1
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Combination of surgery and laser for the treatment of extensive VIN3 and vulval condyloma: A case report. Ann Med Surg (Lond) 2022; 78:103763. [PMID: 35734690 PMCID: PMC9207034 DOI: 10.1016/j.amsu.2022.103763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction and importance Vulval intraepithelial neoplastic lesions (VINs) are rare lesions that appear with limited signs of pre-malignancy restricted to the vulvar epithelium. One of the principal causes of VINs is the human papillomavirus (HPV) infection, especially in people with weakened immune systems and young women. Case presentation A 35-year-old woman presented with VIN3 who had severe immunosuppression and was under corticosteroid treatment. Her lesions were treated with a laser and surgical excision. Clinical discussion Pathological findings indicated full thickness dysplasia and HPV infection. Follow-up after 5 years showed complete recovery and no recurrence, with a restoration of the vulva esthetics. Conclusion Due to the increasing prevalence of VIN malignancy in young women and the importance of maintaining normal anatomy and function of the genitalia, a combination of surgery and laser can be used instead of extensive surgery only. Vulval intraepithelial neoplastic lesions (VIN) are rare lesions that appear with limited signs of malignancy restricted to the epithelium of the vulva. Human papillomavirus (HPV) infection is among the principal causes of VIN, especially in immunocompromised individuals. The VIN is divided into three degrees (like cervical intraepithelial neoplasia-CIN) as VIN1, VIN2, and Vin3.
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2
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van der Meijden WI, Boffa MJ, Ter Harmsel B, Kirtschig G, Lewis F, Moyal-Barracco M, Tiplica GS, Sherrard J. 2021 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2022; 36:952-972. [PMID: 35411963 DOI: 10.1111/jdv.18102] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Affiliation(s)
- W I van der Meijden
- Department of Dermatology, Betsi Cadwaladr University Health Board, Bangor, UK
| | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - B Ter Harmsel
- Department of Gynaecology, Roosevelt kliniek, Leiden, The Netherlands
| | - G Kirtschig
- Gesundheitszentrum Frauenfeld, Frauenfeld, Switzerland
| | - F Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - M Moyal-Barracco
- Department of Dermatology, Tarnier-Cochin Hospital, Paris, France
| | - G-S Tiplica
- Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - J Sherrard
- Department of Sexual Health, Wycombe General Hospital, Bucks, UK
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3
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Zapardiel I, Coronado PJ. Author's response to letter to editor on VULCAN study. Int J Gynecol Cancer 2020; 31:158. [PMID: 33187973 DOI: 10.1136/ijgc-2020-002190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital IdiPAZ, Madrid, Spain
| | - Pluvio J Coronado
- Obstetrics and Gynecology, Hospital Clinico San Carlos IdISSC, Complutense University, Madrid, Spain
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4
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Rijsbergen M, Rijneveld R, Todd M, Feiss GL, Kouwenhoven STP, Quint KD, van Alewijk DCJG, de Koning MNC, Klaassen ES, Burggraaf J, Rissmann R, van Poelgeest MIE. Results of phase 2 trials exploring the safety and efficacy of omiganan in patients with human papillomavirus-induced genital lesions. Br J Clin Pharmacol 2020; 86:2133-2143. [PMID: 31755993 DOI: 10.1111/bcp.14181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS To assess safety and tolerability and explore pharmacodynamics and efficacy of omiganan in external anogenital warts (AGW) and vulvar high-grade squamous intraepithelial lesions (HSIL). METHODS Two randomized controlled trials in patients with external AGW and vulvar HSIL were conducted. Patients received topical omiganan 2.5% or placebo gel once daily for 12 weeks with a follow-up of 12 weeks. Safety and tolerability were monitored and pharmacodynamics and clinical efficacy of omiganan were assessed by analysing lesion count, size and viral load. Self-reported pain, itch and quality of life were assessed by an electronic diary and questionnaire. RESULTS Twenty-four AGW and 12 vulvar HSIL patients were enrolled. All patients had a high treatment adherence (99%). No serious adverse events occurred and all adverse events (n = 27) were mild, transient and self-limiting. The treatment groups were not different in terms of safety and tolerability, lesion count and size, and patient-reported outcomes pain, itch and quality of life. Human papillomavirus load significantly reduced after 12 weeks of treatment with omiganan compared to placebo (-96.6%; 95% confidence interval -99.9 to -7.4%; P = .045) in AGW patients only. CONCLUSION Topical omiganan appears to be safe in patients with AGW and vulvar HSIL and reduced human papillomavirus load after 12 weeks of treatment in AGW patients.
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Affiliation(s)
| | | | - Marina Todd
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | - Stijn T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | | | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Mariëtte I E van Poelgeest
- Centre for Human Drug Research, Leiden, the Netherlands.,Department of Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
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5
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Thuijs NB, van Beurden M, Bruggink AH, Steenbergen RDM, Berkhof J, Bleeker MCG. Vulvar intraepithelial neoplasia: Incidence and long-term risk of vulvar squamous cell carcinoma. Int J Cancer 2020; 148:90-98. [PMID: 32638382 PMCID: PMC7689827 DOI: 10.1002/ijc.33198] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/15/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
The risk of vulvar squamous cell carcinoma (VSCC) in patients with high-grade vulvar intraepithelial neoplasia (VIN) is considered lower in high-grade squamous intraepithelial lesion (HSIL) compared to differentiated VIN (dVIN), but studies are limited. Our study investigated both the incidence of high-grade VIN and the cumulative incidence of VSCC in patients with HSIL and dVIN separately. A database of women diagnosed with high-grade VIN between 1991 and 2011 was constructed with data from the Dutch Pathology Registry (PALGA). The European standardized incidence rate (ESR) and VSCC risk were calculated, stratified for HSIL and dVIN. The effects of type of VIN (HSIL vs dVIN), age and lichen sclerosis (LS) were estimated by Cox regression. In total, 1148 patients were diagnosed with high-grade VIN between 1991 and 2011. Between 1991-1995 and 2006-2011, the ESR of HSIL increased from 2.39 (per 100 000 woman-years) to 3.26 and the ESR of dVIN increased from 0.02 to 0.08. The 10-year cumulative VSCC risk was 10.3%; 9.7% for HSIL and 50.0% for dVIN (log rank P < .001). Type of VIN, age and presence of LS were independent risk factors for progression to VSCC, with hazard ratios of 3.0 (95% confidence interval [CI] 1.3-7.1), 2.3 (95% CI 1.5-3.4) and 3.1 (95% CI 1.8-5.3), respectively. The incidence of high-grade VIN is rising. Because of the high cancer risk in patients with dVIN, better identification and timely recognition are urgently needed.
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Affiliation(s)
- Nikki B Thuijs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marc van Beurden
- Antoni van Leeuwenhoek hospital, Department of Gynaecology, Amsterdam, The Netherlands
| | | | - Renske D M Steenbergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Maaike C G Bleeker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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6
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Dièye A, Shinga BW, Tendeng JN, Diedhiou M, Seck B, Ndong A, Dia-Badiane NM. [Vulvar squamous cell carcinoma in a HIV-1 infected patient with first-line antiretroviral therapy failure]. Pan Afr Med J 2020; 36:181. [PMID: 32952825 PMCID: PMC7467881 DOI: 10.11604/pamj.2020.36.181.20628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 06/03/2020] [Indexed: 11/11/2022] Open
Abstract
Le cancer de la vulve est une affection rarement rapportée dans la littérature. Chez la femme jeune, il est le plus souvent lié à l´infection par le papillomavirus humain (HPV) alors que chez les femmes ménopausées, chez qui ce cancer est plus fréquent, il serait lié à la carence œstrogénique. En outre, l´infection à VIH augmente le risque de survenue chez les femmes séropositives de néoplasies vulvaires du fait de la prévalence élevée de l´infection à HPV chez elles. Ainsi devant toute lésion suspecte de la vulve, une biopsie suivie d´un examen anatomo-pathologique devra être réalisée afin de poser le diagnostic. Nous rapportons le cas d´un carcinome épidermoïde de la vulve chez une patiente séropositive au VIH-1 en échec de traitement antirétroviral (ARV) de première ligne.
