1
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Wang Y, Chen L, Qin B, Ren M, Li Q. Reflectance confocal microscopy as a complementary diagnostic tool for vulvar lichen sclerosus and vulvar vitiligo in juvenile Chinese girls. Exp Dermatol 2024; 33:e15033. [PMID: 38414178 DOI: 10.1111/exd.15033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Ying Wang
- Department of Dermatology, Tianjin Children's Hospital/Children's Hospital, Tianjin University, Tianjin, China
| | - Lixin Chen
- Department of Dermatology, Tianjin Children's Hospital/Children's Hospital, Tianjin University, Tianjin, China
| | - Bei Qin
- Department of Dermatology, Tianjin Children's Hospital/Children's Hospital, Tianjin University, Tianjin, China
| | - Min Ren
- Department of Dermatology, Tianjin Children's Hospital/Children's Hospital, Tianjin University, Tianjin, China
| | - Qinfeng Li
- Department of Dermatology, Tianjin Children's Hospital/Children's Hospital, Tianjin University, Tianjin, China
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2
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Kassels A, Elsensohn AN, Kraus CN. Lichen planus is associated with other autoimmune conditions: A retrospective population-level study. J Am Acad Dermatol 2024; 90:650-652. [PMID: 37984722 DOI: 10.1016/j.jaad.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Alexa Kassels
- University of California, Irvine School of Medicine, Irvine, California
| | - Ashley N Elsensohn
- Departments of Dermatology and Pathology, Loma Linda University School of Medicine, Loma Linda, California
| | - Christina N Kraus
- Department of Dermatology, University of California, Irvine, Irvine, California.
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3
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Boscarelli A, Ahmed Y, Schleef J, Guida E. Granular Cell Tumor (Abrikossoff's Tumor) of the Vulva in Childhood. J Indian Assoc Pediatr Surg 2024; 29:72-74. [PMID: 38405250 PMCID: PMC10883173 DOI: 10.4103/jiaps.jiaps_182_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 02/27/2024] Open
Abstract
Granular cell tumors (GCTs) (Abrikossoff's tumors) are rare neoplasms derived from Schwann cells. Immunohistochemistry remains the most useful instrument for diagnosing GCTs. Complete surgical excision has been demonstrated to be curative for benign lesions. However, long-term follow-up in these patients is strongly recommended.
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Affiliation(s)
- Alessandro Boscarelli
- Department of Paediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Padua, Italy
| | - Yusuf Ahmed
- Department of Women’s and Children’s Health, Pediatric Surgery Division, University of Padua, Padua, Italy
| | - Jürgen Schleef
- Department of Paediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Padua, Italy
- Chief of Surgical Department, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Edoardo Guida
- Department of Paediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Padua, Italy
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4
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Chen L, Wang Y, Qin B, Fang H, Li Q. Reflectance confocal microscopy features of vulvar lichen sclerosus in Chinese juvenile girls. J Dermatol 2023; 50:1497-1500. [PMID: 37533335 DOI: 10.1111/1346-8138.16884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/01/2023] [Accepted: 06/19/2023] [Indexed: 08/04/2023]
Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis of unknown pathogenesis, characterized by porcelain-white atrophic plaques around the vulvar and anal areas in girls. With this communication, we performed the study on 16 female girls with clinically and histologically confirmed VLS, described the main identifying characteristics of the lesions in reflectance confocal microscopy (RCM) and elucidated the corresponding relationship between RCM findings and histology. We recommend RCM, a noninvasive technique, as a complementary diagnostic tool for VLS.
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Affiliation(s)
- Lixin Chen
- Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Ying Wang
- Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Bei Qin
- Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Hongwei Fang
- Department of Otolaryngology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Qinfeng Li
- Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
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5
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Cheraghlou S, Doudican NA, Criscito MC, Stevenson ML, Carucci JA. Defining and quantifying histopathologic risk factors for regional and distant metastases in a large cohort of vulvar squamous cell carcinomas. J Am Acad Dermatol 2023; 89:1022-1030. [PMID: 37054818 DOI: 10.1016/j.jaad.2023.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/16/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Vulvar squamous cell carcinoma (vSCC) is a rare tumor with a good prognosis when treated at a localized stage. However, once regional/distant metastasis occurs, vSCC can be rapidly fatal. Thus, it is important to identify tumor prognostic features so that high-risk cases can be prioritized for further diagnostic workup and treatment. OBJECTIVE To estimate the risk of regional/distant metastasis at presentation and sentinel lymph node status for vSCC based on histopathologic characteristics. METHODS A retrospective cohort study of 15,188 adult vSCC cases from the National Cancer Database diagnosed from 2012 to 2019. RESULTS We provide specific estimates of the risk of clinically positive nodes and metastatic disease at presentation and sentinel lymph node positivity according to tumor size, moderate/poor tumor differentiation, and lymph-vascular invasion. These histopathologic factors were all significantly associated with the tested clinical outcomes in a multivariable analysis. Moderate (hazard ratio, 1.190; P < .001) and poor differentiation (hazard ratio, 1.204; P < .001) and lymph-vascular invasion (hazard ratio, 1.465; P < .001) were also associated with significantly poorer overall survival. LIMITATIONS Data on disease-specific survival not available in the data set. CONCLUSIONS We demonstrate the association of the histopathologic characteristics of vSCC with clinically important outcomes. These data may provide individualized information when discussing diagnostic/treatment recommendations, particularly regarding sentinel lymph node biopsy. These data may also guide future staging and risk stratification efforts for vSCC.
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Affiliation(s)
- Shayan Cheraghlou
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Nicole A Doudican
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Maressa C Criscito
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Mary L Stevenson
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - John A Carucci
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
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6
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Rammal R, Goel K, Elishaev E, Soong TR, Jones MW, Zhao C, Clark BZ, Carter GJ, Yu J, Fine JL, Villatoro TM, Skvarca L, Harinath L, Bhargava R. Utility of TRPS1 immunohistochemistry in confirming breast carcinoma: Emphasis on staining in triple-negative breast cancers and gynecologic tumors. Am J Clin Pathol 2023; 160:425-434. [PMID: 37352847 DOI: 10.1093/ajcp/aqad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/11/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVES Our aim was to explore the performance of TRPS1 as an immunohistochemical diagnostic marker; find the optimal conditions for its use in breast carcinomas, especially triple-negative breast cancers (TNBCs); and compare its results in carcinomas of a select few organ sites, with an emphasis on gynecologic tumors. METHODS Tissue microarrays from breast carcinomas (n = 197), endometrial adenocarcinomas (n = 69), ovarian tumors (n = 250), vulvar squamous cell carcinomas (n = 97), pancreatic ductal adenocarcinomas (n = 20), and gastric adenocarcinomas (n = 12) were stained with TRPS1 using 2 different conditions (protocol 1: high pH; protocol 2: low pH). Breast carcinomas consisted of hormone receptor (HR)-positive/ERBB2 (formerly HER2 or HER2/neu)-negative (n = 53) samples, HR-positive/ERBB2-positive (n = 6) samples, and TNBCs (n = 138). RESULTS Comparing TRPS1 results in breast carcinomas vs tumors from other organ sites, the sensitivity of TRPS1 was 91% and 87%, respectively, while the specificity was 66% and 74% for protocol 1 and 2, respectively. For TNBCs vs gynecologic tumors, the sensitivity of TRPS1 was 89% and 85%, respectively, while the specificity was 65% and 73%, respectively. CONCLUSIONS TRPS1 stains approximately 90% of breast carcinomas but also up to 71% of endometrial carcinomas, albeit with a weaker median expression. Our data show that although TRPS1 is a highly sensitive marker for TNBCs, it is not as highly specific as previously reported.
