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Meriggiola MC, Villa P, Maffei S, Becorpi A, Di Paolantonio T, Nicolucci A, Salvatore S, Nappi RE. Vulvovaginal atrophy in women with and without a history of breast cancer: Baseline data from the PatiEnt satisfactiON studY (PEONY) in Italy. Maturitas 2024; 183:107950. [PMID: 38462385 DOI: 10.1016/j.maturitas.2024.107950] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/22/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES To assess clinical characteristics of postmenopausal women with moderate/severe vulvovaginal atrophy, as well as its impact on sexual function, well-being, and quality of life, and to provide an overview of most used treatments. STUDY DESIGN Ongoing longitudinal, observational study conducted in 17 Italian gynecology centers, involving women already treated or initiating a local vaginal estrogen therapy or ospemifene. We report baseline data for women with and without a history of breast cancer. Participants filled in self-reported questionnaires at study entry. MAIN OUTCOME MEASURES Severity of vulvovaginal atrophy; ongoing treatments; patient-reported outcomes, including severity of symptoms, Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and SF-12® Health Survey. RESULTS Overall, 334 women (20.4 % with a history of breast cancer) started or continued local therapy (61.1 %) or ospemifene (38.8 %) at study entry. Vulvovaginal atrophy was severe in 28.6 %, and was responsible for severe symptoms, particularly vulvar dryness with burning or irritation and pain during sexual intercourse. Both sexual dysfunction (FSFI≤26) (81.5 %) and sexual distress (FSDS-R ≥ 11) (74.4 %) were common. A reduction in the SF-12 mental component score was documented. Women with breast cancer more often had severe vulvovaginal atrophy (41.2 %), had more severe symptoms, and the impact of vaginal symptoms on emotional well-being, sexual functioning and self-concept/body image was greater. The majority of them (83.8 %) received ospemifene as a treatment. CONCLUSIONS Moderate/severe vulvovaginal atrophy is a common, often neglected condition with an impact on QoL and sexuality, particularly in women with a history of breast cancer. It is important to alleviate the burden associated with the disease.
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Affiliation(s)
- Maria Cristina Meriggiola
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Gynecology and Physiopathology of Human Reproduction, 40138 Bologna, Italy.
| | - Paola Villa
- Department of Obstetrics and Gynecology, Catholic University, Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Silvia Maffei
- Department of Cardiovascular Endocrinology and Metabolism, Gynaecological and Cardiovascular Endocrinology and Osteoporosis Unit, "Gabriele Monasterio" Foundation and Italian National Research Council (CNR) Pisa, 56124 Pisa, Italy.
| | - Angelamaria Becorpi
- Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, 50134 Florence, Italy.
| | | | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, 65122 Pescara, Italy.
| | - Stefano Salvatore
- Obstetrics and Gynaecology Department, IRRCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20125 Milan, Italy.
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; Research Center for Reproductive Medicine and Gynecological Endocrinology - Menopause Unit, IRCCS S. Matteo Foundation, 27100 Pavia, Italy.
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El Hanbuli HM, Sarie MAA, Ibrahium GA, Al-Amaragy A, Elsonbaty M. Adenosquamous carcinoma of the vulva: Rare tumor with unusual clinical presentation. J Cutan Pathol 2024; 51:329-331. [PMID: 38228312 DOI: 10.1111/cup.14587] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 01/18/2024]
Abstract
A 52-year-old female presented with labial ulcer of 4-month duration. Examination showed 1 cm × 1 cm single superficial ulcer in the right labium majus. Excision was done, and histopathologic examination revealed surface ulceration and dermal invasion by epithelial neoplasm formed of biphasic proliferation of squamoid and gland-forming cells. Immunohistochemical staining with p63 showed nuclear staining of the squamoid nests and was negative in areas with glandular differentiation, while epithelial membrane antigen and carcinoembryonic antigen highlighted the glandular elements. The case was diagnosed as primary cutaneous adenosquamous carcinoma (ASC). ASC is an uncommon malignant cutaneous neoplasm that is more aggressive than conventional squamous cell carcinoma. There are a few reports of ASC that presented as an erythematous papule or plaque with a preference for the head, neck, or upper extremities. We report a novel case of vulval ASC presented as a superficial ulcer, which is considered a unique site, and its clinical presentation.
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Affiliation(s)
- Hala M El Hanbuli
- Pathology Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | | | | | | | - Mostafa Elsonbaty
- Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Asyut, Egypt
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3
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Tamayo SC, Quddus MR, Singh K. Recurrent Primary Paget Disease of Vulva with Paget-Like Epithelial Cells in Papillary Dermis: Displaced or Invasion? Int J Surg Pathol 2024; 32:507-510. [PMID: 37461289 DOI: 10.1177/10668969231188902] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
While histological diagnosis of Paget disease of vulva is mostly straightforward, identifying and confirming invasion can be challenging. Often invasion is accompanied by epidermal hyperplasia, marked inflammatory response and desmoplastic reaction. Diagnosis of invasion in Paget disease portends a poor outcome. We report findings from a recurrent primary vulvar Paget disease where overall histomorphology of possible invasive disease is unusual and raises a possibility of displacement of Paget cells in the dermis. We compare histology of the index case with known invasive vulvar Paget disease cases retrieved from our pathology archives. Unique histomorphology in the index case suggests a possibility of previous excision related dermal displacement of Paget cells.