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Affiliation(s)
- Alassane Dièye
- UFR des Sciences de la Santé, Université Gaston Berger de Saint-Louis, Saint-Louis, Sénégal
| | - Bruce Wembulua Shinga
- Service des Maladies Infectieuses et Tropicales du CHNU de Fann, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Jacques Noel Tendeng
- UFR des Sciences de la Santé, Université Gaston Berger de Saint-Louis, Saint-Louis, Sénégal
| | - Moustapha Diedhiou
- UFR des Sciences de la Santé, Université Gaston Berger de Saint-Louis, Saint-Louis, Sénégal
| | - Birame Seck
- Service de Chirurgie Générale, Centre Hospitalier Régional de Saint-Louis, Saint-Louis, Sénégal
| | - Abdourahmane Ndong
- Service de Chirurgie Générale, Centre Hospitalier Régional de Saint-Louis, Saint-Louis, Sénégal
| | - Ndèye Méry Dia-Badiane
- UFR des Sciences de la Santé, Université Gaston Berger de Saint-Louis, Saint-Louis, Sénégal
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7
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Zapardiel I, Iacoponi S, Coronado PJ, Zalewski K, Chen F, Fotopoulou C, Dursun P, Kotsopoulos IC, Jach R, Buda A, Martinez-Serrano MJ, Grimm C, Fruscio R, Garcia E, Sznurkowski JJ, Ruiz C, Noya MC, Barazi D, Diez J, Diaz De la Noval B, Bartusevicius A, De Iaco P, Otero M, Diaz M, Haidopoulos D, Franco S, Blecharz P, Zuñiga MA, Rubio P, Gardella B, Papatheodorou DC, Yildirim Y, Fargas F, Macuks R. Prognostic factors in patients with vulvar cancer: the VULCAN study. Int J Gynecol Cancer 2020; 30:1285-1291. [PMID: 32571891 DOI: 10.1136/ijgc-2019-000526] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/29/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer. METHODS This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed. RESULTS After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget's disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05). CONCLUSIONS Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.
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Affiliation(s)
- Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Sara Iacoponi
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Pluvio J Coronado
- Gynecology Department, Hospital Clinico Universitario San Carlos - IdISSC, Madrid, Spain
| | - Kamil Zalewski
- Gynecologic Oncology Department, Maria Sklodowska-Curie Memorial Cancer Center - Institute of Oncology, Warsaw, Poland
| | - Frank Chen
- Department of Gynecology, Campus Virchow-Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Christina Fotopoulou
- Department of Gynecology, Campus Virchow-Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Polat Dursun
- Department of Obstetrics and Gynecology Division of Gynecologic Oncology, Baskent University School of Medicine, Ankara, Turkey
| | | | - Robert Jach
- Gynecology Department, University Hospital, Jagiellonian University, Krakow, Poland
| | - Alessandro Buda
- Gynecologic Oncology Department, Hospital San Gerardo, Monza, Lombardia, Italy
| | | | - Christoph Grimm
- Division of General Gynaecology and Gynaecological Oncology, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Robert Fruscio
- Gynecologic Oncology Department, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Enrique Garcia
- Gynecologic Oncology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Cristina Ruiz
- Gynecologic Oncology Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Maria C Noya
- Gynecology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Dib Barazi
- Gynecologic Oncology Department, Ciudad Sanitaria de Bellvitge, Barcelona, Spain
| | - Javier Diez
- Gynecologic Oncology Department, Hospital de Cruces, Vizcaya, Spain
| | | | - Arnoldas Bartusevicius
- Gynecologic Oncology Department, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | | | - Maria Otero
- Gynecology Department, Complejo Hospitalario de Leon, Leon, Spain
| | - Maria Diaz
- Gynecology Department, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, Spain
| | | | - Silvia Franco
- Gynecology Department, Hospital Vall D'Hebron, Barcelona, Spain
| | - Pawel Blecharz
- Gynecologic Oncology Department, Maria Sklodowska-Curie Memorial Cancer Center, Krakow, Poland
| | - Miguel A Zuñiga
- Gynecology Department, Complejo Hospitalario Torrecardenas, Almeria, Spain
| | - Patricia Rubio
- Gynecology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Barbara Gardella
- Gynecologic Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Yusuf Yildirim
- Gynecologic Oncology Department, Ege Gynaecology Training and Research Hospital, Izmir, Turkey
| | - Francesc Fargas
- Gynecology Department, Instituto Universitario Dexeus, Barcelona, Spain
| | - Ronalds Macuks
- Gynecologic Oncology Department, Riga East Clinical University Hospital Latvian Oncology Center, Riga, Latvia
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8
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Ayakannu T, Murugesu S, Taylor AH, Sokhal P, Ratnasekera L, Wilhelm-Benartzi CSM, Lyons D, Chatterjee J. The Impact of Focality and Centricity on Vulvar Intraepithelial Neoplasia on Disease Progression in HIV+ Patients: A 10-Year Retrospective Study. Dermatology 2019; 235:327-333. [PMID: 31256169 DOI: 10.1159/000500469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 04/15/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The impact of lesion focality and centricity in relation to patient outcome and disease recurrence of vulvar intraepithelial neoplasia (VIN) is an understudied area of research, especially in immunocompromised women. The prevalence and incidence of VIN have increased steadily since the 1980s because of the co-existence of human papillomavirus (HPV) and human immunodeficiency virus (HIV). In this study, we retrospectively examined the records of VIN patients to determine the effect of lesion focality and centricity with respect to the interval to disease recurrence. MATERIALS AND METHODS All women diagnosed with VIN and managed between January 2002 and December 2011 were included (n = 90) and followed up until December 2017. Symptoms at the time of presentation, including HIV positivity (n = 75), were collated, including the influences of multifocality and multicentricity on time to disease recurrence. RESULTS Multicentricity caused a more rapid recurrence of disease than unicentricity (p = 0.006), whereas multifocality increased the risk of recurrence more than unifocality (p < 0.0001). Viral load in the HIV+ patients was not associated with time to disease recurrence, but the reduced number of CD4+ lymphocytes present in HIV+ patients was. Treatment modalities had no effect on disease recurrence. CONCLUSION Both focality and centricity have effects on interval to recurrence and final patient outcome, with multifocal disease having a poorer prognosis. Centricity and focality should be recorded at the time of diagnosis and act as a warning for disease recurrence. HIV+ VIN patients with multifocal disease and/or known immunosuppression (low CD4+ lymphocyte counts) should be regarded as "high-risk" patients and treated accordingly.
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Affiliation(s)
- Thangesweran Ayakannu
- Department of Gynaecology Oncology, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, United Kingdom.,Department of Gynaecology Oncology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sughashini Murugesu
- Department of Obstetrics and Gynaecology, Hillingdon Hospital, Uxbridge, United Kingdom
| | - Anthony H Taylor
- Department of Molecular and Cellular Biology, University of Leicester, Leicester, United Kingdom
| | - Priya Sokhal
- Department of Cancer and Surgery, Imperial College London, Institute of Reproductive and Development Biology, London, United Kingdom
| | - Limandhee Ratnasekera
- Department of Cancer and Surgery, Imperial College London, Institute of Reproductive and Development Biology, London, United Kingdom
| | - Charlotte S M Wilhelm-Benartzi
- Department of Cancer and Surgery, Imperial College London, Institute of Reproductive and Development Biology, London, United Kingdom
| | - Deirdre Lyons
- Department of Obstetrics and Gynaecology, St. Mary's Hospital, London, United Kingdom
| | - Jayanta Chatterjee
- Department of Gynaecology Oncology, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, United Kingdom, .,Department of Gynaecology Oncology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, United Kingdom, .,Department of Cancer and Surgery, Imperial College London, Institute of Reproductive and Development Biology, London, United Kingdom,
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9
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Pubic Hair Shaving Is Correlated to Vulvar Dysplasia and Inflammation: A Case-Control Study. Infect Dis Obstet Gynecol 2017; 2017:9350307. [PMID: 29104417 PMCID: PMC5591962 DOI: 10.1155/2017/9350307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/25/2017] [Indexed: 11/28/2022] Open
Abstract
Objective The risk factors for vulvar dysplasia and infections are not fully known. In this study, we aimed to investigate the correlation between pubic hair shaving and the occurrence of vulvar inflammation, dysplasia, and cancer. Methods This study was performed between January 2013 and December 2016 in which a standardized questionnaire concerning genital hair shaving was administered to vulvar dysplasia and cancer patients and healthy participants. The presence of human papilloma virus (HPV) infection and the occurrence of genital inflammation were documented. Results We recruited 49 patients with vulvar dysplasia or cancer and 234 healthy women as a control group. Smoking, HPV infection, genital inflammation, and complete pubic hair removal were significantly more common in the vulvar dysplasia/cancer group. Pubic hair shaving per se presented a clear association with vulvar dysplasia/cancer. Shaving the labia majora in particular showed also an association. Conclusion Our findings suggest that partial or complete pubic hair shaving using a razor is correlated with and could be a potential risk factor for the development of genital inflammation, vulvar dysplasia, and malignancies. These results need to be confirmed in larger studies. HPV status and genital inflammation should be documented by medical personnel.
