvovaginal and ocular involvement and treatment in female patients with Stevens-Johnson syndrome and toxic epidermal necrolysis: A review. Int J Womens Dermatol 2022; 7:520-528. [PMID: 35024409 PMCID: PMC8721055 DOI: 10.1016/j.ijwd.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 10/31/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious adverse cutaneous drug reactions, characterized by epidermal detachment and mucous membrane involvement. SJS/TEN is more common in female patients, with unique findings in the ocular and vulvar regions. Early recognition and intervention, as well as long-term follow-up, are crucial to prevent devastating scarring and sequelae. This review examines the vulvar and ocular manifestations of SJS/TEN and describes the current treatment recommendations for female patients, requiring close consultation and collaboration among dermatology, ophthalmology, and gynecology.
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Affiliation(s)
- M Teresa Magone
- Ophthalmology Consult Services Section, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary Maiberger
- Department of Dermatology, Veterans Affairs Medical Center, Washington, DC
| | - Janine Clayton
- Ophthalmology Consult Services Section, National Eye Institute, National Institutes of Health, Bethesda, Maryland.,Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland
| | - Helena Pasieka
- Uniformed Services University of Health Sciences, Bethesda, Maryland
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Karasu S, Cilengir AH, Ocal I, Aydogmus S. Transperineal Ultrasonographic and Magnetic Resonance Imaging Findings of Vaginal Adenosis. Curr Med Imaging 2021; 18:82-85. [PMID: 34102982 DOI: 10.2174/1573405617666210608153631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vaginal adenosis is a rare clinicopathological entity which refers to the presence of glandular endometrial tissue in the vaginal wall. CASE REPORT A gravida 46-year-old woman was presented to the gynecology department with symptoms of chronic pelvic pain. Maternal Diethylstilbestrol (DES) usage has been proven effective in the development of vaginal adenosis. It can also be idiopathic. Its sonographic or magnetic resonance imaging (MRI) findings have not been described in English literature previously. CONCLUSION Here, we report the clinical, transperineal ultrasonographic (US) and MRI findings of a pathologically proven case of vaginal adenosis.
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Affiliation(s)
- Sebnem Karasu
- Kâtip Celebi University, Faculty of Medicine, Ataturk Training and Research Hospital, Department of Radiology, Turkey
| | | | - Irfan Ocal
- Kâtip Celebi University, Faculty of Medicine, Ataturk Training and Research Hospital, Department of Pathology, Turkey
| | - Serpil Aydogmus
- Kâtip Celebi University, Faculty of Medicine, Ataturk Training and Research Hospital, Department of Obstetrics and Gynecology, Turkey
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Crowder CA, Jeney SES, Kraus CN, Bernal N, Lane F. Vulvovaginal involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis: management and techniques used to reduce gynecologic sequelae. Int J Dermatol 2021; 61:158-163. [PMID: 34037244 DOI: 10.1111/ijd.15676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vulvovaginal involvement in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) is common, likely underdiagnosed, and can result in severe sequelae if not managed acutely. There are few studies on acute management of vulvovaginal SJS/TEN. Current recommendations are predominantly based on expert opinion. We aimed to determine the frequency of vulvovaginal involvement in SJS/TEN at a single institution, identify treatment modalities, and assess outcomes at a tertiary care burn center. METHODS This is a retrospective review of vulvovaginal SJS/TEN cases between 2009 and 2019. Demographic and clinical data including exam findings, treatment regimens, and outpatient follow-up were collected from the electronic medical record. RESULTS Vulvovaginal involvement was observed in 12.7% (19/149) of cases of female patients with SJS/TEN. The mean age was 38.7 years (SD 23.6), and 21% (4/19) of patients were pediatric (age 9-18). Vulvar involvement was seen in 47.3% (9/19), and vulvar plus vaginal involvement was reported in 42.1% (8/19). Treatment regimens were variable until 2017, at which time institutional guidelines were implemented including application of ultrapotent topical steroid, vaginal estrogen, and menstrual suppression. Gynecology follow-up occurred in 15.7% (3/19) of cases. One complication of superficial vaginal agglutination was noted and was successfully treated in the office with blunt dissection. CONCLUSION The most common treatment modalities employed at our institution included application of ultrapotent topical steroid, vaginal estrogen, and menstrual suppression. While follow-up was limited for our patient population, we propose an algorithm to prevent long-term sequalae of vulvovaginal SJS/TEN. Gynecologic surveillance is recommended to reduce urogynecologic sequelae.