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Affiliation(s)
- Rayan Rammal
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Kanika Goel
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Esther Elishaev
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - T Rinda Soong
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Mirka W Jones
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Chengquan Zhao
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Beth Z Clark
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Gloria J Carter
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Jing Yu
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Jeffrey L Fine
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Tatiana M Villatoro
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Lauren Skvarca
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Lakshmi Harinath
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, US
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7
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Affiliation(s)
- Alexa Kassels
- University of California, Irvine School of Medicine, Irvine, California
| | - Libby Edwards
- Department of Dermatology, Southeast Vulvar Clinic, Charlotte, North Carolina
| | - Christina N. Kraus
- Department of Dermatology, University of California, Irvine, Irvine, California
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8
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Rao EM, Wilkowski CM, DeSouza L, McNally A, Lucas J. Surgical treatment of early-stage vulvar squamous cell carcinomas: a systematic review of guidelines for dermatologic surgeons. Int J Womens Dermatol 2023; 9:e104. [PMID: 37521753 PMCID: PMC10378987 DOI: 10.1097/jw9.0000000000000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Elizabeth M. Rao
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Larissa DeSouza
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amy McNally
- Department of Gynecologic Oncology, Minnesota Oncology, St. Paul, Minnesota
| | - Jennifer Lucas
- Department of Dermatology, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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9
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Risner V, McColgan Y, Salazar G. Interventional Treatment of Labial Varices. Semin Intervent Radiol 2023; 40:384-388. [PMID: 37575344 PMCID: PMC10415056 DOI: 10.1055/s-0043-1771040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Labial varices are commonly seen in women with varicose veins of the pelvis. Initial management is conservative management since labial varies typically resolve, particularly in pregnant patients following delivery. Varices can be seen also in association with pelvic varices in the pelvic venous disease spectrum. Sclerotherapy is often the management. This article reviews the presentation and treatment of patients with labial varices, with a focus on interventional radiologic management.
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Affiliation(s)
- Victoria Risner
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | | | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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10
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Balfour A, Raffi J, Lee BA, Kraus CN. Red vulvar plaque with unilateral edema. JAAD Case Rep 2023; 38:117-119. [PMID: 37521193 PMCID: PMC10372043 DOI: 10.1016/j.jdcr.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
- Alex Balfour
- School of Medicine, University of California, Irvine, California
| | - Jodie Raffi
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Bonnie A. Lee
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Christina N. Kraus
- Department of Dermatology, University of California, Irvine, Irvine, California
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11
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Kurakula S, Nallur Siddaraju M, Kumarswamy V, Raza QUA, Kompella AR. Non-Obstetric Traumatic Vulvar Hematoma Managed in a Low-Resource Setting: A Case Report of a Rare Condition. Cureus 2023; 15:e40369. [PMID: 37456375 PMCID: PMC10340129 DOI: 10.7759/cureus.40369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Most cases of vulvar hematomas are caused by either genital tract injury during childbirth or trauma. Although uncommon, instances of spontaneous vulvar hematomas occurring without trauma or unusual sexual practices have been reported. In this report, we present the case of a 24-year-old woman who experienced an injury after a fall, resulting in a rapidly enlarging vulvar hematoma. Due to the worsening pain and swelling, surgical intervention was undertaken for her management.
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Affiliation(s)
- Sowjanya Kurakula
- Obstetrics and Gynecology, Mamta Institute of Medical Sciences, Khammam, IND
- Obstetrics and Gynecology, Sekgoma Memorial Hospital, Serowe, BWA
- Obstetrics and Gynecology, Nyangabgwe Referral Hospital, Francistown, BWA
- Obstetrics and Gynecology, Gandhi Medical College, Musheerabad, IND
| | | | - Varalakshmi Kumarswamy
- Obstetrics and Gynecology, RajaRajeshwari Medical College, Bangalore, IND
- Obstetrics and Gynecology, M.S Ramaiah Medical College, Bangalore, IND
- Obstetrics and Gynecology, RNT Medical Hospital, Udaipur, IND
| | - Qurat Ul Ain Raza
- Internal Medicine, RAK Medical & Health Sciences University, Ras al Khaimah, ARE
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12
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Shi K, Zhang B, Kong BY, Zhang Y, Igartua C, Mohan LS, Quan VL, Panah E, Isales MC, Beaubier N, Taxter TJ, White KP, Zou L, Gerami P. Distinct genomic features in a retrospective cohort of mucosal, acral, and vulvovaginal melanomas. J Am Acad Dermatol 2023; 88:1051-1059. [PMID: 31306728 DOI: 10.1016/j.jaad.2019.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/21/2019] [Accepted: 07/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compared with sun-exposed melanomas, less is known regarding the pathogenesis of sun-protected melanomas. Sun-protected melanomas share many epidemiologic factors, but their genetic heterogeneity is not well studied. OBJECTIVE We investigated the genomic profile of acral, mucosal, and vulvovaginal melanomas. We hypothesize that mucosal melanomas, recognized for their uniquely aggressive clinical behavior, have distinct genomic features. METHODS We performed whole transcriptome messenger RNA and DNA (1711 genes) sequencing, messenger RNA expression profiling, tumor mutational burden, ultraviolet signature, and copy number variants analysis on 29 volar/digital acral, 7 mucosal, and 6 vulvovaginal melanomas. RESULTS There was significant genetic heterogeneity, particularly in acral melanomas, with 36% having BRAF alterations, whereas other melanomas had none (P = .0159). Nonzero ultraviolet signatures were more frequent in acral melanomas, suggesting greater ultraviolet involvement. Mucosal melanomas formed a distinct group with increased expression of cell cycle and proliferation genes. Various targetable aberrations were identified, such as AURKA and ERBB2, in mucosal and acral melanomas, respectively. LIMITATIONS The sample size was a small. CONCLUSION There is significant genetic heterogeneity among sun-protected melanomas. Mucosal melanomas have upregulation in cell cycle and proliferation genes, which may explain their aggressive behavior. Ultraviolet radiation plays some role in a subset of acral but not other melanomas.
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Affiliation(s)
- Katherine Shi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Betty Y Kong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yongzhan Zhang
- Department of Chemical and Biological Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | | | - Lauren S Mohan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victor L Quan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elnaz Panah
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Maria Cristina Isales
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | - Lihua Zou
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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13
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Li KP, Ajebo EM, Diamond D, Powell M, Belcher M. Primary vulvar melanoma in an adolescent patient. Pediatr Dermatol 2023. [PMID: 36949654 DOI: 10.1111/pde.15296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/26/2023] [Indexed: 03/24/2023]
Abstract
Herein we describe the case of a Black adolescent who was found to have widely metastatic melanoma originating from a primary vulvar lesion. The lesion presented as a pink, vegetative nodule of the clitoral hood which grew in size over several years and was confirmed to be melanoma on shave biopsy. This patient's amelanotic presentation in conjunction with the rare incidence of vulvar melanoma contributed to the delay in diagnosis. This case exemplifies the challenge of early recognition of potentially malignant vulvar lesions for primary care providers in adolescents.