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10
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van der Meijden WI, Boffa MJ, Ter Harmsel WA, Kirtschig G, Lewis FM, Moyal-Barracco M, Tiplica GS, Sherrard J. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2017; 31:925-941. [PMID: 28164373 DOI: 10.1111/jdv.14096] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 12/14/2016] [Indexed: 12/21/2022]
Abstract
Vulval conditions may present to a variety of clinicians, such as dermatologists, gynaecologists and general practitioners. Women with these conditions are best managed by a multidisciplinary approach, which includes clear referral pathways between disciplines or access to a specialist multidisciplinary vulval service. Informed consent is a prerequisite for all examinations, investigations and treatments. Consent is particularly important for intimate examinations of the anogenital area, and a chaperone should be offered in all cases. All efforts should be made to maintain a patient's dignity. Depending on symptoms and risk factors, screening for sexually transmitted infections (STI) should be considered. If the patient presents with vulval itch, particularly if also complaining of increased vaginal discharge, vulvaginal candidiasis should be excluded. Sexual dysfunction should be considered in all patients with vulval complaints, either as the cause of the symptoms or secondary to symptoms, and assessed if appropriate. This guideline covers several aspects, such as diagnosis and treatment, of the more common vulval conditions (relatively) often encountered at vulval clinics, i.e. vulval dermatitis (eczema), psoriasis, lichen simplex chronicus, lichen sclerosus, lichen planus, vulvodynia and vulval intraepithelial neoplasia (VIN).
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Affiliation(s)
| | - M J Boffa
- Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta
| | - W A Ter Harmsel
- Department of Gynaecology, Roosevelt kliniek, Leiden, The Netherlands
| | - G Kirtschig
- University Hospital of Tübingen, Tübingen, Germany
| | - F M Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London and Frimley Health NHS Trust, London, UK
| | - M Moyal-Barracco
- Department of Dermatology, Tarnier-Cochin Hospital, Paris, France
| | - G S Tiplica
- Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - J Sherrard
- Department of Sexual Health, Churchill Hospital, Oxford, UK
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11
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MALDI Mass Spectrometry Imaging Reveals Decreased CK5 Levels in Vulvar Squamous Cell Carcinomas Compared to the Precursor Lesion Differentiated Vulvar Intraepithelial Neoplasia. Int J Mol Sci 2016; 17:ijms17071088. [PMID: 27399691 PMCID: PMC4964464 DOI: 10.3390/ijms17071088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/24/2016] [Accepted: 06/30/2016] [Indexed: 12/14/2022] Open
Abstract
Vulvar cancer is the fourth most common gynecological cancer worldwide. However, limited studies have been completed on the molecular characterization of vulvar squamous cell carcinoma resulting in a poor understanding of the disease initiation and progression. Analysis and early detection of the precursor lesion of HPV-independent vulvar squamous cell carcinoma (VSCC), differentiated vulvar intraepithelial neoplasia (dVIN), is of great importance given dVIN lesions have a high level of malignant potential. Here we present an examination of adjacent normal vulvar epithelium, dVIN, and VSCC from six patients by peptide Matrix-assisted laser desorption/ionization Mass Spectrometry Imaging (MALDI-MSI). The results reveal the differential expression of multiple peptides from the protein cytokeratin 5 (CK5) across the three vulvar tissue types. The difference observed in the relative abundance of CK5 by MALDI-MSI between the healthy epithelium, dVIN, and VSCC was further analyzed by immunohistochemistry (IHC) in tissue from eight VSCC patients. A decrease in CK5 immunostaining was observed in the VSCC compared to the healthy epithelium and dVIN. These results provide an insight into the molecular fingerprint of the vulvar intraepithelial neoplasia that appears to be more closely related to the healthy epithelium than the VSCC.
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12
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Imoto S, Inamine M, Kudaka W, Nagai Y, Wakayama A, Nakamoto T, Ooyama T, Aoki Y. Prognostic factors in patients with vulvar cancer treated with primary surgery: a single-center experience. SPRINGERPLUS 2016; 5:125. [PMID: 26933624 PMCID: PMC4759437 DOI: 10.1186/s40064-016-1767-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022]
Abstract
Vulvar cancer is a relatively rare disease. The aim of this study was to investigate prognostic factors in vulvar squamous cell carcinoma patients treated with primary surgery. Forty cases of vulvar squamous cell carcinoma treated with primary surgery were retrospectively analyzed. Overall survival (OS) and disease-specific survival (DSS) were calculated using the Kaplan–Meier method and prognostic factors were analyzed by multivariate analyses. The median age was 68 years. The FIGO stage distribution was as follows: 18 cases (45.0 %) in stage I, four cases (10.0 %) in stage II, 15 cases (37.5 %) in stage III, and three cases (7.5 %) in stage IV. A radical local excision was performed in 15 patients, and radical vulvectomy in 25 patients, and seven of these patients were treated with postoperative RT. The 5-year DSS rate was 72.6 %, and the 5-year OS rate was 70.3 %. Age and surgical margin ≤5 mm were independent prognostic factors for OS, and positive inguinal LN metastasis and surgical margin ≤5 mm were identified as independent prognostic factors for DSS. Complete radical excision is important regardless of operation mode. Adjuvant treatment should be considered for inguinal LN positive patients.
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Affiliation(s)
- Sayaka Imoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, 903-0215 Japan
| | - Morihiko Inamine
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, 903-0215 Japan
| | - Wataru Kudaka
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, 903-0215 Japan
| | - Yutaka Nagai
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, 903-0215 Japan
| | - Akihiko Wakayama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, 903-0215 Japan
| | - Tomoko Nakamoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, 903-0215 Japan
| | - Takuma Ooyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, 903-0215 Japan
| | - Yoichi Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, 903-0215 Japan
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Luchini C, Nottegar A, Solmi M, Sergi G, Manzato E, Capelli P, Scarpa A, Veronese N. Prognostic implications of extranodal extension in node-positive squamous cell carcinoma of the vulva: A systematic review and meta-analysis. Surg Oncol 2015; 25:60-5. [PMID: 26394825 DOI: 10.1016/j.suronc.2015.09.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 12/23/2022]
Abstract
Squamous cell carcinoma (SCC) of the vulva is the fourth most common gynecological cancer, usually staged with the TNM or FIGO systems. Since 2009, FIGO staging has taken the extranodal extension (ENE) of lymph node metastases into account. ENE is defined as the spread of a lymph node metastasis into surrounding soft tissue. Although the TNM and FIGO systems acknowledge the importance of ENE in SCC, no comprehensive studies have analyzed the prognostic impact of this parameter. We therefore queried the PubMed and SCOPUS databases from their inception up until 04/01/2015, adopting no language restrictions: all prospective studies reporting on prognostic parameters in patients with vulvar SCC, and comparing participants with and without ENE were eligible for our analysis. Data were summarized using risk ratios (RR) for the number of deaths/recurrences and hazard ratios (HR) for the time-dependent risk related to ENE positivity, adjusting for potential confounders. Among 859 hits, 13 studies were found eligible and were included in our meta-analysis. Compared with ENE-negative (ENE-) cases, the ENE-positive (ENE+) patients had significantly higher rates of all-cause mortality (6 studies: RR = 3.18; 95%CI: 2.02-5.00, p < 0.0001, I(2) = 56%), cancer-specific mortality (3 studies: RR = 2.03; 95%CI: 1.12-3.69, p = 0.02, I(2) = 80%), and recurrence (4 studies: RR = 2.69, 95%CI: 1.61-3.76, p < 0.0001, I(2) = 57%). Using HRs after adjusting for potential confounders, ENE + carried a significantly higher risk of all-cause mortality (6 studies: HR = 3.08, 95%CI: 1.73-5.48, p < 0.0001, I(2) = 66%), and recurrence (5 studies: HR = 3.93, 95%CI: 2.33-6.62, p < 0.0001, I(2) = 28%). Our meta-analysis clarifies the prognostic significance of ENE in vulvar SCC, also pointing to its implications for gross sampling, histology and oncological staging.