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Affiliation(s)
- Steffanie Charlyne Tamayo
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - M Ruhul Quddus
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kamaljeet Singh
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, RI, USA
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Kibbi N, Owen JL, Worley B, Wang JX, Harikumar V, Aasi SZ, Chandra S, Choi JN, Fujisawa Y, Iavazzo C, Kim JYS, Lawrence N, Leitao MM, MacLean AB, Ross JS, Rossi AM, Servaes S, Solomon MJ, Alam M. Anatomic Subtype Differences in Extramammary Paget Disease: A Meta-Analysis. JAMA Dermatol 2024; 160:417-424. [PMID: 38446447 PMCID: PMC10918581 DOI: 10.1001/jamadermatol.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/28/2023] [Indexed: 03/07/2024]
Abstract
Importance Extramammary Paget disease (EMPD) is a rare, highly recurrent cutaneous malignant neoplasm of unclear origin. EMPD arises most commonly on the vulvar and penoscrotal skin. It is not presently known how anatomic subtype of EMPD affects disease presentation and management. Objective To compare demographic and tumor characteristics and treatment approaches for different EMPD subtypes. Recommendations for diagnosis and treatment are presented. Data Sources MEDLINE, Embase, Web of Science Core Collection, and Cochrane Reviews CENTRAL from December 1, 1990, to October 24, 2022. Study Selection Articles were excluded if they were not in English, reported fewer than 3 patients, did not specify information by anatomic subtype, or contained no case-level data. Metastatic cases on presentation were also excluded. Data Extraction and Synthesis Abstracts of 1295 eligible articles were independently reviewed by 5 coauthors, and 135 articles retained. Reporting was in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The analysis was cunducted in August 2019 and updated in November 2022. Findings Most vulvar EMPD cases were asymptomatic, and diagnosis was relatively delayed (mean, 25.1 months). Although most vulvar EMPD cases were intraepidermal (1247/1773 [70.3%]), radical surgeries were still performed in almost one-third of cases. Despite this aggressive surgical approach, 481 of 1423 (34%) recurred, commonly confined to the skin and mucosa (177/198 [89.4%]). By contrast, 152 of 1101 penoscrotal EMPD cases (14%) recurred, but more than one-third of these recurrences were regional or associated with distant metastases (54 of 152 [35.5%]). Perianal EMPD cases recurred in one-third of cases (74/218 [33.9%]), with one-third of these recurrences being regional or associated with distant metastasis (20 of 74 [27.0%]). Perianal EMPD also had the highest rate of invasive disease (50% of cases). Conclusions and Relevance The diagnosis and treatment of EMPD should differ based on anatomic subtypes. Considerations for updated practice may include less morbid treatments for vulvar EMPD, which is primarily epidermal, and close surveillance for local recurrence in vulvar EMPD and metastatic recurrence in perianal EMPD. Recurrences in penoscrotal subtype were less common, and selective surveillance in this subtype may be considered. Limitations of this study include the lack of replication cohorts and the exclusion of studies that did not stratify outcomes by anatomic subtype.
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Affiliation(s)
- Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Joshua L. Owen
- Dermatology Service, Audie L Murphy VA Medical Center, San Antonio, Texas
- Division of Dermatology, University of Texas Health San Antonio, San Antonio
| | | | - Jake X. Wang
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vishnu Harikumar
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sumaira Z. Aasi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Sunandana Chandra
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer N. Choi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Christos Iavazzo
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | - John Y. S. Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Naomi Lawrence
- Division of Dermatology, Cooper Hospital, Rowan University, Camden, New Jersey
| | - Mario M. Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of OB/GYN, Weill Cornell Medical College, New York, New York
| | - Allan B. MacLean
- Department of Gynaecology, University College, London, United Kingdom
| | - Jeffrey S. Ross
- Departments of Pathology and Urology, Upstate Medical University, Syracuse, New York
- Medical Director, Foundation Medicine, Inc, Boston, Massachusetts
| | - Anthony M. Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sabah Servaes
- Department of Radiology, West Virginia University Children’s Hospital, Charleston, West Virginia
| | - Michael J. Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Murad Alam
- Department of Dermatology, Ehime University, To-on, Japan
- Department of Otolaryngology–Head and Neck Surgery and Surgery (Organ Transplantation), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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D'Souza SL, Ravikumar G, Antony M, Tirumale R. Vulvar Lichenoid Dermatoses With Emphasis on the Distinction Between Lichen Sclerosus and Lichen Planus: A 10-Year Study. J Low Genit Tract Dis 2024; 28:189-197. [PMID: 38518217 DOI: 10.1097/lgt.0000000000000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Lichen planus (LP) and lichen sclerosus (LS) are the most common vulvar lichenoid dermatoses. The diagnostic challenges are due to site-specific variation in microscopic appearance and small-sized biopsies. Authentication of diagnostic criteria to distinguish LS and LP to uncover any resemblance or divergence in presentation of these conditions is attempted. METHODS Cases of vulvar LP and LS diagnosed between January 2012 to December 2022 were included. The clinical details