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Affiliation(s)
- Kathy P Li
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Etsubdenk M Ajebo
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Davis Diamond
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Matthew Powell
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Matthew Belcher
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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14
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Dupont M, Parent M, Vanhooteghem O. About a Rare Association Between Vulvar Dowling Degos Disease and HS. Int J Womens Health 2023; 15:355-359. [PMID: 36923583 PMCID: PMC10010119 DOI: 10.2147/ijwh.s398604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Dowling Degos disease (DDD) is a rare genodermatosis that manifests itself as acquired, reticulated hyperpigmentation of the folds. We report the case of a 45-year-old woman who presented since the age of 30 with hyperpigmented macules of reticulated appearance of vulvar, perianal and bilateral axillary location associated with hidradenitis suppurativa (HS) at Hurley stage 2 of later onset. DDD is classically described in the flexural folds and, to our knowledge; less than a dozen cases of vulvar location are published in the literature. We postulate that DDD is responsible for the development of HS in susceptible patients. Indeed, this association seems to be explained by a common pathophysiological mechanism, targeting the Notch signalling pathway, involved in the proliferation and differentiation of epidermal cells that can induce the development of HS. DDD should be considered as a comorbid factor of HS.
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Affiliation(s)
- Manon Dupont
- Dermatology Department, CHU UCL Namur, Site Sainte Elisabeth, Namur, 5000, Belgium
| | - Muriel Parent
- Department of Pathology, Institute of Pathology and Genetics (IPG), Gosselies, 6041, Belgium
| | - Olivier Vanhooteghem
- Dermatology Department, CHU UCL Namur, Site Sainte Elisabeth, Namur, 5000, Belgium
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15
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Karpathiou G, Orlando F, Dumollard JM, Mobarki M, Chauleur C, Péoc'h M. The Premetastatic Lymph Node Niche in Gynecologic Cancer. Int J Mol Sci 2023; 24. [PMID: 36835583 DOI: 10.3390/ijms24044171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
It has been suggested that a primary tumor can "prepare" the draining of lymph nodes to "better accommodate" future metastatic cells, thus implying the presence of a premetastatic lymph node niche. However, this phenomenon remains unclear in gynecological cancers. The aim of this study was to evaluate lymph-node draining in gynecological cancers for premetastatic niche factors, such as myeloid-derived suppressor cells (MDSCs), immunosuppressive macrophages, cytotoxic T cells, immuno-modulatory molecules, and factors of the extracellular matrix. This is a monocentric retrospective study of patients who underwent lymph-node excision during their gynecological-cancer treatment. In all, 63 non-metastatic pelvic or inguinal lymph nodes, 25 non-metastatic para-aortic lymph nodes, 13 metastatic lymph nodes, and 21 non-cancer-associated lymph nodes (normal controls) were compared for the immunohistochemical presence of CD8 cytotoxic T cells, CD163 M2 macrophages, S100A8/A9 MDSCs, PD-L1+ immune cells, and tenascin-C, which is a matrix remodeling factor. PD-L1-positive immune cells were significantly higher in the control group, in comparison to the regional and distant cancer-draining lymph nodes. Tenascin-C was higher in metastatic lymph nodes than in both non-metastatic nodes and control lymph nodes. Vulvar cancer-draining lymph nodes showed higher PD-L1 values than endometrial cancer and cervical cancer-draining lymph nodes. Endometrial cancer-draining nodes had higher CD163 values and lower CD8 values, compared to vulvar cancer-draining nodes. Regarding regional draining nodes in low- and high-grade endometrial tumors, the former showed lower S100A8/A9 and CD163 values. Gynecological cancer-draining lymph nodes are generally immunocompetent, but vulvar cancer draining nodes, as well as high-grade endometrial cancer draining nodes, are more susceptible to harboring premetastatic niche factors.
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16
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Chen L, Wang Y, Gao X, Qin B, Ren M, Zhang W, Wei R, Su H, Li Q. In vivo evaluation of vulvar lichen sclerosus with reflectance confocal microscopy and therapeutic monitoring in children. Skin Res Technol 2023; 29:e13234. [PMID: 36380494 PMCID: PMC9838761 DOI: 10.1111/srt.13234] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vulvar lichen sclerosus (VLS) in girls presents with itching, dysuria, and constipation and may result in the loss of vulvar architecture. In patients with an ambiguous clinical presentation, reflectance confocal microscopy (RCM) could be a helpful noninvasive diagnostic tool. The aim of this study was to describe the RCM characteristics of VLS and explore the clinical application value of RCM in therapeutic monitoring. METHODS Sixteen patients with VLS were included in the study. All patients were periodically evaluated clinically with RCM, and different treatment regimens were given based on the patient's clinical appearances and RCM features. RESULTS Some major key diagnostic features of VLS can be observed by RCM, including round to oval cyst-like structures with medium-to-low-refractive keratinoid substances (75%), thinning of the epidermal thickness (100%), destruction of the ring-like structures around dermal papillae (100%), disorderly distributed coarse medium-refractive fibrous material (100%),polygonal, plump, high-refractive cellular structures and linear low-refractive canalicular structures (100%). All of these characteristics had a high correspondence with histopathological features. The clinical manifestations improved after individualized treatment regimens based on the clinical appearances and RCM features. CONCLUSION RCM allows the visualization of major key diagnostic features of VLS and represents a valid option for objective therapeutic monitoring.
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Affiliation(s)
- Lixin Chen
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Ying Wang
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Xibo Gao
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Bei Qin
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Min Ren
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Wanxing Zhang
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Ran Wei
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Haihui Su
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Qinfeng Li
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
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17
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Chen S, Deng X, Xie C, Dong Q, Yang H. Near complete remission of a locally advanced giant melanoma of the vulva following hypo-fractionated radiotherapy and immune checkpoint inhibitors: A case report. Oncol Lett 2022; 24:458. [PMID: 36380876 PMCID: PMC9650599 DOI: 10.3892/ol.2022.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Melanoma is known to be insensitive to radiotherapy; however, the present study reports the case of a patient with vulvar malignant melanoma in which near complete remission of the target area was observed after implementing immune checkpoint inhibitors (ICIs) and hypo-fractionated radiotherapy (HFRT). The patient was treated with an intensity-modulated radiation therapy technique that delivered a hypo-fractionated dose of 3,000 cGy in six fractions. After 3 days, the patient underwent immunotherapy with two cycles of 240 mg triprizumab every 2 weeks. Tumors that underwent radiotherapy had markedly decreased in size and a near complete remission of the melanoma was observed 4 months after radiotherapy. However, the metastases in the liver and lungs continued to grow, new metastases appeared in the abdominal subcutaneous tissue and enlarged lymph nodes were observed in the pelvic area. The results of the present study indicated that ICIs and HFRT exert a marked local effect, but no abscopal effect.
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Affiliation(s)
- Shuang Chen
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xuemei Deng
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Chen Xie
- Department of Oncology, Luzhou People's Hospital, Luzhou, Sichuan 646000, P.R. China
| | - Qingke Dong
- Department of Oncology, Luzhou People's Hospital, Luzhou, Sichuan 646000, P.R. China
| | - Hongru Yang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China,Correspondence to: Dr Hongru Yang, Department of Oncology, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang, Luzhou, Sichuan 646000, P.R. China, E-mail:
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18
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van Dongen J, de Heus E, Eickholt L, Schrieks M, Zantingh I, Brouwer OR, Oonk MHM, Grotenhuis BA, Ezendam NPM, Duijts SFA. Challenges and controversies patients and (health care) professionals experience in managing vaginal, vulvar, penile or anal cancer: The SILENCE study. Eur J Cancer Care (Engl) 2022; 31:e13676. [PMID: 35938519 PMCID: PMC9787908 DOI: 10.1111/ecc.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients with vaginal, vulvar, penile or anal cancer experience deteriorated psychosocial functioning and decreased Quality of Life (QoL). The aims of this study were to explore (1) the challenges and controversies patients experience in managing vaginal, vulvar, penile or anal cancer; their unmet needs; and how this affects their psychosocial functioning and (2) the gaps health care professionals (HCPs) experience in providing psychosocial support and potential improvements in care. METHODS Semi-structured interviews with patients with vaginal, vulvar, penile or anal cancer and with HCPs were conducted. All interviews were transcribed verbatim and thematically analysed. RESULTS Fourteen patients (86% female; mean age 55.5) and 12 HCPs (75% female; mean age 46.4) participated. Four themes were identified: (1) recognisable symptoms but unfamiliar diagnosis, (2) 'double hit' has severe impact on psychosocial functioning, (3) personal and tailored information is important but not guaranteed and (4) all-encompassing care to improve psychosocial functioning and QoL. CONCLUSION Patients with vaginal, vulvar, penile or anal cancer encounter a lack of awareness and knowledge about their rare cancer type, difficulties regarding communication and long-term changes in body image and sexuality. Awareness of symptoms should be raised and psychosocial care should be offered on a structural basis.