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Affiliation(s)
- Carly A Crowder
- Division of Urogynecology, Department of Obstetrics and Gynecology, UC Irvine Medical Center, Orange, CA, USA
| | - Sarah E S Jeney
- Division of Urogynecology, Department of Obstetrics and Gynecology, UC Irvine Medical Center, Orange, CA, USA
| | - Christina N Kraus
- Department of Dermatology, UC Irvine Medical Center, Orange, CA, USA
| | - Nicole Bernal
- Division of Trauma, Burns, and Critical Care, Department of General Surgery, UC Irvine Medical Center, Orange, CA, USA
| | - Felicia Lane
- Division of Urogynecology, Department of Obstetrics and Gynecology, UC Irvine Medical Center, Orange, CA, USA
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Awosogba TP, Whitney J, Broder JC, McKee A, Paquette C, Nitschmann CC. A case of vaginal adenosis with gastric differentiation. Gynecol Oncol Rep 2020; 34:100672. [PMID: 33294576 PMCID: PMC7691171 DOI: 10.1016/j.gore.2020.100672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/24/2020] [Accepted: 11/01/2020] [Indexed: 11/15/2022] Open
Abstract
Vaginal adenosis is a non-obligate pre-cursor for vaginal clear cell carcinoma. Vaginal adenosis is rare and presents with a variety of signs and symptoms. Unclear link between adenosis and carcinoma without diethylstilbestrol exposure. Surveillance with physical examinations, imaging and biopsies is recommended.
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Affiliation(s)
- Temitope P Awosogba
- Department of Obstetrics and Gynecology, New York University Langone Health, 660 First Ave, New York, NY, 10016, USA
| | - Janelle Whitney
- Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Jennifer C Broder
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, USA
| | - Andrea McKee
- Department of Radiation Oncology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, USA
| | - Cherie Paquette
- Department of Pathology and Laboratory Sciences, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, USA
| | - Caroline C Nitschmann
- Department of Obstetrics and Gynecology, New York University Langone Health, 660 First Ave, New York, NY, 10016, USA
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Malignant transformation of vaginal adenosis to clear cell carcinoma without prenatal diethylstilbestrol exposure: a case report and literature review. BMC Cancer 2019; 19:798. [PMID: 31409310 PMCID: PMC6693164 DOI: 10.1186/s12885-019-6026-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022] Open
Abstract
Background We report an extremely rare case of vaginal clear cell carcinoma, which originated from the malignant transformation of vaginal adenosis without prenatal diethylstilbestrol (DES) exposure. Case presentation In this case, the patient was a Chinese woman with a history of two decades of intermittent vaginal pain, sexual intercourse pain and vaginal contact bleeding. On September 1, 2011, when the patient was 39 years old, a vaginal biopsy revealed vaginal adenosis. After intermittent drug and laser treatment, her symptoms did not improve. Four years later, on March 4, 2015, another vaginal biopsy for abnormal vaginal cytology revealed atypical vaginal adenosis. After treatment with sirolimus, her symptoms and abnormal vaginal cytology results persisted, and she underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy and excision of the vaginal lesions. One year after the hysterectomy, on August 15, 2017, the vaginal cytology results suggested atypical glandular cells, and a biopsy revealed vaginal clear cell carcinoma originating from the atypical vaginal adenosis. A wide local resection of the vaginal lesions was performed, followed by concurrent chemoradiotherapy. Regular follow-up over 16 months showed no evidence of the recurrence of vaginal adenosis or cancer. Conclusions Based on the evolution of a series of pathological evidence, we report the fourth case in the world of vaginal clear cell carcinoma originating from vaginal adenosis without prenatal DES exposure. Wide local excision with radiotherapy provided at least 16 months of disease-free survival.
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Han T, Jin Y, Li Y, Bi Y, Pan L. Clinicopathologic features and outcomes of primary vaginal adenosis as a dermatologic and gynecologic burden: A retrospective study. Medicine (Baltimore) 2018; 97:e13470. [PMID: 30544435 PMCID: PMC6310491 DOI: 10.1097/md.0000000000013470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the recent 20 years, primary vaginal adenosis is extremely rare and the data of clinical presentations, management, and outcome have not been studied systematically.In this retrospective study, women with vaginal adenosis between January 1997 and June 2017 were identified from the hospital's medical records. Data on patient age, history, symptoms, mass location, size, diagnosis, complications, treatment, and recurrence were analyzed by SPSS 20.0.Twenty women were histopathologically diagnosed as having vaginal adenosis (mean age, 37.9 ± 10.6 years). All patients denied utero exposure. The most common symptom was vaginal pain or abnormal bleeding. For all patients, the local vaginal lesions were surgically excised. Seven patients had complications with endometriosis. 15 patients lived without recurrence, and 1 patient underwent postoperative local recurrence after 81 months. Primary vaginal squamous cell carcinoma in another patient was confirmed to arise from adenosis; she survived with disease. The remaining 3 patients developed carcinoma of different types in varied periods of a disease-free state (5 months, 30 months, and 23 years, respectively); 1 patient died of progressive disease, and 2 patients survived with disease.Primary vaginal adenosis is a spontaneous lesion with a propensity for late canceration. Local lesion resection is the primary treatment.