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Affiliation(s)
- Claudio Luchini
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Piazzale Scuro, 10, 37134 Verona, Italy.
| | - Alessia Nottegar
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Piazzale Scuro, 10, 37134 Verona, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padua, Via Giustiniani, 5, 35128 Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine, DIMED, University of Padua, Via Giustiani, 2, 35128 Padova, Italy
| | - Enzo Manzato
- Department of Medicine, DIMED, University of Padua, Via Giustiani, 2, 35128 Padova, Italy
| | - Paola Capelli
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Piazzale Scuro, 10, 37134 Verona, Italy
| | - Aldo Scarpa
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Piazzale Scuro, 10, 37134 Verona, Italy
| | - Nicola Veronese
- Department of Medicine, DIMED, University of Padua, Via Giustiani, 2, 35128 Padova, Italy
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Engbang JPN, Koh VM, Tchente CN, Fewou A. [Histo-epidemiological aspects of genital cancers in women in the Littoral Region, Cameroon]. Pan Afr Med J 2015; 21:116. [PMID: 26327953 PMCID: PMC4546725 DOI: 10.11604/pamj.2015.21.116.6755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/04/2015] [Indexed: 02/06/2023] Open
Abstract
Décrire les caractéristiques épidémiologiques et histopathologiques des tumeurs malignes génitales de la femme dans la région du littoral du Cameroun. Il s'agissait d'une étude rétrospective descriptive et analytique portant sur les cancers des organes génitaux de la femme, histologiquement prouvés pendant une période de 10 ans (2004-2013), répertoriés dans les registres des trois laboratoires d'anatomopathologie de la région (Hôpital Laquintinie de Douala, Hôpital Général de Douala, laboratoire Anapathos) et des services d'oncologie de ces hôpitaux. Les variables étudiées étaient: la fréquence, l’âge, le sexe, la localisation de la tumeur et le type histopathologique. Au total, 802 cas de cancers génitaux de la femme ont été recensés, soit une fréquence annuelle de 80,2 cas en moyenne. Le col utérin avec 580 cas (72,32%) a été la localisation la plus fréquente; suivi de l'endomètre (corps utérin) avec 93 cas (11,60%), puis des ovaires 91 cas (11,35%). L’âge moyen des patientes était de 50, 30±12,67 ans, avec les extrêmes allant de 14 à 85 ans. Selon le type histologique, les tumeurs épithéliales ont été les plus fréquemment rencontrées, soit 758 patientes (94,51%), les lymphomes venaient en seconde position avec 29 cas (3, 62%), les autres variétés histologiques (sarcomes, tumeurs germinales, tumeurs du mésenchyme et du cordon) représentant moins chacune de 1%. Les tumeurs malignes des organes génitaux féminins sont fréquentes dans la région du littoral du Cameroun, elles sont dominées essentiellement par le cancer du col utérin. Les tumeurs épithéliales sont le type histologique le plus fréquent.
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Affiliation(s)
- Jean Paul Ndamba Engbang
- Faculté de Médecine et des Sciences Pharmaceutiques de l'Université de Douala, Cameroun ; Hôpital Laquintinie de Douala, Cameroun
| | - Valère Mve Koh
- Faculté de Médecine et des Sciences Pharmaceutiques de l'Université de Douala, Cameroun ; Centre Hospitalier Universitaire de Yaoundé, Cameroun
| | - Charlotte Nguefack Tchente
- Faculté de Médecine et des Sciences Pharmaceutiques de l'Université de Douala, Cameroun ; Hôpital Général de Douala, Cameroun
| | - Amadou Fewou
- Hôpital Général de Douala, Cameroun ; Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun
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Zhu Y, Gu WJ, Wang HK, Gu CY, Ye DW. Surgical treatment of primary disease for penile squamous cell carcinoma: A Surveillance, Epidemiology, and End Results database analysis. Oncol Lett 2015; 10:85-92. [PMID: 26170981 DOI: 10.3892/ol.2015.3221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 03/27/2015] [Indexed: 11/12/2022] Open
Abstract
Current guidelines recommend penile sparing surgery (PSS) for selected penile cancer cases. The present study described the use of PSS in a population-based cohort, and also examined the role of PSS on penile cancer-specific mortality (PCSM). Data from the Surveillance, Epidemiology, and End Results (SEER) database were used to identify individuals that were diagnosed with penile squamous cell carcinoma between 1998 and 2009 and treated with surgery. Patients were sorted into two groups: Local tumor excision (LTE) and partial/total penectomy (PE). Factors associated with the receipt of LTE and PCSM following LTE were examined. In addition, PCSM was compared between LTE and PE following propensity score matching. Of the 1,292 eligible patients, 24.2% underwent LTE. For stage T1 disease, the rates of LTE increased moderately from 29 to 40% over the last decade. Following multivariate analyses, young age, African descent, a tumor size of <3 cm and stage T1 disease were identified to positively influence the receipt of LTE. With a median follow-up period of 55 months, the four-year PCSM rate was 9.8% in patients treated with LTE. Older age, a tumor size of 3-4 cm and regional/distant disease (SEER stage) were significant predictors of PCSM. Furthermore, in matched cohorts with stage T1 disease, the four-year PCSM rates were 8.9 and 10.0% for patients that received LTE or PE, respectively (P=0.93). In conclusion, underuse of PSS is pronounced in the general community with significant age and ethnicity disparities. The current population-based study provides evidence supporting the oncological safety of PSS compared with PE in early-stage disease.
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Affiliation(s)
- Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Wei-Jie Gu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Hong-Kai Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Cheng-Yuan Gu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
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16
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Nygård M, Hansen BT, Dillner J, Munk C, Oddsson K, Tryggvadottir L, Hortlund M, Liaw KL, Dasbach EJ, Kjær SK. Targeting human papillomavirus to reduce the burden of cervical, vulvar and vaginal cancer and pre-invasive neoplasia: establishing the baseline for surveillance. PLoS One 2014; 9:e88323. [PMID: 24505474 PMCID: PMC3914976 DOI: 10.1371/journal.pone.0088323] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 01/10/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Infection with high-risk human papillomavirus (HPV) is causally related to cervical, vulvar and vaginal pre-invasive neoplasias and cancers. Highly effective vaccines against HPV types 16/18 have been available since 2006, and are currently used in many countries in combination with cervical cancer screening to control the burden of cervical cancer. We estimated the overall and age-specific incidence rate (IR) of cervical, vulvar and vaginal cancer and pre-invasive neoplasia in Denmark, Iceland, Norway and Sweden in 2004-2006, prior to the availability of HPV vaccines, in order to establish a baseline for surveillance. We also estimated the population attributable fraction to determine roughly the expected effect of HPV16/18 vaccination on the incidence of these diseases. METHODS Information on incident cervical, vulvar and vaginal cancers and high-grade pre-invasive neoplasias was obtained from high-quality national population-based registries. A literature review was conducted to define the fraction of these lesions attributable to HPV16/18, i.e., those that could be prevented by HPV vaccination. RESULTS Among the four countries, the age-standardised IR/10⁵ of cervical, vaginal and vulvar cancer ranged from 8.4-13.8, 1.3-3.1 and 0.2-0.6, respectively. The risk for cervical cancer was highest in women aged 30-39, while vulvar and vaginal cancers were most common in women aged 70+. Age-standardised IR/10⁵ of cervical, vulvar and vaginal pre-invasive neoplasia ranged between 138.8-183.2, 2.5-8.8 and 0.5-1.3, respectively. Women aged 20-29 had the highest risk for cervical pre-invasive neoplasia, while vulvar and vaginal pre-invasive neoplasia peaked in women aged 40-49 and 60-69, respectively. Over 50% of the observed 47,820 incident invasive and pre-invasive cancer cases in 2004-2006 can be attributed to HPV16/18. CONCLUSION In the four countries, vaccination against HPV 16/18 could prevent approximately 8500 cases of gynecological cancer and pre-cancer annually. Population-based cancer and vaccination registries are essential to assess the predicted public health effects of HPV vaccination.
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Affiliation(s)
- Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | | | - Joakim Dillner
- Departments of Laboratory Medicine, Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kristján Oddsson
- The Cancer Detection Clinic, The Icelandic Cancer Society, Reykjavik, Iceland
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland
- Faculty of Medicine, Laeknagardur, University of Iceland, Reykjavik, Iceland
| | - Maria Hortlund
- Office for Medical Service, Department of Clinical Microbiology, Division of Laboratory Medicine, Region Skåne, Malmö, Sweden
| | - Kai-Li Liaw
- Department of Epidemiology, Merck Research Laboratories, North Wales, Pennsylvania, United States of America
| | - Erik J. Dasbach
- Health Economic Statistics, Merck Research Laboratories, North Wales, Pennsylvania, United States of America
| | - Susanne Krüger Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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17
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Goldstone SE, Vuocolo S. A prophylactic quadrivalent vaccine for the prevention of infection and disease related to HPV-6, -11, -16 and -18. Expert Rev Vaccines 2014; 11:395-406. [DOI: 10.1586/erv.12.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Treatment of Vulvar Intraepithelial Neoplasia With CO2 Laser Vaporization and Excision Surgery. J Low Genit Tract Dis 2013; 17:446-51. [DOI: 10.1097/lgt.0b013e318284c1ed] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Kushnir CL, Fleury AC, Hill MC, Silver DF, Spirtos NM. The use of argon beam coagulation in treating vulvar intraepithelial neoplasia III: a retrospective review. Gynecol Oncol 2013; 131:386-8. [PMID: 23887037 DOI: 10.1016/j.ygyno.2013.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 11/18/2022]
Abstract
UNLABELLED Argon beam coagulation (ABC) has unique properties which make it suitable for the local treatment of superficial epithelial disorders such as vulvar intraepithelial neoplasia (VIN III). OBJECTIVE To evaluate argon beam coagulation in treating multifocal VIN III. METHODS Argon beam coagulation was used in twenty-nine patients. ABC was set at 80 W, 7 L/min. All patients were given 1% silvadene cream to apply to vulva. Patients had follow-up appointments two weeks and six weeks postoperatively. Patients were followed every three to six months for the subsequent year. RESULTS 2 of 29 (6.8%) experienced moderate pain within the first two weeks postoperatively requiring prescriptions for perocet. 2 of 29 (6.8%) had yeast infection requiring diflucan. Mean follow-up time was 34.9 months (11.7-37.4). 15 of 29 (51.7%) had no recurrence within the follow-up period. 14 of 29 (48.3%) recurred within the follow-up period. The mean time to recurrence is 23.2 months. CONCLUSION This small retrospective review is the first to evaluate argon beam coagulation in treating multifocal VIN III. This review indicates that ABC is comparable to other vulva organ conserving therapies. ABC retains cosmesis, and form of the vulva. This is a major advantage over surgery. Repeat treatments are also possible, which is important in a condition such as VIN, which tends to be multifocal and recurrent.