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Affiliation(s)
- Jessy van Dongen
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands
| | - Eline de Heus
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands,Department of Medical OncologyRadboud University Medical CenterNijmegenNetherlands
| | - Lauren Eickholt
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands
| | - Marga Schrieks
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie van Kankerpatiëntenorganisaties, NFK)UtrechtNetherlands
| | - Ilaniek Zantingh
- Center for Quality of LifeThe Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital (NKI‐AvL)AmsterdamThe Netherlands
| | - Oscar R. Brouwer
- Department of UrologyThe Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital (NKI‐AvL)AmsterdamNetherlands
| | - Maaike H. M. Oonk
- Department of Obstetrics and GynecologyUniversity Medical Center GroningenGroningenNetherlands
| | - Brechtje A. Grotenhuis
- Department of Surgical OncologyThe Netherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AvL)AmsterdamNetherlands
| | - Nicole P. M. Ezendam
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseasesTilburg UniversityTilburgNetherlands
| | - Saskia F. A. Duijts
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands,Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamNetherlands
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19
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Wu W, Sun L, Lu J, Yang X, Liu Q, Wang J. Vulvar Verruciform Xanthoma: A Comprehensive Literature Review. Clin Cosmet Investig Dermatol 2022; 15:1675-1680. [PMID: 36003527 PMCID: PMC9394516 DOI: 10.2147/ccid.s371979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022]
Abstract
Verruciform xanthoma (VX) is a rare, benign, mucocutaneous, verrucous, papillary lesion. This paper retrospectively summarizes clinical and pathologic features of 32 vulvar verruciform xanthoma reported from China and abroad. The skin lesions are generally single, mainly in labia minora, clitoris and fourchette with partly extending to the groin, buttocks and anus. The possible inducing factors include long-term scratching, local itching, severe lymphedema or lymphangioma circumscriptum. Severe cutaneous trauma and chronic inflammation may be the main causes. Clinically, it can easily be misdiagnosed as condylomata acuminata, squamous cell carcinoma, bowenoid papulosis, etc. It is reported to be related to underlying disorders. The main treatment is complete resection.
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Affiliation(s)
- Weiwei Wu
- Department of Plastic and Dermatological Surgery, The Fifth People's Hospital of Hainan Province, Haikou, People's Republic of China
| | - Lengbing Sun
- Department of Dermatology, The Fifth People's Hospital of Hainan Province, Haikou, People's Republic of China.,School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, People's Republic of China
| | - Jiejie Lu
- Department of Dermatology, The Fifth People's Hospital of Hainan Province, Haikou, People's Republic of China
| | - Xianxu Yang
- Department of Dermatology, The Fifth People's Hospital of Hainan Province, Haikou, People's Republic of China
| | - Qiao Liu
- School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, People's Republic of China.,Department of Dermatology,The Second Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, People's Republic of China
| | - Junzhi Wang
- First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, People's Republic of China
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20
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Ederaine SA, Torgerson RR, Marnach ML. A rare case of recurrent group A streptococcal vulvovaginitis in a premenopausal woman. Int J Womens Dermatol 2022; 8:e022. [PMID: 35647255 PMCID: PMC9132516 DOI: 10.1097/jw9.0000000000000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/09/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sophia A Ederaine
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Rochelle R Torgerson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Mary L Marnach
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota
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21
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van der Sluis N, Scheers ECAH, Krenning G, van der Lei B, Oonk MHM, van Dongen JA. Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: a review on literature. Exp Dermatol 2022; 31:689-699. [PMID: 35276020 PMCID: PMC9314062 DOI: 10.1111/exd.14561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory dermatosis that mostly affects the genital and anal skin areas. Symptoms may vary from pruritis and pain to sexual dysfunction; however, LS can also be asymptomatic. LS occurs at all ages and in both sexes. Approximately 5% of all women affected by vulvar LS will develop vulvar squamous cell carcinoma. Topical treatment is safe but less effective resulting in chronic course in most patients, who suffer from persistent itching and pain. In severe cases of therapy‐resistant LS, there is no adequate treatment. Fat grafting is a novel regenerative therapy to reduce dermal fibrosis. The therapeutic effect of adipose tissue grafts for LS is already investigated in various pioneering studies. This review provides an overview of these studies and the putative mechanisms‐of‐action of fat grafting to treat LS.
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Affiliation(s)
- Nanouk van der Sluis
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Plastic-, Reconstructive- and Hand Surgery, Medisch Spectrum Twente (MST), Enschede, The Netherlands
| | - Esther C A H Scheers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Guido Krenning
- Department of Pathology and Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maaike H M Oonk
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris A van Dongen
- Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht University, Utrecht, the Netherlands
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22
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Dang J, McCuaig CC, Funaro D. Vulvar involvement in epidermolysis bullosa: Case series. JAAD Case Rep 2021; 17:21-27. [PMID: 34660868 PMCID: PMC8502715 DOI: 10.1016/j.jdcr.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Julie Dang
- Division of Dermatology, Department of Medicine, Centre Hospitalier de L'Université de Montréal, Montréal, Quebec, Canada
- Correspondence to: Julie Dang, MD, Division of Dermatology, Department of Medicine, Centre Hospitalier de L'Université de Montréal, 1051 rue Sanguinet, Pavillon D, 2e étage, Clinique de dermatologie, Montréal, QC H2X 3E4, Canada.
| | - Catherine C. McCuaig
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Deana Funaro
- Division of Dermatology, Department of Medicine, Centre Hospitalier de L'Université de Montréal, Montréal, Quebec, Canada
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
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23
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Lim Y, Singh M. Metastatic Vulval Crohn's Disease With Good Outcome on Ustekinumab. Cureus 2021; 13:e16252. [PMID: 34373813 PMCID: PMC8346268 DOI: 10.7759/cureus.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/06/2022] Open
Abstract
Vulval Crohn’s disease is a rare manifestation of Crohn’s disease. Although it is usually caused by a fistulating process, it may be a result of a metastatic disease process as well, the exact mechanisms of which are not well understood yet. Vulval Crohn’s disease may occur before the onset of bowel symptoms and may continue to be active while bowel symptoms are quiescent. Coupled with the fact that most vulval Crohn’s lesions are similar to other disease processes, it can prove to be a diagnostic challenge. Due to its rarity, no guidelines for treatment exist; however, most reports agree that when symptoms are not controlled with antibiotics and topical steroids, immunosuppressive medications such as oral steroids and biological agents are the way forward. Although surgery may be an option, data suggest that its use is scarce. We report the case of a 47-year-old Caucasian woman with bilateral metastatic vulval Crohn’s disease from a district hospital in the United Kingdom who responded well to ustekinumab. This is one of the first few cases reporting good clinical outcomes with the agent.