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Affiliation(s)
| | - Ying Jin
- Department of Obstetrics and Gynecology
| | - Yan Li
- Department of Obstetrics and Gynecology
| | - Yalan Bi
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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Spontaneous de novo vaginal adenosis resembling Bartholin’s cyst: A case report. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Martin AA, Atkins KA, Lonergan CL, McHargue CA. Vaginal adenosis as a dermatologic complaint. J Am Acad Dermatol 2013; 69:e92-3. [PMID: 23866893 DOI: 10.1016/j.jaad.2009.11.590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 11/17/2009] [Accepted: 11/19/2009] [Indexed: 11/17/2022]
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González-Díaz E, Fernández-Fernández C, Suárez-Álvarez B, Reyero M, González-García C. Adenosis vaginal no relacionada con dietilestilbestrol. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2007. [DOI: 10.1016/s0210-573x(07)74495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dubé V, Lickrish GM, MacNeill KN, Colgan TJ. Villoglandular Adenocarcinoma In Situ of Intestinal Type of the Hymen. J Low Genit Tract Dis 2006; 10:156-60. [PMID: 16829755 DOI: 10.1097/00128360-200607000-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adenocarcinomas of the lower genital tract are rare diseases, and most of them arise from the Bartholin glands. Villoglandular adenocarcinoma of intestinal type is a very uncommon neoplasm of unknown origin with only few cases described on the vulva and in the vagina. It is characterized by villoglandular architecture, mucinous-type epithelium with intestinal differentiation (goblet cells), and direct apposition of the tumor with the surface epithelium. We report a case that developed on the hymen of a 64-year-old woman and discuss its possible origin as arising de novo from the squamous epithelium.
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Affiliation(s)
- Valérie Dubé
- Department of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada
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Emberger M, Lanschuetzer CM, Laimer M, Hawranek T, Staudach A, Hintner H. Vaginal adenosis induced by Stevens-Johnson syndrome. J Eur Acad Dermatol Venereol 2006; 20:896-8. [PMID: 16898932 DOI: 10.1111/j.1468-3083.2006.01586.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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P103 - Efficacité du traitement au nitrate d’argent dans l’adénose vulvaire. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)79832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Noël JC, Buxant F, Fayt I, Bebusschere G, Parent D. Vulval adenosis associated with toxic epidermal necrolysis. Br J Dermatol 2005; 153:457-8. [PMID: 16086774 DOI: 10.1111/j.1365-2133.2005.06751.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eren F, Savci D, Erbarut I, Gökaslan H. Benign glandular cells in posthysterectomy vaginal smears: the incidence is higher than expected. Cytopathology 2004; 15:195-9. [PMID: 15324446 DOI: 10.1111/j.1365-2303.2004.00162.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, we have investigated the frequency and clinical significance of glandular cells in posthysterectomy vaginal smears. The slides of vaginal cuff smears of 290 patients were reviewed. The glandular cells were categorized into three groups: (1) squamous metaplastic-like cells; (2) columnar endocervical-like cells; and (3) small round cuboidal cells. Glandular cells were found in 39 (13%) of the 290 vaginal smears. Group 1 type cells were seen in 76% (n = 30), group 2 type cells in 38% (n = 15) and group 3 type cells in 47% (n = 19) of the smears. In 19 (48%) of the smears combination of two or three groups were seen. The presence of glandular cells showed a strong association with inflammation/repair as a background finding in the smears. No correlation could be found between the presence of atrophy and history of chemotherapy or radiotherapy. Apart from these there was a prominent increase in reporting benign glandular cells after the application of the current Bethesda 2001 reporting criteria in our laboratory. As a result our study showed that the finding of glandular cells in posthysterectomy vaginal smears is more frequent than expected and most of them could be related to inflammatory and regenerative processes in the absence of a clearly identified underlying cause.
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Affiliation(s)
- F Eren
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey.
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