included age, presenting symptoms, examination findings, and other organ involvement. Histopathological analysis of epidermal, dermal, and adnexal findings was done. RESULTS There were 28 cases of vulvar LP and 72 cases of LS, with a median age of 51 and 60 years, respectively. Depigmentation and atrophy were the major clinical features in LS, whereas ulcers/erosions and erythema were more prevalent in LP with a significantly higher incidence of oral involvement. The most diagnostic feature in LS was diffuse dermal sclerosis (76.8%) and interstitial pattern of inflammation (81.4%), whereas the characteristic features in LP cases was a lichenoid pattern of inflammation (85.7%), necrotic keratinocytes, and lymphocytic exocytosis. In 44.4% of LS, unconventional features like compact orthokeratosis, parakeratosis, thickened/wedge-shaped hypergranulosis, and sawtooth rete pegs were noted. Lichen sclerosus with lichenoid inflammation (21.4%) mimicked LP, from which it was distinguished by presence of thickened or diminished granular layer with basal melanin absence (60%) and dermal homogenization (80%). CONCLUSION Although the classical, well-established variant of LS poses no diagnostic difficulty, the unconventional variant may mimic LP. Identification of the subtle histological clues demonstrated in this study can help to arrive at the correct diagnosis.
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Affiliation(s)
| | - Gayatri Ravikumar
- Department of Pathology, St. John's Medical College, Bangalore, India
| | - Meryl Antony
- Department of Dermatology, St. John's Medical College and Hospital, Bangalore, India
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6
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Rosell Echevarría MJ, Hernández Rodríguez RA, Perez-Etchepare E, Gómez Culebras MA. Supernumerary breast in vulva. An Pediatr (Barc) 2024; 100:e15-e16. [PMID: 38575469 DOI: 10.1016/j.anpede.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/24/2020] [Indexed: 04/06/2024] Open
Affiliation(s)
- María José Rosell Echevarría
- Servicio de Cirugía Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain.
| | | | - Eduardo Perez-Etchepare
- Servicio de Cirugía Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Mario Alberto Gómez Culebras
- Servicio de Cirugía Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
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7
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Abstract
Genitourinary syndrome of menopause is a common, under-reported, and undertreated chronic progressive condition requiring long-term treatment. Hypoestrogenism in the urogenital tissues is associated with bothersome dyspareunia, vulvovaginal symptoms, overactive bladder, and frequent urinary tract infections. Vaginal hormone therapies, including vaginal estrogen and intravaginal dehydroepiandrostenedione, are safe and effective and improve symptoms and clinical findings. Systemic hormone therapy treats vulvovaginal atrophy less effectively than vaginal hormone therapies with increased stress and urge urinary incontinence. Oral ospemifene effectively treats vaginal dryness and dyspareunia. Clinicians need to ask about symptoms of genitourinary syndrome of menopause, confirm the diagnosis, and suggest appropriate treatment options.
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Affiliation(s)
- JoAnn V Pinkerton
- Department of Obstetrics and Gynecology, Division of Midlife Health, The University of Virginia Health System
| | - Monique H Vaughan
- Department of Obstetrics and Gynecology, Division of Pelvic Medicine and Reconstructive Surgery, The University of Virginia Health System, Charlottesville, Virginia
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Florida
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Lambrinoudaki I, Mili N, Augoulea A, Armeni E, Vakas P, Panoulis K, Vlahos N, Mikos T, Grimbizis G, Rodolakis A, Athanasiou S. Lower Urinary Tract Symptoms in Greek Women After Menopause: The LADY Study. Int Urogynecol J 2024; 35:627-636. [PMID: 38280043 DOI: 10.1007/s00192-024-05724-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/15/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The genitourinary syndrome of menopause (GSM), apart from symptoms related to vulvovaginal atrophy (VVA), also consists of lower urinary tract symptoms (LUTS). Based on the common embryological origin of the genital and lower urinary system, the presence of estrogen receptors, and the high prevalence of VVA and LUTS in the menopausal population, the two conditions can coexist. This study is aimed at investigating the prevalence and risk factors of LUTS in a sample of Greek peri- and postmenopausal women. METHODS Four hundred and fifty (450) women, aged 40-70 years, attending three outpatient gynecology clinics for routine examination, completed a structured interview and responded to a validated questionnaire (International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms, ICIQ-FLUTS). RESULTS Urinary urgency or frequency affected 51.6% and dysuria 43.6% of the participants. Mild urgency or frequency was described by 25.6%, moderate by 14.4%, and severe by 11.6% of the women. Mild dysuria was reported by 26.26%, moderate by 5.8%, and severe by 11.6%. Age, weight, BMI, and number of pregnancies and abortions correlated with a higher ICIQ-FLUTS score. Women with moderate/severe symptoms of VVA, such as irritation, a burning sensation, and pruritus of the vulva or vagina, had a higher ICIQ-FLUTS score than women without such symptoms (beta coefficient 2.42, CI 1.204, 3.635, p < 0.001). CONCLUSIONS Lower urinary tract symptoms are very common among peri- and postmenopausal women and are linked to symptoms of VVA. Our data support the need for prompt evaluation of women transitioning to menopause, as these symptoms compromise the quality of life.