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Affiliation(s)
- Yizhe Lim
- Obstetrics and Gynaecology, Torbay Hospital, Torquay, GBR
| | - Manpreet Singh
- Obstetrics and Gynaecology, Torbay Hospital, Torquay, GBR
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24
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Ignatov T, Gaßner J, Bozukova M, Ivros S, Mészáros J, Ortmann O, Eggemann H, Ignatov A. Contralateral lymph node metastases in patients with vulvar cancer and unilateral sentinel lymph node metastases. Acta Obstet Gynecol Scand 2021; 100:1520-1525. [PMID: 33811323 DOI: 10.1111/aogs.14157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/21/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The risk of contralateral lymph node metastases following unilateral sentinel lymph node (SLN) metastases in patients with vulvar cancer(s) remains to be systematically assessed. MATERIAL AND METHODS We performed a multicenter, retrospective registry-based study of 476 patients with vulvar cancer. The primary outcome measure was the rate of contralateral non-SLN metastases in the case of positive unilateral SLN. RESULTS Out of 476 patients with primary vulvar cancer, 202 received SLN biopsy: 58 unilateral and 144 bilateral. Out of 66 patients with unilateral metastatic SLN, 62 (93.9%) received contralateral lymphadenectomy-18 after unilateral and 44 after bilateral SLN biopsy. In the study group, 132 SLN were assessed with a median number of 2 (range 1-4) per patient and 76 of these were positive. Lymph node-positivity was associated with advanced tumor stage, as well as lymph and vascular space invasion. In the group of patients with bilateral inguino-femoral lymphadenectomy, 1004 lymph nodes were resected with a median number of 15 (range 10-29) per patient. After full dissection of the inguino-femoral lymph nodes, no contralateral non-SLN metastases were found. CONCLUSIONS The risk of contralateral non-SLN metastases in patients with unilateral SLN metastases was low. Therefore, the impact of contralateral lymphadenectomy on patient survival should be investigated in further studies.
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Affiliation(s)
- Tanja Ignatov
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany.,Department of Gynecology and Obstetrics, Otto-von-Guericke University, Magdeburg, Germany
| | - Johannes Gaßner
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | | | - Stylianos Ivros
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, Magdeburg, Germany.,Gynecologic Oncology Unit, Metropolitan Hospital, Athens, Greece
| | - József Mészáros
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Holm Eggemann
- Department of Gynecology and Obstetrics, Klinikum Magdeburg, Magdeburg, Germany
| | - Atanas Ignatov
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany.,Department of Gynecology and Obstetrics, Otto-von-Guericke University, Magdeburg, Germany
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25
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Giannouli A, Tsinopoulou VR, Tsitsika A, Deligeoroglou E, Bacopoulou F. Vulvar Varicosities in an Adolescent Girl with Morbid Obesity: A Case Report. Children (Basel) 2021; 8:children8030202. [PMID: 33800092 PMCID: PMC7998964 DOI: 10.3390/children8030202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
Vulvar varicosities in nonpregnant females, either isolated or as a part of the pelvic congestion syndrome, are rare. We present a case of an adolescent girl with morbid obesity with bilateral bluish protrusions on the labia minora, as an incidental finding, that coincided with her excessive weight gain. The adolescent underwent thorough clinical examination, doppler ultrasound, contrast venography and varicography, and magnetic resonance angiography to rule out alternative diagnoses. Imaging results confirmed the presence of large venous lakes. Venous drainage to the internal iliac vein and connections with the long saphenous vein were delineated. Incompetence, dilatation, or reflux of ovarian or internal iliac veins, or their main tributaries, were not noted. Since the adolescent was asymptomatic and other pathologies, such as vascular malformations or hemangiomas were excluded, she was managed conservatively with counseling about lifestyle modification and weight reduction. This is only the third reported case of vulvar venous varicosities in adolescents. Female sex, along with obesity, are known risk factors for varicose vein formation; however, the pathogenesis is not fully understood. Additional research is needed to elucidate the role of excess adipose tissue in the pathophysiology of vulvar varicose veins and to optimize diagnostic workup and management in adolescence.
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Affiliation(s)
- Aikaterini Giannouli
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece;
| | - Vasiliki Rengina Tsinopoulou
- Unit of Paediatric Endocrinology and Metabolism, 2nd Department of Paediatrics, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, 54621 Thessaloniki, Greece;
| | - Artemis Tsitsika
- Adolescent Health Unit, 2nd Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, Greece;
| | - Efthimios Deligeoroglou
- Department of Pediatric & Adolescent Gynecology, Mitera Children’s Hospital, 15123 Athens, Greece;
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece;
- Correspondence: ; Tel.: +30-6973208208
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26
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Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages. The aim of this review is to focus on first-line, second-line, and maintenance therapies as well as follow-up of women with VLS. With numerous controversies, we decided to conduct a scoping review on this subject. A review protocol was developed, and the Knowledge Resource Services website was used to run a search of articles pertaining to VLS with keywords “Vulvar,” “Vulval,” and “Lichen Sclerosus.” The search was limited to published data from the last 10 years, i.e., July 2009 onward, and researches published in English language. A total of 338 articles pertaining to VLS were obtained. Out of this, 62 were original articles related to management of VLS. Effective treatments such as high-potency topical steroids are now the standard of care and first-line treatment. Follow-up may be done every three to six months for the first two years and then at least yearly to ensure adequacy of treatment and encourage compliance. Long-term follow-up in specialist clinics is recommended for women who have persistent complaints, thickened skin, or history of neoplastic lesion. Monitoring young patients yearly is recommended as there are chances of recurrence.
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Affiliation(s)
| | - Neha Mishra
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Greater Noida, IND.,Obstetrics and Gynecology, Government Institute of Medical Sciences, Greater Noida, IND
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27
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Gilissen L, Schollaert I, Huygens S, Goossens A. Iatrogenic allergic contact dermatitis in the (peri)anal and genital area. Contact Dermatitis 2021; 84:431-438. [PMID: 33350482 DOI: 10.1111/cod.13764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) from topical medication often occurs in occluded areas, for example, with wound treatment, but also in certain body locations, such as the anogenital area. OBJECTIVES To investigate the demographics and specific lesion location of patients with ACD from topical drugs applied onto the (peri)anal/genital area, and to identify the respective causal topical pharmaceutical products and ingredients involved. METHODS From January 2000 to December 10, 2018, 532 patients were tested with the baseline series, sometimes with additional series, and the topical medication used along with the ingredients. The relevant data were extracted from our electronic databases developed in-house. RESULTS Forty-four patients (9%) out of 473 patients suffering from lesions in the (peri)anal/genital area had positive patch test results to topical drug preparations and/or their ingredients, sometimes in association with cosmetics for intimate hygiene. The most frequent sensitizing active principles were local anaesthetics and corticosteroids, while wool alcohols and to a minor extent benzoic acid were the most frequent culprits among the vehicle components and preservative agents, respectively. CONCLUSIONS The local conditions (eg, occlusion, sweating, moist) in the anogenital area may favour skin sensitization to topical medication used to treat various skin diseases.