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Affiliation(s)
- Christina L Kushnir
- Department of Obstetrics and Gynecology, Johns Hopkins Medical Institutions, Kelly Gynecologic Oncology Service, 600 North Wolfe Street, Phipps 281, Baltimore, MD 21287, USA
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20
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Iacoponi S, Zapardiel I, Diestro MD, Hernandez A, De Santiago J. Prognostic factors associated with local recurrence in squamous cell carcinoma of the vulva. J Gynecol Oncol 2013; 24:242-8. [PMID: 23875074 PMCID: PMC3714462 DOI: 10.3802/jgo.2013.24.3.242] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 12/27/2012] [Accepted: 01/09/2013] [Indexed: 11/30/2022] Open
Abstract
Objective To analyze the prognostic factors related to the recurrence rate of vulvar cancer. Methods Retrospective study of 87 patients diagnosed of vulvar squamous cell carcinoma diagnosed at a tertiary hospital in Madrid between January 2000 and December 2010. Results The pathological mean tumor size was 35.1±22.8 mm, with stromal invasion of 7.7±6.6 mm. The mean free margin after surgery was 16.8±10.5 mm. Among all patients, 31 (35.6%) presented local recurrence (mean time 10 months; range, 1 to 114 months) and 7 (8%) had distant metastases (mean time, 5 months; range, 1 to 114 months). We found significant differences in the mean tumor size between patients who presented a relapse and those who did not (37.6±21.3 mm vs. 28.9±12.1 mm; p=0.05). Patients with free margins equal or less than 8 mm presented a relapse rate of 52.6% vs. 43.5% of those with free margin greater than 8 mm (p=0.50). However, with a cut-off of 15 mm, we observed a local recurrence rate of 55.6% vs. 34.5%, respectively (p=0.09). When the stromal invasion cut-off was >4 mm, local recurrence rate increased up to 52.9% compared to 37.5% when the stromal invasion was ≤4 mm (p=0.20). Conclusion Tumor size, pathologic margin distance and stromal invasion seem to be the most important predictors of local vulvar recurrence. We consider the cut-off of 35 mm of tumor size, 15 mm tumor-free surgical margin and stromal invasion >4 mm, high risk predictors of local recurrence rate.
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Affiliation(s)
- Sara Iacoponi
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
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21
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Impact of the new FIGO 2009 staging classification for vulvar cancer on prognosis and stage distribution. Gynecol Oncol 2012; 127:147-52. [DOI: 10.1016/j.ygyno.2012.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 05/31/2012] [Accepted: 06/04/2012] [Indexed: 11/21/2022]
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Zekan J, Mutvar A, Huic D, Petrovic D, Karelovic D, Mitrovic L. Reliability of sentinel node assay in vulvar cancer: the first Croatian validation trial. Gynecol Oncol 2012; 126:99-102. [PMID: 22503824 DOI: 10.1016/j.ygyno.2012.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/27/2012] [Accepted: 04/01/2012] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the reliability of sentinel node assay in early stage vulvar cancer patients by using preoperative lymphoscintigraphy. METHODS Technetium-99m colloid albumin was injected intradermally around the tumor for lymphoscintigraphic mapping and intraoperative hand-held gamma probe detection of sentinel nodes. For all patients, sentinel node biopsy was followed by inguinofemoral lymphadenectomy, regardless of the sentinel lymph node status. RESULTS From December 2008 until May 2011, 25 consecutive patients with T1 or T2 stage of vulvar squamous cell cancer were enrolled. The median age of patients was 69 years (range, 48-79). The detection of sentinel lymph node was successful in all 25 patients. A total of 36 sentinel lymph nodes were harvested and metastatic carcinoma was identified in 12 sentinel nodes from 8 patients. There was 1 patient with metastatic non-sentinel lymph node despite the negative sentinel node. Two patients with negative sentinel nodes proven by routine histopathological examination were positive by immunohistochemical staining. The sensitivity, specificity and negative predictive value of sentinel node assay with immunohistochemistry included were 89%, 100%, and 94%, respectively. CONCLUSIONS Lymphoscintigraphy and sentinel lymph node biopsy under gamma-detecting probe guidance proved to be an easy and reliable method for the detection of sentinel node in early vulvar cancer. Immunohistochemical analysis improves the sensitivity for the detection of regional micrometastases. The sentinel node assay is highly accurate in predicting the status of the remaining inguinofemoral lymph nodes. Our results indicate that patients best suited to SLN assay have had a simple punch biopsy to confirm the diagnosis rather than a previous tumor excision. This technique represents a true advance in the selection of patients for less radical surgery.
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Affiliation(s)
- Josko Zekan
- Department of Gynecologic Oncology, Zagreb University Hospital Center, Croatia.
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23
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Li X, Zhu L, Gu Y, Jin H, Wang C, Lang J. A multicenter study of the clinical characteristics of usual-type vulvar intraepithelial neoplasia in China. Int J Gynaecol Obstet 2012; 117:18-22. [DOI: 10.1016/j.ijgo.2011.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 11/10/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
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Haupt RM, Sings HL. The efficacy and safety of the quadrivalent human papillomavirus 6/11/16/18 vaccine gardasil. J Adolesc Health 2011; 49:467-75. [PMID: 22018560 DOI: 10.1016/j.jadohealth.2011.07.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 06/20/2011] [Accepted: 07/01/2011] [Indexed: 11/29/2022]
Abstract
Human papillomavirus (HPV) infection causes cervical cancer, a significant portion of anal, genital, and oropharyngeal cancers, genital warts, and recurrent respiratory papillomatosis. In June 2006, a quadrivalent HPV-6/11/16/18 vaccine (Gardasil/Silgard) was licensed in the United States, and subsequently in the European Union (September 2006). It has since been approved in 121 countries, with >74 million doses distributed globally as of March 2011. As the incidence of HPV infection peaks 5-10 years after the onset of sexual activity, preadolescents and adolescents represent an appropriate target group to implement HPV vaccination programs so as to achieve the maximal public health benefit. In this article, we provide an overview of the prophylactic efficacy of the vaccine in young women who were found to be negative to at least one of the four vaccine HPV types, thus approximating sexually naive adolescents. Because adolescents are also at high risk for other infections which are preventable by currently available vaccines, the development of concurrent immunization strategies may lead to better compliance, thereby contributing to the overall goal of protection against preventable diseases. We also summarize concomitant administration studies with meningococcal, diphtheria, tetanus, and pertussis vaccines, which were conducted in adolescents aged 9-15 years. Prophylactic efficacy in other populations (males aged 16-26 years) is also summarized along with long-term safety and efficacy studies.
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Affiliation(s)
- Richard M Haupt
- Vaccine Clinical Research, Merck Sharp and Dohme Corp., Whitehouse Station, New Jersey, USA.