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Affiliation(s)
- Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
| | - Nikoletta Mili
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Panagiotis Vakas
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Konstantinos Panoulis
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Themistoklis Mikos
- First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Grigorios Grimbizis
- First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Stavros Athanasiou
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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9
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Doust J, Huguenin A, Hickey M. Genitourinary Syndrome of Menopause: Does Everyone Have It? Clin Obstet Gynecol 2024; 67:4-12. [PMID: 37972946 DOI: 10.1097/grf.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
In 2014, the North American Menopause Society and the International Society for the Study of Women's Sexual Health recommended using the term genitourinary syndrome of menopause (GSM) to cover a range of genital and urinary symptoms that might be experienced during and after menopause. The term as currently defined, however, includes symptoms that may not be menopausal symptoms. The term GSM also includes "objective" measures such as vaginal pH that do not relate to symptom severity and are not priorities for clinicians or patients. We question the validity of GSM as a new syndrome and recommend the definition of the syndrome be revised to ensure it more closely reflects the symptoms attributable to menopause and the experience, difficulties, and response to treatment of those affected.
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Affiliation(s)
- Jenny Doust
- Australian Women and Girls' Health Research Centre, Faculty of Medicine, School of Public Health, University of Queensland, Herston, Queensland
| | - Annabelle Huguenin
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Parkville, Victoria, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Parkville, Victoria, Australia
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10
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Diem SJ, Danan ER. GSM and Quality of Life Measures. Clin Obstet Gynecol 2024; 67:58-67. [PMID: 37972951 DOI: 10.1097/grf.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The impact of bothersome vulvovaginal symptoms related to hypoestrogenism on quality of life (QOL) has been evaluated in large international surveys and qualitative studies of vulvovaginal atrophy, most of which were completed before the introduction of the term genitourinary syndrome of menopause (GSM) and focus primarily on vulvovaginal atrophy. The QOL domain most affected in these studies is sexual function, although women also report impacts on self-confidence, self-esteem, sleep, and general enjoyment of life. Health-related QOL measures are available that evaluate the impact of some symptoms associated with GSM on QOL; new measures are in development that assess the full range of symptoms associated with GSM.
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Affiliation(s)
- Susan J Diem
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Elisheva R Danan
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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11
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Barrios M, Perez NE, Briski LM, Pluguez-Turull C. Recurrent ectopic primary breast adenocarcinoma of the vulva with a 19-year follow-up period. BMJ Case Rep 2024; 17:e257791. [PMID: 38367988 PMCID: PMC10875544 DOI: 10.1136/bcr-2023-257791] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
We present a case of an ectopic breast adenocarcinoma of the vulva with metastatic local recurrence and a total follow-up period of 19 years, the longest documented in the literature to our knowledge. Following surgical excision, radiation therapy and hormonal treatment after the recurrence, the patient has remained disease free. This case demonstrates the potential for malignant transformation in accessory breast tissue and highlights the importance of close surveillance and regular physical examinations in patients with a history of ectopic breast malignancy.
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Affiliation(s)
- Mirelys Barrios
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nathalie E Perez
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laurence M Briski
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cedric Pluguez-Turull
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
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12
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Bahadur A, Mundhra R, Heda A, Singh A. Large vulvar fibroepithelial polyp and review of differentials. BMJ Case Rep 2024; 17:e259389. [PMID: 38355212 PMCID: PMC10868316 DOI: 10.1136/bcr-2023-259389] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Vulval fibroepithelial polyps (FEPs) are a rare type of vulval fibroblastic tumour commonly found in premenopausal women. It is important to obtain an accurate pathological diagnosis because, despite being benign, the condition shares some characteristics with malignant vulva lesions in its differential diagnosis. We present a case of young woman in her 20s with a giant FEP. After surgical excision, the patient did not manifest any signs of recurrence after 1-year follow-up. Our review focuses on the distinguishing characteristics of these rare neoplasms as we explore their differential diagnosis.