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Affiliation(s)
- Liesbeth Gilissen
- Department of Dermatology, Contact Allergy Unit, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | | | - Sara Huygens
- Department of Dermatology, Contact Allergy Unit, University Hospitals Leuven, Leuven, Belgium
| | - An Goossens
- Department of Dermatology, Contact Allergy Unit, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
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28
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Pergialiotis V, Bellos I, Biliou EC, Varnava P, Mitsopoulou D, Doumouchtsis SK. An arm-based network meta-analysis on treatments for vulvar lichen sclerosus and a call for development of core outcome sets. Am J Obstet Gynecol 2020; 222:542-550.e6. [PMID: 31697910 DOI: 10.1016/j.ajog.2019.10.095] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/20/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the present systematic review is to evaluate the available medical treatments for vulvar lichen sclerosus, using an arm-based network meta-analysis protocol. DATA SOURCES We searched Medline (1966-2019), Scopus (2004-2019), Cochrane Central Register of Controlled Trials CENTRAL (1999-2019), Clinicaltrials.gov (2008-2019) databases, and Google Scholar (2004-2019) database along with the reference list of all included studies. STUDY ELIGIBILITY CRITERIA All observational, randomized, and single-arm studies that evaluated medical treatments for vulvar lichen sclerosus were considered eligible for inclusion in the present systematic review. STUDY APPRAISAL A network meta-analysis was carried out in R 3.4.3 using the pcnetmeta package, which uses a Bayesian hierarchical model (based in Markov chain Monte Carlo convergence simulation). RESULTS Sixteen studies were included in this present meta-analysis, which recruited 954 women with vulvar lichen sclerosus. Their quality was evaluated with the JADAD, Cochrane risk of bias, and risk of bias in nonrandomised studies of interventions-I tools. Clobetasol treatment ranked as the best treatment for disease remission after evaluating rank probabilities (40% chance of ranking first compared with tacrolimus [38%]). However, the density plot revealed partial overlapping with tacrolimus. The lowest probability of experiencing a relapse was observed with pimecrolimus (15% [2-48%]); however, the density plot revealed significant overlapping with mometasone furoate, testosterone, and clobetasol. CONCLUSION Robust evidence concerning the superiority of potent steroids at least over calcineurin inhibitors is still lacking in the field of vulvar lichen sclerosus. On the other hand, the gross heterogeneity in terms of selected population, duration of treatment, administered regimen, outcome reporting, and selection of outcome measures leaves several fields unanswered.
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Affiliation(s)
- Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece; Third Department of Obstetrics and Gynecology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini-Chrysovalantou Biliou
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Varnava
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Mitsopoulou
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Stergios K Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece; Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals National Health Service Trust, London, United Kingdom; St George's University of London, London, United Kingdom
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Batra J, Goraya SK, Grewal S, Singh A. Metastatic Crohn's Disease of the Vulva: A Rare Presentation. Indian Dermatol Online J 2020; 11:416-418. [PMID: 32695706 PMCID: PMC7367556 DOI: 10.4103/idoj.idoj_352_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/14/2019] [Accepted: 09/15/2019] [Indexed: 11/25/2022] Open
Abstract
Crohn's disease, a chronic inflammatory granulomatous disease of gastrointestinal tract, may rarely have extra intestinal manifestations. Vulvar Crohn's disease may be contiguous or noncontiguous with the gastrointestinal tract. It can cause significant symptoms and has a major impact on quality of life.
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Affiliation(s)
| | - Sukhjot Kaur Goraya
- Department of Dermatology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Aminder Singh
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Affiliation(s)
| | - Melanie A Clark
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Allison T Vidimos
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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Namuduri RP, Lim TY, Yam PK, Gatsinga R, Lim-Tan SK, Chew SH, Koh MJ, Mansor S. Vulvar basal cell carcinoma: clinical features and treatment outcomes from a tertiary care centre. Singapore Med J 2019; 60:479-482. [PMID: 30773599 DOI: 10.11622/smedj.2019014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We retrospectively reviewed the clinical features, management and outcomes of patients diagnosed with basal cell carcinoma (BCC) of the vulva at the Gynaecological Cancer Centre, KK Women's and Children's Hospital, Singapore, between 1 January 2000 and 28 February 2014. Patients with vulvar BCC were identified from the cancer registry, and their medical records reviewed and analysed. A total of 11 patients with vulvar BCC were identified. Mean age at diagnosis was 63 (range 30-85) years. Ethnically, ten patients were Chinese and one was Malay. Average time from onset of symptoms to diagnosis was 13.8 (range 2-60) months. The most common presenting symptoms were lump and pruritus. All patients were managed surgically. Recurrence was noted in only one patient. Vulvar BCC, although rare, has an excellent prognosis when managed appropriately. Histological diagnosis of all persistent papules, plaques and pigmented lesions is important for early diagnosis.
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Affiliation(s)
- Rama P Namuduri
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Timothy Yk Lim
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Philip Kl Yam
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | | | - Soo Kim Lim-Tan
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Sung Hock Chew
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Mark Ja Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
| | - Sorsiah Mansor
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
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Ou Y, Cannon MJ, Nakagawa M. Regulatory T Cells in Gynecologic Cancer. MOJ Immunol 2018; 6:34-42. [PMID: 30637330 PMCID: PMC6329475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Increasing evidence supports that regulatory T cells (Tregs) within the tumor, tumor draining lymph nodes, ascites and peripheral blood of patients with cancer are associated with poor prognosis. Tregs are important mediators of active immune evasion in cancer. In this review, the potential mechanisms of Treg actions and the roles of Tregs specifically in the tumor microenvironment derived from three types of gynecological cancers, cervical, vulvar and ovarian, are described. The correlations between Tregs and clinical immunotherapeutic study outcomes are discussed. Successful modulation of Tregs would likely have significant impact on the effectiveness of immunotherapeutic treatments in cancer patients.
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Affiliation(s)
- Yang Ou
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Martin J. Cannon
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Mayumi Nakagawa
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR USA
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Dederichs F, Iesalnieks I, Sladek M, Tzivinikos C, Hansen R, Muñoz C, Pavli P, Cavicchi M, Abitbol V, Rahier JF, Vavricka S, Katsanos K, Domènech E. Genital Granulomatosis in Male and Female Patients With Crohn's Disease: Clinical Presentation and Treatment Outcomes. J Crohns Colitis 2018; 12:197-203. [PMID: 29029098 DOI: 10.1093/ecco-jcc/jjx131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/16/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Genital granulomatosis [GG] is a metastatic form of Crohn's disease [CD], characterised by granulomatous inflammation of the genital skin without contact with the gastrointestinal tract. Little is known about GG, as most publications are case reports or small series, and only sporadic in male cases. METHODS AND AIMS Cases of GG were retrospectively collected through the Collaborative Network For Exceptionally Rare case reports project of the European Crohn's and Colitis Organisation. RESULTS A total of 43 patients [9 males, 34 females] were diagnosed as having GG, mostly as oedema and/or ulcers. Histological confirmation of granulomas was obtained in 70% of the cases. CD location was colonic or ileocolonic in 97% and perianal disease was documented in 57%. There was no significant difference between males and females in CD phenotype or genital lesions. GG was the first manifestation of inflammatory bowel disease [IBD] in one-third of the patients; these patients were younger at the time of GG occurrence and they all were non-smokers. GG occurred in the absence of gastrointestinal disease activity in 30% of the cases. Ten out of 11 patients [91%] responded to systemic corticosteroid treatment, 5/9 patients responded to immunomodulators, and 9/11 patients responded to anti-tumour necrosis factor alpha [TNF-α] agents. CONCLUSIONS GG is a rare extraintestinal manifestation of CD. It mainly occurs among women, in the setting of colonic involvement of CD, and perianal disease is often associated. Most cases are successfully managed with systemic corticosteroids or anti-TNF agents.