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25
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Bryant D, Rai N, Rowlands G, Hibbitts S, Jones J, Tristram A, Fiander A, Powell N. Human papillomavirus type distribution in vulval intraepithelial neoplasia determined using PapilloCheck DNA Microarray. J Med Virol 2011; 83:1358-61. [PMID: 21618551 DOI: 10.1002/jmv.22107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2011] [Indexed: 11/06/2022]
Abstract
Vulval intraepithelial neoplasia is a precursor of vulval carcinoma, and is frequently associated with human papillomavirus (HPV) infection. Estimates of HPV prevalence in vulval intraepithelial neoplasia vary widely in the UK. The objective of this study was to assess HPV infection in a sample of women with vulval intraepithelial neoplasia, confirmed histologically, and determine the proportion of disease associated with HPV types targeted by prophylactic HPV vaccines. HPV infection was assessed in biopsies from 59 patients using the Greiner Bio-One PapilloCheck® DNA chip assay. Valid results were obtained for 54 cases. HPV infection was present in 43 of the 54 cases (79.6%: 95% CI 67.1-88.2%). The most common HPV types were HPV 16 (33/54: 61.1%), HPV 33 (8/54: 14.8%), HPV 6 (5/54: 9.3%), and HPV 42 (3/54: 5.6%). The mean age of HPV positive women was significantly less than the mean age of HPV negative women. This is the largest UK series of vulval intraepithelial neoplasia in which HPV type has been investigated, and 34/54 (63.0%, 95% CI: 49.6-78.6%) cases were associated with HPV 16/18, which are targeted by current prophylactic HPV vaccines.
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Affiliation(s)
- Dean Bryant
- School of Medicine, Cardiff University, Cardiff, UK
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Terlou A, van Seters M, Kleinjan A, Heijmans-Antonissen C, Santegoets LAM, Beckmann I, van Beurden M, Helmerhorst TJM, Blok LJ. Imiquimod-induced clearance of HPV is associated with normalization of immune cell counts in usual type vulvar intraepithelial neoplasia. Int J Cancer 2011; 127:2831-40. [PMID: 21351262 DOI: 10.1002/ijc.25302] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recently, we reported on the efficacy of imiquimod for treatment of usual type vulvar intraepithelial neoplasia (uVIN). A histologic regression of uVIN to normal tissue was observed in 58% of patients. As success of treatment is related to clearance of high-risk human papilloma virus (HPV), the aim of our study was to assess differences in immune cell counts and in the expression of p16(INK4a) in VIN tissue before and after imiquimod treatment, in relation to HPV clearance and clinical response. Vulvar tissue samples taken prior to imiquimod treatment and 4 weeks after treatment were tested for the presence of HPV. Previously determined immune cell counts (CD1a, CD207, CD208, CD123/CD11c, CD94, CD4, CD8 and CD25/HLA-DR) in epidermis and dermis of 25 VIN patients and 19 healthy controls were completed with the counts for CD14 and CD68. The expression of p16(INK4a) was investigated by immunohistochemistry in 15 patients. Before imiquimod treatment, both HPV cleared and HPV noncleared patients showed mainly in the dermis significantly upregulated immune cell counts compared to healthy controls. However, in patients that cleared HPV and showed histologic regression already 4 weeks after imiquimod treatment, immune cell counts and p16(INK4a) expression were normalized. In conclusion, our data indicate that imiquimod-induced clearance of HPV results in normalization of counts for certain immune cells and is strongly correlated with histologic regression of the disease.
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Affiliation(s)
- Annelinde Terlou
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream: clinical implications. Int J Clin Oncol 2011; 16:610-2. [PMID: 21249413 DOI: 10.1007/s10147-010-0180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
Abstract
The authors report a case of usual-type (basaloid-type) vulvar intraepithelial neoplasia (VIN) 3 that failed to respond to imiquimod cream. A 51-year-old Japanese woman visited her local gynecologist complaining of vulvar itching. Atypical cells were noted in cytology smears, but nine vulvar biopsy specimens showed benign proliferation of epithelial tissue. The patient was placed under careful observation for 8 months, when the vulvar smears once again showed atypical cells and biopsy specimens revealed VIN3. The patient was then referred to our hospital where she was given a diagnosis of VIN 3, basaloid type of usual type. The biopsy specimens were positive for p16 and the lesions were confirmed to be human papilloma virus (HPV)-related. We recommended simple vulvectomy but the patient requested conservative treatment with imiquimod cream. With her written informed consent, we prescribed imiquimod cream to be self-administered 3 times a week. Colposcopy and pap smear test were performed every 2 weeks. Four weeks after the start of treatment, a fingertip-sized papule was detected at the patient's vaginal introitus. By 6 weeks, the lesion had enlarged, and biopsy specimens revealed invasive squamous cell carcinoma. At 7 weeks, we performed simple vulvectomy. The surgical specimen showed stage pT1b keratinizing-type squamous cell carcinoma. HPV-16 DNA was detected in the specimen.
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Lai KW, Mercurio MG. Medical and surgical approaches to vulvar intraepithelial neoplasia. Dermatol Ther 2010; 23:477-84. [DOI: 10.1111/j.1529-8019.2010.01351.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Home Study Course. J Low Genit Tract Dis 2009. [DOI: 10.1097/lgt.0b013e3181b81788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garland SM, Insinga RP, Sings HL, Haupt RM, Joura EA. Human papillomavirus infections and vulvar disease development. Cancer Epidemiol Biomarkers Prev 2009; 18:1777-84. [PMID: 19505910 DOI: 10.1158/1055-9965.epi-09-0067] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We describe the prevalence of 14 common types [human papillomavirus (HPV)-6/11/16/18/31/33/35/39/45/51/52/56/58/59] in vulvar intraepithelial neoplasia grades 1 to 3 (VIN 1-3) and HPV genotype-specific infection in relation to the development of VIN 1-3. METHODS Data were analyzed from women enrolled in the placebo arms of three randomized double-blind trials. Anogenital examinations, including collection of labial/vulvar/perineal/perianal swabs, occurred at day 1 and every 6 to 12 months through 48 months. Lesions that were possibly, probably, or definitely HPV related or of unknown etiology were biopsied. Biopsies and swabs were HPV typed. Biopsies were read for endpoint determination (VIN 1-3) by up to four pathologists. RESULTS Incident infection with HPV-16 was the most common (6.0/100 person-years). The mean time from incident infection to the development of VIN 1-3 was 18.5 months (95% confidence interval, 13.4-23.6). HPV-6 or -11 was observed in 64.5% of VIN 1 and 29.0% of VIN 2/3, whereas HPV-16 was observed in 6.5% of VIN 1 and 64.5% of VIN 2/3. CONCLUSION A vaccine that includes both low- and high-risk types could prevent more than half of VIN 1-3 lesions, including the precursor lesions to HPV-related vulvar carcinoma. Understanding the incidence and duration of vulvar HPV infection and risk for progression to VIN 1-3 may inform therapeutic decisions for vulvar disease and mathematical models that assess the cost-effectiveness of vaccination.
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Affiliation(s)
- Suzanne M Garland
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Medical University of Vienna, Allgemeines Krankenhaus der Stadt Wien, Vienna, Austria
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Vlastos AT, Charvet I, Dellacasa I, Capanna F, Pelte MF, Thueler P, Saint-Ghislain M, Depeursinge C, Meda P. Diagnosis of vulvar lesions by non-invasive optical analysis: a pilot study. Rare Tumors 2009; 1:e8. [PMID: 21139902 PMCID: PMC2994441 DOI: 10.4081/rt.2009.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 06/30/2009] [Indexed: 11/25/2022] Open
Abstract
A procedure that could allow an early in vivo and non-invasive detection of vulvar lesions would be extremely useful. We tested an innovative optical method (Optiprobe), which uses a harmless, visible light source for the in vivo, on-line detection of minimal alterations in the structure of vulvar epithelium. A group of 3 female volunteers without gynecological symptoms were first screened to evaluate optical properties of normal vulvar tissue. Next, a group of 16 patients undergoing gynecological examination for vulvar lesions was evaluated by the Optiprobe at suspected sites before these sites were biopsied for histological analysis. Adjacent, non-involved sites were also measured to provide internal controls. Histological analysis of the biopsies identified one case that did not show obvious alterations, 4 cases of high-grade vulvar intraepithelial neoplasia (VIN), 5 cases of vulvitis, and 6 cases of lichen sclerosis (LS). The optical properties of the VIN cases were significantly different from those of controls, due to a decrease in the absorption spectra and an increase in the scattering spectra. In contrast, a significant increase in the absorption spectra and a decrease in the scattering spectra were observed in the cases of vulvitis. In the LS cases, the absorption spectra were as in controls, whereas the scattering spectra were significantly decreased. We conclude that the Optiprobe provides a useful tool for a rapid and non-invasive detection of vulvar alterations. The method should contribute to reduce the number of biopsies and to facilitate the long-term follow-up of vulvar lesions.