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Affiliation(s)
- Anupama Bahadur
- Obstetrics and Gynaecology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, Uttarakhand, India
| | - Rajlaxmi Mundhra
- Obstetrics and Gynaecology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, Uttarakhand, India
| | - Ayush Heda
- Obstetrics and Gynaecology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, Uttarakhand, India
| | - Ashok Singh
- Pathology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, Uttarakhand, India
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13
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Vilela CL, de Lima Faria GE, Boggio RF. Treatment of Atrophy of the Labia Majora: Calcium Hydroxyapatite or Hyaluronic Acid? Aesthetic Plast Surg 2024; 48:472-477. [PMID: 37673803 DOI: 10.1007/s00266-023-03617-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE The study aimed to evaluate and compare the efficacy and safety of treating atrophied labia majora with hyaluronic acid (HA) and calcium hydroxyapatite (CaHA). METHODS Ten participants complaining of sagging or loss of volume in the labia majora were evaluated and randomly assigned to two groups-treated with CaHA or AH. Photographic documentation was taken and appreciated by the participants and by blind observers. RESULTS The study showed an improvement in labia majora regarding volumization and flaccidity that was more significant after 90 days of treatment in both treatments. Besides flaccidity, volume replacement resulted in better balance and proportion between the labia majora and labia minora. The evaluators, independent and blind, judged that in 80% of the cases of the HA group and in 50% of cases of the CaHA group, there was an excellent improvement. CONCLUSION CaHA and HA are both effective and safe for treating the intimate region, and this study cannot prove the superiority of one over the other. An appropriate assessment involving the analysis of sagging and/or volume loss and the creation of a sequential treatment protocol, involving CaHA and HA, seems to be the best solution. LEVEL OF EVIDENCE I Evidence obtained from at least one properly designed randomized controlled trial. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Clarissa Lima Vilela
- Instituto Boggio - Medicina, ensino e pesquisa, Rua Cincinato Braga, 37, 8°Andar Bela Vista, São Paulo, SP, CEP 04004-030, Brazil
| | | | - Ricardo Frota Boggio
- Instituto Boggio - Medicina, ensino e pesquisa, Rua Cincinato Braga, 37, 8°Andar Bela Vista, São Paulo, SP, CEP 04004-030, Brazil
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14
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Warmke LM, Mustafa A, Zou YS, Davis JL, Ulbright TM, Segura SE. Myxoid epithelioid smooth muscle tumor of the vulva: A distinct entity with MEF2D::NCOA2 gene fusion. Genes Chromosomes Cancer 2024; 63:e23209. [PMID: 37870842 DOI: 10.1002/gcc.23209] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023] Open
Abstract
Smooth muscle tumors are the most common mesenchymal tumors of the female genital tract, including the vulva. Since vulvar smooth muscle tumors are rare, our understanding of them compared to their uterine counterparts continues to evolve. Herein, we present two cases of morphologically distinct myxoid epithelioid smooth muscle tumors of the vulva with novel MEF2D::NCOA2 gene fusion. The tumors involved 24 and 37-year-old women. Both tumors presented as palpable vulvar masses that were circumscribed, measuring 2.8 and 5.1 cm in greatest dimension. Histologically, they were composed of epithelioid to spindle-shaped cells with minimal cytologic atypia and prominent myxoid matrix. Rare mitotic figures were present (1-3 mitotic figures per 10 high-power field (HPF)), and no areas of tumor necrosis were identified. By immunohistochemistry, the neoplastic cells strongly expressed smooth muscle actin, calponin, and desmin, confirming smooth muscle origin. Next-generation sequencing identified identical MEF2D::NCOA2 gene fusions. These two cases demonstrate that at least a subset of myxoid epithelioid smooth muscle tumors of the vulva represent a distinct entity characterized by a novel MEF2D::NCOA2 gene fusion. Importantly, recognition of the distinct morphologic and genetic features of these tumors is key to understanding the biological potential of these rare tumors.
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Affiliation(s)
- Laura M Warmke
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amin Mustafa
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ying S Zou
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jessica L Davis
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas M Ulbright
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sheila E Segura
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Dongre HN, Elnour R, Tornaas S, Fromreide S, Thomsen LCV, Kolseth IBM, Nginamau ES, Johannessen AC, Vintermyr OK, Costea DE, Bjørge L. TP53 mutation and human papilloma virus status as independent prognostic factors in a Norwegian cohort of vulva squamous cell carcinoma. Acta Obstet Gynecol Scand 2024; 103:165-175. [PMID: 37840151 PMCID: PMC10755123 DOI: 10.1111/aogs.14689] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Vulva squamous cell carcinoma (VSCC) develops through two separate molecular pathways-one involving high-risk human papilloma virus infection (HPV-associated), and the other without HPV infection (HPV-independent) often involving TP53 mutation. HPV-associated VSCC generally has a better progression-free survival than HPV-independent VSCC. The aim of this study was to determine TP53 mutation status using immunohistochemistry, compare different methods of HPV detection and correlate both with survival in a retrospective cohort of 123 patients with VSCC. MATERIAL AND METHODS Immunohistochemistry for p53, Ki67 and p16INK4A (a surrogate marker for HPV infection) was performed on formalin-fixed paraffin-embedded tissues from a cohort of surgically treated VSCC patients to identify molecular subtypes of VSCC. Presence of HPV infection was detected by HPV DNA PCR and HPV mRNA in situ hybridization (ISH). The Pearson chi-square test and multivariable Cox regression model were used to investigate the association of different parameters with progression-free survival and disease-specific survival (DSS), and Kaplan-Meier curves were used to show the association of different parameters with survival. RESULTS The results of p53 and p16INK4A immunohistochemistry confirmed three VSCC subtypes associated with different prognosis. The TP53 mutation status was identified as an independent prognostic factor of worse progression-free survival (p = 0.024) after adjustment for FIGO stage. p16INK4A immunohistochemistry, mRNA ISH, and DNA PCR had excellent concordance in terms of HPV detection. According to the multivariable Cox regression model, the presence of hrHPV mRNA correlated significantly with increased progression-free survival (p = 0.040) and DSS (p = 0.045), after adjustment for other confounders. CONCLUSIONS p53 and p16INK4A immunohistochemistry stratify VSCC cohort into three subtypes with TP53mutated patients having the worst prognosis. The detection of hrHPV mRNA by ISH was an independent predictor of increased survival. Thus, the combined detection of p53 and HPV mRNA might improve risk stratification in VSCC.