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Affiliation(s)
| | | | | | | | | | - Carmen Muñoz
- Villafranca del Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | | | | | | | - Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol, Badalona, and CIBEREHD, Madrid, Spain
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Deuster E, Jeschke U, Ye Y, Mahner S, Czogalla B. Vitamin D and VDR in Gynecological Cancers-A Systematic Review. Int J Mol Sci 2017; 18:ijms18112328. [PMID: 29113037 PMCID: PMC5713297 DOI: 10.3390/ijms18112328] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 12/26/2022] Open
Abstract
In recent years, a vast amount of studies have centered on the role of vitamin D in the pathogenesis of certain types of cancers such as breast, colorectal and lung cancer. Increasing evidence suggests that vitamin D and its receptor play a crucial role in the development of gynecological cancers. In this review, we systematically analyzed the effect of vitamin D and the vitamin D receptor on endometrial, ovarian, cervical, vulvar and vaginal cancer. Our literature research shows that vitamin D levels and vitamin-D-related pathways affect the risk of gynecological cancers. Numerous ecological studies give evidence on the inverse relationship between UVB exposure and gynecological cancer risk. However, epidemiologic research is still inconclusive for endometrial and ovarian cancer and insufficient for rarer types of gynecological cancers. The vitamin D receptor (VDR) is upregulated in all gynecological cancers, indicating its influence on cancer etiology. The VDR polymorphism FokI (rs2228570) seems to increase the risk of ovarian cancer. Other nuclear receptors, such as the RXR, also influence gynecological cancers. Although there is limited knowledge on the role of the VDR/RXR on the survival of endometrial, cervical, vulvar or vaginal cancer patients, some studies showed that both receptors influence survival. Therefore, we suggest that further studies should focus on the vitamin D- and its hetero dimer receptor RXR in gynecological cancers.
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Affiliation(s)
- Eileen Deuster
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistr 15, Munich 81377, Germany.
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistr 15, Munich 81377, Germany.
| | - Yao Ye
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistr 15, Munich 81377, Germany.
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistr 15, Munich 81377, Germany.
| | - Bastian Czogalla
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistr 15, Munich 81377, Germany.
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Bertolotti A, Dupin N, Bouscarat F, Milpied B, Derancourt C. Cryotherapy to treat anogenital warts in nonimmunocompromised adults: Systematic review and meta-analysis. J Am Acad Dermatol 2017; 77:518-526. [PMID: 28651824 DOI: 10.1016/j.jaad.2017.04.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/27/2017] [Accepted: 04/10/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cryotherapy is one of the most commonly used therapeutic modalities to treat anogenital warts (AGWs), but this treatment was not clearly established in the recent international recommendations. OBJECTIVE To compare the efficacy and safety of cryotherapy versus other AGW treatments. METHODS Through a systematic search of 12 electronic databases, we identified 11 randomized controlled trials, screened from database inception through October 2016, that met the inclusion criteria (including immunocompetent adults with AGWs receiving cryotherapy in 1 of the comparison groups). Primary endpoint was complete clearance of AGW. Risk-for-bias assessment was based on Cochrane Handbook recommendations. Meta-analyses used Review Manager v5.3 software. RESULTS Cryotherapy efficacy did not appear to differ from that of trichloroacetic acid, podophyllin, or imiquimod. Electrosurgery was weakly associated with better AGW clearance than cryotherapy (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.65-0.99). Cryotherapy was associated with more immediate low-level adverse events (erythema, stinging, or irritation; RR 3.02, 95% CI 1.38-6.61) and immediate pain requiring oral analgesics (RR 2.11, 95% CI 1.07-4.17) but fewer erosions (RR 0.57, 95% CI 0.36-0.90). LIMITATIONS All but 1 randomized-controlled trial had a high risk for bias. CONCLUSION With low-level quality of the evidence, cryotherapy is an acceptable first-line therapy to treat AGWs.
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Affiliation(s)
- Antoine Bertolotti
- Centre d'Investigation Clinique Antilles-Guyane, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique; Antilles-Guyane University, Fort-de-France, Martinique.
| | - Nicolas Dupin
- Department of Dermatology, Cochin Hospital, Paris-Descartes University, Paris, France
| | - Fabrice Bouscarat
- Department of Dermatology, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Brigitte Milpied
- Department of Dermatology and Pediatric Dermatology, National Centre for Rare Skin Disorders, Saint-André and Pellegrin Hospitals, Bordeaux, France
| | - Christian Derancourt
- Antilles-Guyane University, Fort-de-France, Martinique; Délégation à la Recherche Clinique et à l'Innovation, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique; Department of Dermatology, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
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Mayor PC, Lele S. Photodynamic Therapy in Gynecologic Malignancies: A Review of the Roswell Park Cancer Institute Experience. Cancers (Basel) 2016; 8:cancers8100088. [PMID: 27669307 PMCID: PMC5082378 DOI: 10.3390/cancers8100088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/09/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022] Open
Abstract
Photodynamic therapy (PDT) is a treatment modality used in the management of solid tumor malignancies that employs the use of a photosensitizing agent, a light source and oxygen in order to illicit a direct cytotoxic effect. Its use in gynecologic malignancies is somewhat novel and has been used for palliative and curative intent. At the Roswell Park Cancer Institute, the use of PDT in the management of gynecologic cancers began in the mid 1980s and since that time 35 patients have received PDT as a treatment for recurrent or metastatic cutaneous and vulvar, vaginal, anal, and cervical recurrences. In our experience, 85% patients with metastatic cutaneous lesions had a complete response. Twenty-seven percent of patients with metastatic vaginal, cervical or anal recurrences had a complete response to therapy with a median response time of 28 months. Side effects from the treatment included moderate to severe burning sensation, pain and edema at the treatment site requiring narcotic pain medication for symptom management in patients who underwent treatment to cutaneous lesions as well as lower genital tract recurrences. PDT should be considered an option in patients who are too frail to undergo the standard of care or decline the standard of care in lieu of a less invasive treatment modality.
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Affiliation(s)
- Paul C Mayor
- Department of Surgery, Division of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
| | - Shashikant Lele
- Department of Surgery, Division of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Sethi R, Cunha A, Mellis K, Siauw T, Diederich C, Pouliot J, Hsu IC. Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology. J Contemp Brachytherapy 2016; 8:208-14. [PMID: 27504130 DOI: 10.5114/jcb.2016.60679] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/13/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Three-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy. MATERIAL AND METHODS Three brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic. RESULTS Patient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences. CONCLUSIONS We established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators.
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Victoria-Martínez AM, Cubells-Sánchez L, Martínez-Leborans L, Sánchez-Carazo JL, de Miquel VA. Vulvar Epidermal Inclusion Cyst as a Long-term Complication of Female Genital Mutilation. Indian J Dermatol 2016; 61:119. [PMID: 26955127 PMCID: PMC4763638 DOI: 10.4103/0019-5154.174090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case report of a patient with epidermal inclusion cyst as a late complication of female genital mutilation (FGM). We describe the management of the patient, and a review of the literature. We report the clinical and pathological findings in a 37-year-old female patient from Nigeria, with a clitoral mass of 1 year duration. She declared to have an FGM since she was 5 years. The lesion was excised successfully with good cosmetic results. Histological examination revealed epidermal cyst with the presence of granular layer. An epidermal inclusion cyst can develop as a long-term consequence of FGM.