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Vulvar cancer in young women: demographic features and outcome evaluation. Am J Obstet Gynecol 2009; 200:645.e1-5. [PMID: 19286150 DOI: 10.1016/j.ajog.2009.01.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 11/03/2008] [Accepted: 01/13/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study was to identify prognostic and environmental factors associated with vulvar carcinoma in young women. STUDY DESIGN This study was a review of patients younger than 45 years who were diagnosed with vulvar squamous cell carcinoma between 1994 and 2006. RESULTS Fifty-six patients were identified. Median age was 38 years and median follow-up was 25.3 months. Fifty-eight percent of patients presented with stage I disease; 77% smoked tobacco. Of patients with advanced disease, 53.3% were smokers, 40% had human papillomavirus (HPV) exposure, 46.7% had a history of vulvar intraepithelial neoplasia (VIN), and 6.7% were immunocompromised. Symptoms were present for more than 12 months in 47%, but symptom duration did not correlate with stage (P = .42) or positive lymph nodes (P = .28). Disease recurred in 10.7% and 5.4% died of disease. CONCLUSION Young women with vulvar cancer tend to have early-stage disease, smoke, have a history of HPV, and have VIN. Many of the factors that place these patients at continuous risk are modifiable.
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Abstract
PURPOSE OF REVIEW Recommendations for human papillomavirus (HPV) vaccination during adolescence primarily for a disease, cancer, that occurs only during adulthood is a paradigm shift for pediatricians. Additional postlicensure data and guidelines about HPV biology and epidemiology, disease association, adverse effects, vaccination during pregnancy, and cost-benefit analyses are now available to inform pediatricians and guide HPV vaccination recommendations. RECENT FINDINGS The prespecified, end-of-study combined analysis of HPV vaccine efficacy studies for prevention of cervical cancer, and now also for prevention of vulvar and vaginal cancers, confirmed 98-100% vaccine efficacy. Postlicensure surveillance identified a new association of vaccine administration with syncope, and provides assurance of the safety of inadvertent vaccination during pregnancy. Several cost-effectiveness analyses consistently demonstrated that HPV vaccination of 12-year-old girls and catch-up vaccination through 18 years of age, and possibly to 26 years of age, is cost-effective, although the thresholds of affordability vary by study. The downward trend in age of initial HPV infection and the need to educate parents and patients about HPV disease and vaccination underscore the essential role of pediatricians in managing HPV illness. SUMMARY It is critical for pediatricians to thoroughly understand HPV biology and disease and champion HPV vaccination to prevent cervical, vulvar, and vaginal cancers, even though these benefits accrue during adulthood and will likely require 2-4 decades to realize the financial and public health benefits. Several new developments are expected in the near future, including licensure for use in boys and men and the approval of a second, bivalent HPV vaccine.
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Kagan KO, Abele H, Wallwiener D, Schauf B. Laser application in obstetrics and gynecology – A short introduction to therapeutic options. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mla.2008.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van de Nieuwenhof H, van der Avoort I, de Hullu J. Review of squamous premalignant vulvar lesions. Crit Rev Oncol Hematol 2008; 68:131-56. [DOI: 10.1016/j.critrevonc.2008.02.012] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 02/15/2008] [Accepted: 02/26/2008] [Indexed: 01/31/2023] Open
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Al-Shebail MM, Qureshi VF. Malignancies in Clitoris: A Review of Literature on Etiology, Diagnosis, Pathology and Treatment Strategies. ACTA ACUST UNITED AC 2008. [DOI: 10.3923/ijcr.2008.110.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Analysis of the incidence and mortality of vulval cancer in women in South East England 1960–1999. Arch Gynecol Obstet 2008; 279:113-7. [DOI: 10.1007/s00404-008-0677-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Accepted: 04/24/2008] [Indexed: 11/25/2022]
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Paavonen J. Human papillomavirus infection and the development of cervical cancer and related genital neoplasias. Int J Infect Dis 2008; 11 Suppl 2:S3-9. [PMID: 18162244 DOI: 10.1016/s1201-9712(07)60015-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The human papillomaviruses (HPV) are simple, nonenveloped, double-stranded DNA viruses, which are responsible for an enormous global burden of genital disease. HPV is associated with 500,000 new cases of cervical cancer and 250,000 cervical cancer deaths worldwide each year. Oncogenic HPV types 16 and 18 are responsible for a majority of cervical cancers and can also cause low- and high-grade cervical lesions (CIN 1, 2, 3) as well as high-grade vulvar or vaginal intraepithelial neoplasia (VIN or VaIN 2/3). Nononcogenic types HPV 6 and 11 also contribute to the overall burden of HPV disease, giving rise to CIN 1, anogenital warts, cutaneous lesions, and respiratory papillomatosis. PERSPECTIVES A substantial body of clinical evidence demonstrates the effectiveness of cytological screening in preventing cervical cancer, but these techniques have not eradicated the disease and are not widely available in most developing countries. Furthermore, evaluation and management of HPV-associated cytologic abnormalities is costly, drains health care resources, and increases the risk for adverse pregnancy outcome. CONCLUSIONS Targeting cervical cancer through universal immunization with a quadrivalent HPV 6, 11, 16, 18 vaccine may herald the beginning of the end of this deadly disease and substantially reduce the overall global burden of HPV-related genital diseases.
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Affiliation(s)
- Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.
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Steben M. RETIRED: Clinical Manifestations and Diagnosis of HPV-Related Disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007. [DOI: 10.1016/s1701-2163(16)32575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Joura EA, Leodolter S, Hernandez-Avila M, Wheeler CM, Perez G, Koutsky LA, Garland SM, Harper DM, Tang GWK, Ferris DG, Steben M, Jones RW, Bryan J, Taddeo FJ, Bautista OM, Esser MT, Sings HL, Nelson M, Boslego JW, Sattler C, Barr E, Paavonen J. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet 2007; 369:1693-702. [PMID: 17512854 DOI: 10.1016/s0140-6736(07)60777-6] [Citation(s) in RCA: 432] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Vulval and vaginal cancers among younger women are often related to infection with human papillomavirus (HPV). These cancers are preceded by high-grade vulval intraepithelial neoplasia (VIN2-3) and vaginal intraepithelial neoplasia (VaIN2-3). Our aim was to do a combined analysis of three randomised clinical trials to assess the effect of a prophylactic quadrivalent HPV vaccine on the incidence of these diseases. METHODS 18 174 women (16-26 years) were enrolled and randomised to receive either quadrivalent HPV6/11/16/18 L1 virus-like-particle vaccine or placebo at day 1, and months 2 and 6. Individuals underwent detailed anogenital examination at day 1, 1 month after dose three, and at 6-12-month intervals for up to 48 months. Suspect genital lesions were biopsied and read by a panel of pathologists and vaccine HPV type-specific DNA testing was done. The primary endpoint was the combined incidence of VIN2-3 or VaIN2-3 associated with HPV16 or HPV18. Primary efficacy analyses were done in a per-protocol population. FINDINGS The mean follow-up time was 3 years. Among women naive to HPV16 or HPV18 through 1 month after dose three (per-protocol population; vaccine n=7811; placebo n=7785), the vaccine was 100% effective (95% CI 72-100) against VIN2-3 or VaIN2-3 associated with HPV16 or HPV18. In the intention-to-treat population (which included 18 174 women who, at day 1, could have been infected with HPV16 or HPV18), vaccine efficacy against VIN2-3 or VaIN2-3 associated with HPV16 or HPV18 was 71% (37-88). The vaccine was 49% (18-69) effective against all VIN2-3 or VaIN2-3, irrespective of whether or not HPV DNA was detected in the lesion. The most common treatment-related adverse event was injection-site pain. INTERPRETATION Prophylactic administration of quadrivalent HPV vaccine was effective in preventing high-grade vulval and vaginal lesions associated with HPV16 or HPV18 infection in women who were naive to these types before vaccination. With time, such vaccination could result in reduced rates of HPV-related vulval and vaginal cancers.
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Affiliation(s)
- Elmar A Joura
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
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Six L, Joura EA. [Cervix carcinoma--Austrian Vaccination Committee recommends HPV vaccination]. Wien Med Wochenschr 2007; 157:130-2. [PMID: 17427010 DOI: 10.1007/s10354-007-0395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Singh K, Yeo Y, Honest H, Ganesan R, Luesley D. Antigen processing and correlation with immunological response in vulval intraepithelial neoplasia—A study of CD1a, CD54 and LN3 expression. Gynecol Oncol 2006; 102:489-92. [PMID: 16516282 DOI: 10.1016/j.ygyno.2006.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 12/27/2005] [Accepted: 01/04/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the antigen-presenting cells and co-stimulatory factors (HLA class 2 antigen and adhesion molecule) in different grades of vulval intraepithelial neoplasia (VIN). MATERIAL AND METHODS Forty-five histology specimens were obtained from 21 women who had previously undergone vulval biopsies for VIN and included 12 specimens of VIN I, 5 of VIN II and 28 of VIN III. The CD1a (Langerhans cell/antigen-presenting cell marker) and co-stimulatory factors--HLA Class 2 antigens (LN3) and the adhesion molecule (CD54)--were semi-quantitatively analyzed in all the specimens. Pearson Chi-squared test was used for statistical analysis. RESULTS CD1a was increased in 11/12 (91.6%) biopsies with VIN I, in 3/5 (60%) of VIN II and in 4/28(14.3%) of VIN III. There was thus an inverse correlation between CD1a and severity of VIN (Pearson Chi-squared = 26.876, P = 0.001). Qualitatively, there was a basal location of CD1a-positive cells in normal epithelium but had a haphazard distribution in both low grade and high grade VIN. There was no statistical significance in the distribution of LN3 and CD54 in different grades of VIN. CONCLUSIONS This study shows an alteration in the numbers and spatial arrangement of CD1a-positive Langerhans/antigen-presenting cells in different grades of VIN. There is an increase in the number of cells with CD1a expression in low grade VIN and a decrease in the number of these cells in high grade VIN. Reduction in CD1a expression may reflect the inability of the host to mount an adequate immune response due to reduced antigen presentation in high grade VIN.