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Affiliation(s)
- Harsh Nitin Dongre
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Rammah Elnour
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Stian Tornaas
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Siren Fromreide
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Liv Cecilie Vestrheim Thomsen
- Center for Cancer Biomarkers CCBIO, Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
| | | | | | - Anne Christine Johannessen
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of Pathology, Laboratory ClinicHaukeland University HospitalBergenNorway
| | - Olav Karsten Vintermyr
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of Pathology, Laboratory ClinicHaukeland University HospitalBergenNorway
| | - Daniela Elena Costea
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of Pathology, Laboratory ClinicHaukeland University HospitalBergenNorway
| | - Line Bjørge
- Center for Cancer Biomarkers CCBIO, Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
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16
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Calhau A, Salgueiro Neto R, Leiria Gomes R, Freitas T, Oliveira I. Unusual Presentation of Lymphangioma Circumscriptum of the Vulva: In Association With Crohn Disease. J Low Genit Tract Dis 2024; 28:113-115. [PMID: 38117567 DOI: 10.1097/lgt.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
ABSTRACT Lymphangioma circumscriptum (LC) is a rare benign condition, with marked dilation of surface lymphatic vessels in the deep and subcutaneous layers. Vulvar LC can become a highly disabling condition with vulvar discomfort, itching, burning and lymph seeping being the dominant symptoms. Biopsy is mandatory for the diagnosis. There is no consensus on the standard treatment for vulvar LC and recurrence is frequent. In complex cases with wide disease location, combination of different treatment options, such as abrasive methods and surgery, may lead to the best clinical and aesthetical result, with extended disease-free periods. We present a patient with a long history of Crohn disease with multiple pelvic surgeries who developed an extensive vulvar LC.
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Affiliation(s)
- Ana Calhau
- Gynecology and Obstetrics Unit of Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Madeira Island, Portugal
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17
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Bagwell K, Mohamed K, Benrubi D, Omman R. Syringocystadenoma Papilliferum of the Vulva: An Extremely Rare Vulvar Tumor. J Low Genit Tract Dis 2024; 28:107-109. [PMID: 38117566 DOI: 10.1097/lgt.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
| | - Khaled Mohamed
- Department of Pathology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | | | - Reeba Omman
- Department of Pathology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
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18
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Barcellini A, Golia D'Augè T, Mandato VD, Cuccu I, Musella A, Fruscio R, Vitale MG, Martinello R, Mangili G, Pignata S, Palaia I. Primary neuroendocrine neoplasms of the vulva: A review of the MITO rare cancer group. Crit Rev Oncol Hematol 2024; 193:104201. [PMID: 37977312 DOI: 10.1016/j.critrevonc.2023.104201] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
Gynecological neuroendocrine neoplasms are rare entities and can be divided into two groups: carcinoids and neuroendocrine carcinomas. Due to their rarity their management is not standardized. The aim of this work is to summarize and discuss the current literature evidence on this pathology. A scoping literature review was performed in multiple databases. Thirty-one studies were included: 30 case reports and one case series. Patients' age ranged between 28 and 92 years. Surgery was the most used treatment and the surgical approach included local excision (N = 16/31; 51.6%) with (N = 5/16; 31.25%) or without (N = 11/16; 68.75%) inguinal lymphadenectomy. Adjuvant radiotherapy was delivered in 12 (38.7%) cases; instead, platinum-based therapies were frequently used when chemotherapy was chosen for adjuvant treatment. The overall survival ranged between 20 days to 4 years. However, further research is needed; currently, multimodal approach including surgery, chemotherapy and radiotherapy appeared safe and feasible for the treatment of these rare and aggressive diseases.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Tullio Golia D'Augè
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
| | - Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Angela Musella
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Robert Fruscio
- University of Milan Bicocca, IRCCS San Gerardo, Monza, Italy
| | - Maria Giuseppa Vitale
- Department of Oncology and Hematology, University Hospital of Modena, 41100 Modena, Italy
| | - Ruby Martinello
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Italy
| | - Giorgia Mangili
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, IRCCS Milan, Italy
| | - Sandro Pignata
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
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19
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Smet C, Martins AC, Costa T. Deep (aggressive) angiomyxoma of the vulva in a pregnant woman. BMJ Case Rep 2023; 16:e254564. [PMID: 38129079 DOI: 10.1136/bcr-2023-254564] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Aggressive angiomyxoma is a rare mesenchymal tumour, which usually appears in the pelvic region of women in their reproductive age. Although benign, it is a locally infiltrative tumour with frequent recurrence. We report a case of a pregnant woman in her 30s with a vulvar aggressive angiomyxoma which was initially misdiagnosed. Features of this case are discussed, highlighting the difficulty in its diagnosis and the challenge of the follow-up and treatment of recurrences.