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Affiliation(s)
| | | | | | | | - Víctor Alegre de Miquel
- Department of Dermatology, University General Hospital of Valencia, Valencia, Spain; Universidad de Valencia, Valencia, Spain
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Abstract
Lichen planus (LP) is an inflammatory autoimmune disease that affects both glabrous and mucosal skin. Although pathophysiology has not yet been fully defined, LP is a T-cell mediated disorder that demonstrates an increased Th1 cytokine expression as well as T-cell reactivity against basement membrane zone components. In males, genital LP often takes its more classic form as pink, shiny, flat-topped papules on the glans and coronal sulcus. In women, erosive disease is most common and often leads to significant scarring and sexual dysfunction. Therapeutic management is challenging, and control rather than cure is the goal. Topical corticosteroids remain first-line therapy, but some women will require systemic immunosuppressants to achieve remission. Surgery is less common for women with significant scarring who wish to resume sexual activity. Further research is needed on pathogenesis, and randomized controlled trials are necessary to better define best treatments for this chronic disease.
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Abstract
Actinomycosis is a chronic infection caused by Actinomyces israelii, usually seen in immunocompromised patients or in the background of tissue injury. Vulvar actinomycosis presenting as a fixed swelling in an elderly individual can mimic malignancy and pose a diagnostic dilemma. We report here a case of vulvar actinomycosis diagnosed by fine needle aspiration (FNA). A 60-year-old postmenopausal female presented with a gradually increasing 15 cm × 10 cm vulvar swelling involving the right mons and right labia majora. The swelling was nodular, fixed, and nonulcerated, with multiple healed and few active discharging sinus tracts draining serosanguineous fluid and yellowish sulfur granules. FNA was diagnostic, as it revealed colonies of Actinomyces surrounded by polymorphs. Histopathology of excised specimen confirmed the cytological findings. FNA is an effective tool in the diagnosis of actinomycosis, although, its documentation is rare. Difficulties in the management can be avoided by early diagnosis using the FNA technique.
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Affiliation(s)
| | | | | | - Dilip S Sarate
- Department of Pathology, Government Medical College, Akola, Maharashtra, India
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Abstract
Metastatic Crohn's disease (CD), a type of extraintestinal CD may present with gynecological manifestation which causes diagnostic dilemma and needs multidisciplinary approach. Vulvar lesions occur in very small number of cases with CD of which asymmetrical labial swelling and edema is the most common presentation. We report a case of hypertrophic exophytic variety of vulvar CD because of its rarity.
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Affiliation(s)
- Debajit Das
- From the Department of Dermatology, Silchar Medical College, Silchar, Assam, India
| | - Bhaskar Gupta
- From the Department of Dermatology, Silchar Medical College, Silchar, Assam, India
| | - Mahimanjan Saha
- From the Department of Dermatology, Silchar Medical College, Silchar, Assam, India
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Abstract
Paediatric vulvar skin conditions are relatively common but often cause diagnostic difficulties for clinicians, which can lead to anxiety within the children's families. Vulvar skin conditions can be caused by various underlying aetiologies. Most are general dermatologic conditions that occur in the vulvar area, such as eczema, psoriasis, skin lesions or infections. However, other conditions such as lichen sclerosus and napkin dermatitis ('nappy rash') only affect the genital region. Every affected child needs a sensitive evaluation of the complaint including an assessment of the impact of the condition on the patient and her family. Paediatric vulvar disease often influences bowel and bladder habits and may lead to behavioural problems. General measures such as avoidance of irritants or soap substitution and regular use of emollients are helpful for all patients. Specific therapy depends upon the underlying diagnosis. Time spent reassuring the families, reinforcing regimens and providing written documentation can all be very helpful in successful management of paediatric vulvar skin conditions.
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Affiliation(s)
- Rosalind C Simpson
- Centre of Evidence Based Dermatology, King's Meadow Campus, University of Nottingham, Lenton Lane, NG7 2NR, United Kingdom.
| | - Ruth Murphy
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, United Kingdom.
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Abstract
The treatment of early-stage vulvar cancer has remained surgical over time. Fortunately, less invasive surgical options have emerged, decreasing the significant morbidity associated with treatment. In the past decade, sentinel lymph node (SLN) dissection alone in select patients with vulvar cancer has been shown to be safe, feasible and has decreased surgical morbidity. In addition, multiple recent studies have reported low groin recurrence rates in women that underwent SLN dissection alone, which are similar to groin recurrence rates seen among women that underwent complete inguinal lymph node dissection. We believe SLN dissection should be the standard of care in select patients at institutions with surgeons experienced in the SLN technique. We feel caution should be used when performing SLN dissections in large vulvar lesions and in midline lesions. Further information is needed regarding the appropriate treatment of positive sentinel lymph nodes and, in particular, on the management of micrometastases.
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Affiliation(s)
- Katina Robison
- Department of Obstetrics and Gynecology, Program in Women's Oncology, Women and Infants Hospital, Brown University, 101 Dudley Street Providence, RI, 02905, USA
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Sharma M, Velho V, Mally R, Hrushikesh K. Vulvar migration of the peritoneal end through the inguinal canal in a female infant: An unusual complication of the ventriculo-peritoneal shunt: A case report and review of literature. J Pediatr Neurosci 2013; 8:67-9. [PMID: 23772251 PMCID: PMC3680903 DOI: 10.4103/1817-1745.111430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Migration of the peritoneal end of the ventriculo-peritoneal shunt through the patent processus vaginalis has been described in preterm male infants with 26 such cases in the literature. The occurrence of this rare complication in the female preterm infants has not yet been reported. We report a 3-month-old premature female infant who presented with a gradual increase in head size since birth. Computed tomography revealed obstructive hydrocephalous secondary to the aqueductal stenosis and ventriculo-peritoneal shunt was performed. Ten days following the procedure she presented with swelling and other signs of inflammation over the right vulvar region. X-ray abdomen confirmed the migration of the peritoneal end into the vulva. Surgical obliteration of the patent processus vaginalis and replacement of the peritoneal end was performed. The patient had no recurrence at 6 months of follow-up. This report presents the unusual complication of a common procedure in a female infant with a review of the current literature.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India
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Canfell K, Chesson H, Kulasingam SL, Berkhof J, Diaz M, Kim JJ. Modeling preventative strategies against human papillomavirus-related disease in developed countries. Vaccine 2012; 30 Suppl 5:F157-67. [PMID: 23199959 PMCID: PMC3783354 DOI: 10.1016/j.vaccine.2012.06.091] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 06/11/2012] [Accepted: 06/13/2012] [Indexed: 02/08/2023]
Abstract
Over the last 5 years, prophylactic vaccination against human papillomavirus (HPV) in pre-adolescent females has been introduced in most developed countries, supported by modeled evaluations that have almost universally found vaccination of pre-adolescent females to be cost-effective. Studies to date suggest that vaccination of pre-adolescent males may also be cost-effective at a cost per vaccinated individual of ~US$400-500 if vaccination coverage in females cannot be increased above ~50%; but if it is possible, increasing coverage in females appears to be a better return on investment. Comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centers around the potential trade-off between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. Future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against ~90% of cervical cancers. The timing of the effect of vaccination on cervical screening programs will be country-specific and will depend on vaccination catch-up age range and coverage and the age at which screening starts. Initial evaluations suggest that if screening remains unchanged, it will be less cost-effective in vaccinated compared to unvaccinated women but, in the context of current vaccines, will remain an important prevention method. Comprehensive evaluation of new approaches to screening will need to consider the population-level effects of vaccination over time. New screening strategies of particular interest include delaying the start age of screening, increasing the screening interval and switching to primary HPV screening. Future evaluations of screening will also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Affiliation(s)
- Karen Canfell
- Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, Australia.
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