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Affiliation(s)
- Kavita Singh
- Department of Gynaecological Oncology, Birmingham Women's Hospital, Birmingham, UK.
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Sgambato A, Tarquini E, Resci F, De Paola B, Faraglia B, Camerini A, Rettino A, Migaldi M, Cittadini A, Zannoni GF. Aberrant expression of alpha-dystroglycan in cervical and vulvar cancer. Gynecol Oncol 2006; 103:397-404. [PMID: 16765426 DOI: 10.1016/j.ygyno.2006.03.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 03/10/2006] [Accepted: 03/15/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Cervical and vulvar cancers develop through well-defined precursor lesions but their exact pathogenesis is still unknown. The dystroglycan complex is a transmembrane glycoprotein that forms a continuous link from the extracellular matrix to the actin cytoskeleton. Deregulated expression of dystroglycan has been reported in human malignancies and related to tumor differentiation and aggressiveness. In this study, expression of dystroglycan was evaluated in the multistep cervical and vulvar tumorigenesis. METHODS Expression of the dystroglycan complex was evaluated by immunostaining in lesions representing different stages of vulvar and cervical tumorigenesis using a monoclonal antibody which recognizes carbohydratic epitopes on the alpha-dystroglycan subunit. RESULTS alpha-dystroglycan was constantly detected in normal cervical epithelium with a mean percentage of positive cells higher than 80%. A progressive significant reduction in the mean percentage of positive cells was observed in low (67%) and high grade SIL (14%) and in invasive carcinomas (2.6%) of the cervix. In cancers, no differences were observed in terms of percentage of positive cells when cases were stratified according with either tumor grade or stage. A progressive significant reduction in the mean percentage of positive cells was also observed from normal vulvar epithelium (90%) to VIN1 (66%), VIN2 (28%) and invasive vulvar carcinomas (22%). No significant decrease in the alpha-dystroglycan staining was observed in squamous cell hyperplasia lesions (85%) while lichen sclerosus displayed a percentage of positive cells (47%) significantly lower than normal epithelium. CONCLUSIONS Detection of alpha-dystroglycan is frequently lost in human cervical and vulvar tumorigenesis and further studies are warranted to verify whether evaluation of this molecule might serve as marker of risk progression of preneoplastic lesions and to better understand its significance in terms of cancer development.
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Affiliation(s)
- Alessandro Sgambato
- Centro di Ricerche Oncologiche Giovanni XXIII-Istituto di Patologia Generale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy.
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Zannoni GF, Faraglia B, Tarquini E, Camerini A, Vrijens K, Migaldi M, Cittadini A, Sgambato A. Expression of the CDK inhibitor p27kip1 and oxidative DNA damage in non-neoplastic and neoplastic vulvar epithelial lesions. Mod Pathol 2006; 19:504-13. [PMID: 16474380 DOI: 10.1038/modpathol.3800532] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Vulvar cancer represents an important medical problem worldwide whose incidence is increasing at an alarming rate in young females. Several factors have been linked to vulvar cancer development, but its exact pathogenesis remains to be determined. Vulvar tumorigenesis proceeds through intermediate dysplastic lesions, known as vulvar intraepithelial neoplasias, frequently associated with non-neoplastic epithelial disorders of the vulva, such as lichen sclerosus and squamous cell hyperplasia. In this study, the expression of the CDK inhibitor p27Kip1 and the extent of endogenous oxidative DNA damage were evaluated in vulvar specimens, including normal tissues, lichen sclerosus, squamous cell hyperplasia, vulvar intraepithelial neoplasias and invasive squamous cell carcinomas. We found that p27Kip1 was constantly expressed in normal vulvar epithelium cells while a progressive significant reduction in the percentage of p27Kip1-positive cells was observed in vulvar intraepithelial neoplasias (77%) and in invasive carcinomas (64%). Mean percentage of positive cells in invasive carcinomas, but not in vulvar intraepithelial neoplasias, was also significantly lower than squamous cell hyperplasia lesions (78%) while lichen sclerosus displayed a percentage of positive cells (45%) significantly lower than both vulvar intraepithelial neoplasias and invasive carcinomas. 8-hydroxydeoxyguanosine (8-OHdG) is considered a sensitive biomarker for oxidative stress. We observed a progressive significant increase in the levels of 8-OHdG and in the percentage of positive cells from normal vulvar epithelium to vulvar intraepithelial neoplasias (25%) and to invasive carcinomas (64%). Squamous cell hyperplasia displayed an intermediate percentage of positive cells comparable to vulvar intraepithelial neoplasias 2 but significantly higher than vulvar intraepithelial neoplasias 1 and lower than invasive carcinomas. Lichen sclerosus staining was significantly lower than carcinomas but higher than vulvar intraepithelial neoplasias and squamous cell hyperplasia. These results demonstrate that expression of p27Kip1 is downregulated while oxidative DNA damage increases from early non-neoplastic epithelial alterations through vulvar intraepithelial neoplasias to invasive vulvar carcinomas. Thus, both parameters might play an important role in the development of this cancer and their study might contribute to our understanding of human vulvar carcinogenesis.
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Affiliation(s)
- Gian F Zannoni
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
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Epidemiología, diagnóstico y tratamiento de la neoplasia vulvar intraepitelial (VIN). CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2006. [DOI: 10.1016/s0210-573x(06)74082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Affiliation(s)
- R Rouzier
- Centre Hospitalier Intercommunal de Creteil, Creteil, France.
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McCarron PA, Donnelly RF, Gilmore BF, Woolfson AD, McClelland R, Zawislak A, Price JH. Phototoxicity of 5-aminolevulinic acid in the HeLa cell line as an indicative measure of photodynamic effect after topical administration to gynecological lesions of intraepithelial form. Pharm Res 2005; 21:1871-9. [PMID: 15553235 DOI: 10.1023/b:pham.0000045242.98628.0b] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The depth-resolved pattern of aminolevulinic acid (ALA) concentration in excised vaginal tissue was determined after in vitro application of an ALA-loaded bioadhesive patch. From this data, the tissue concentration of ALA achievable at a specified depth from the surface could be related to the concentration needed to elicit a photodynamic effect in a model gynecological tumor cell line (HeLa). METHODS Excised vaginal tissue was mounted in a modified Franz diffusion cell and exposed to a water-soluble, ALA-loaded, bioadhesive patch. After a period of time, the tissue was cryostatically sectioned and the stratal concentration of radiolabeled ALA determined using scintillation spectroscopy. HeLa cells were cultured in media containing specific concentrations of ALA and exposed to standard photodynamic protocols of light exposure. RESULTS An ALA concentration of 65.6 mM was achievable at 2.375 mm from the tissue surface after application of ALA-loaded patch. The photodynamic effectiveness of this concentration was demonstrated in HeLa with exposure to concentrations exceeding 1.0 mM ALA bringing about reductions in viable cell numbers by 90%. An enhancement of PpIX production using adjunctive EDTA over the clinically relevant 4 h application time interval was shown to be minimal in HeLa. Instead, PpIX production was more closely correlated with ALA concentration, with 100 mM ALA producing approximately 3100 ng PpIX mg(-1) protein in the same time period. CONCLUSIONS Given that vaginal intraepithelial neoplasias can extend to 2.0 mm from the lesion surface, the ALA permeability derived from a bioadhesive patch is sufficient to induce photosensitization suitable for light induced destruction at deep sites of this type of lesion.
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Affiliation(s)
- Paul A McCarron
- School of Pharmacy, Queens University Belfast, Medical Biology Centre, Belfast BT9 7BL, UK.
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Allison R, Cuenca R, Downie G, Randall M, Bagnato V, Sibata C. PD/PDT for gynecological disease: A clinical review. Photodiagnosis Photodyn Ther 2005; 2:51-63. [DOI: 10.1016/s1572-1000(05)00033-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2005] [Revised: 04/05/2005] [Accepted: 04/06/2005] [Indexed: 10/25/2022]
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