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Affiliation(s)
- Carolina Smet
- Obstetrics and Gynecology department, Centro Hospitalar de Lisboa Ocidental - Hospital de São Francisco Xavier, Lisboa, Portugal
| | - Ana Constâncio Martins
- Obstetrics and Gynecology department, Centro Hospitalar de Lisboa Ocidental - Hospital de São Francisco Xavier, Lisboa, Portugal
| | - Teresa Costa
- Pathological anatomy and cytology, Centro Hospitalar de Lisboa Ocidental - Hospital de Egas Moniz, Lisboa, Portugal
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20
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Cancelo MJ, Sánchez Borrego R, Palacios S, Baquedano L, Corbacho Garza T, Fernández Aller N, García Ferreiro C, Quijano Martín JJ, González Calvo AJ. Vulvovaginal atrophy in the CRETA study: the healthcare professionals' perception. Gynecol Endocrinol 2023; 39:2264405. [PMID: 37811796 DOI: 10.1080/09513590.2023.2264405] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES The objective is to assess the perception of gynecologists regarding patients' adherence to vulvovaginal atrophy (VVA) treatments, to evaluate the gynecologists' opinions on what their patients think about treatment adherence, and to compare the gynecologists' opinions with the patients' own perceptions within the CRETA study. METHODS Spanish gynecologists who participated in the CRETA study were asked to fill out an online 41-item questionnaire to evaluate their views on VVA management. RESULTS From 29 centers across Spain, 44 gynecologists completed the survey. Their mean age was 47.2 years old, two-thirds of them were women, and the average professional experience was over 20 years. According to the gynecologists, the therapy most frequently used by VVA-diagnosed women was vaginal moisturizers (45.5%), followed by local estrogen therapy (36.4%) and ospemifene (18.2%). Nevertheless, ospemifene was viewed as the therapeutic option with the most efficacy, easiest route of administration, shorter time to symptom improvement, lower percentage of dropouts, and higher treatment adherence. CONCLUSIONS Spanish gynecologists are in general agreement with their patients regarding VVA treatment preferences and the main issues for adherence and effectiveness. However, there is an opportunity for doctor-patient communication improvement. Among the three therapeutic options evaluated, ospemifene is regarded as offering some competitive advantages.
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Affiliation(s)
- María J Cancelo
- Department of Obstetrics and Gynecology, University Hospital of Guadalajara, Guadalajara, Alcalá University, Spain
| | | | - Santiago Palacios
- Department of Obstetrics and Gynecology, Palacios Institute of Women's Health, Madrid, Spain
| | - Laura Baquedano
- Department of Gynecology, University Hospital Miguel Servet, Zaragoza Health Research Institute of Aragon (IISA), Zaragoza, Spain
| | - Tanit Corbacho Garza
- Department of Obstetrics and Gynecology, Quiron Salud Hospital, Torrevieja, Alicante, Spain
| | - Noelia Fernández Aller
- Department of Obstetrics and Gynecology, Gynecologic Center of León, HM San Francisco, León, Spain
| | - Carmen García Ferreiro
- Department of Obstetrics and Gynecology, Gynecologic Center of León, HM San Francisco, León, Spain
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21
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Mahjabin F, Ordulu Z, Martinez-Duarte E, Falzarano SM. Sebaceous differentiation can occur in vulvar adenoid cystic carcinoma. Int J Gynecol Cancer 2023; 33:1830-1832. [PMID: 37419516 DOI: 10.1136/ijgc-2023-004323] [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] [Indexed: 07/09/2023] Open
Affiliation(s)
- Fnu Mahjabin
- Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Zehra Ordulu
- Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Ernesto Martinez-Duarte
- Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Sara Moscovita Falzarano
- Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
- UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
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22
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Ouedraogo AS, Ido FAHA, Savadogo I, Ouattara S, Ouedraogo RA, Ouedraogo AS, Sanou-Lamien A, Lompo OM. [Primary melanoma of female urethra: A case diagnosed in Ouagadougou]. Ann Pathol 2023; 43:491-494. [PMID: 37716866 DOI: 10.1016/j.annpat.2023.08.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/29/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
We report a case of primary melanoma of a female urethra diagnosed at a non-metastatic stage in a 48-year-old patient with a history of breast carcinoma treated with radiotherapy and hormone therapy. The patient was consulting for dysuria, hematuria, and perineal pain. The clinical examination found a prolapsed and black mass, developed at the expense of the urethra and located at the anterosuperior part of the vulva. The mass biopsy revealed a proliferation of fusiform and globular cells loaded with black pigment expressing the anti-HMB 45 and PS 100 antibodies. The extension assessment showed an absence of secondary localization. The patient underwent total cystourethrectomy without inguinal lymphadenectomy. There was no recurrence observed on day 100 following the surgery.
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Affiliation(s)
- Aimé Sosthène Ouedraogo
- Service d'anatomie pathologique, CHU de Bogodogo, Ouagadougou, Burkina Faso; UFR/SDS université Joseph KI-ZERBO, Ouagadougou, Burkina Faso.
| | | | - Ibrahim Savadogo
- Service d'anatomie pathologique, CHUR de Ouahigouya, Ouahigouya, Burkina Faso
| | - Souleymane Ouattara
- Service d'anatomie pathologique, CHU de Tingandogo, Ouagadougou, Burkina Faso
| | - Rakiswendé Alexis Ouedraogo
- UFR/SDS université Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Service d'histologie embryologie, cytogénétique et biologie de la reproduction, Ouagadougou, Burkina Faso
| | | | - Assita Sanou-Lamien
- UFR/SDS université Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Service d'anatomie pathologique, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Olga M Lompo
- UFR/SDS université Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Service d'anatomie pathologique, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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23
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Cho A, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Park JY. Outcomes and prognostic factors of surgically treated extramammary Paget's disease of the vulva. J Gynecol Oncol 2023; 34:e76. [PMID: 37477099 PMCID: PMC10627755 DOI: 10.3802/jgo.2023.34.e76] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/11/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE Extramammary Paget's disease (EMPD) of the vulva is a rare disease which predominantly presents in postmenopausal Caucasian women. As yet, no studies on Asian female patients with EMPD have been performed. This study aimed to identify the clinical features of patients with vulvar EMPD in Korea, and to evaluate the risk factors of recurrence and postoperative complications in surgically treated EMPD. METHODS We retrospectively reviewed 47 patients with vulvar EMPD who underwent wide local excision or radical vulvectomy. The clinical data and surgical and oncological outcomes following surgery were extracted from medical records and analyzed. Univariate and multivariate analyses for predicting recurrence and postoperative complications were performed. RESULTS 21.3% of patients had complications after surgery, and wound dehiscence was the most common. 14.9% of patients experienced recurrence, and the median interval to recurrence from initial treatment was 69 (range 33-169) months. Vulvar lesions larger than 40 mm was the independent risk factor of postoperative complications (odds ratio [OR]=7.259; 95% confidence interval [CI]=1.545-34.100; p=0.012). Surgical margin status was not associated with recurrence in surgically treated vulvar EMPD patients (OR=0.83; 95% CI=0.16-4.19; p=1.000). CONCLUSION Positive surgical margin is a frequent finding in the patients with vulvar EMPD, but disease recurrence is not related with surgical margin status. Since EMPD is a slow growing tumor, a surveillance period longer than 5 years is required.
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Affiliation(s)
- Angela Cho
- Department of Obstetrics and Gynecology, Jeju University Hospital, Jeju, Korea
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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24
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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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25
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Wadia R, McHenry A, Abi-Raad R, Hui P. TP53 Mutation-driven Stratified Mucin-producing Carcinoma Coexisting With Squamous Cell Carcinoma of the Vulva: A Case Study. Int J Gynecol Pathol 2023; 42:555-560. [PMID: 37255422 DOI: 10.1097/pgp.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Associated with high-risk human papillomavirus infection, invasive stratified mucin-producing carcinoma is a recently characterized adenocarcinoma of the cervix. It often occurs in association with adjacent stratified mucin-producing intraepithelial lesion. Differentiated vulvar intraepithelial neoplasia and related invasive squamous cell carcinoma often arise in background vulvar lichen sclerosus with TP53 mutation as the underlying molecular signature. We present a unique case of vulvar invasive stratified mucin-producing carcinoma-like component coexisting with invasive squamous cell carcinoma in a 64-year-old woman. Both neoplastic components were proven TP53 -driven processes arising in the background of differentiated vulvar intraepithelial neoplasia and lichen sclerosus. The invasive stratified mucin-producing carcinoma-like component behaved aggressively in this case, evidenced by the presence of lymphovascular invasion and inguinal lymph node metastasis.
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Affiliation(s)
- Roxanne Wadia
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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An Y, Liu L, Wu R, Mu Q. Vulva involvement of metastatic Crohn's disease: A rare and easily ignored clinical finding. Asian J Surg 2023; 46:4846-4847. [PMID: 37328372 DOI: 10.1016/j.asjsur.2023.05.132] [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: 05/13/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Yuepan An
- Department of Gynaecology, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, 010020, China
| | - Li Liu
- Department of Dermatology, International Mongolian Hospital of Inner Mongolia, Hohhot, 010020, China
| | - Rina Wu
- Department of Dermatology, International Mongolian Hospital of Inner Mongolia, Hohhot, 010020, China
| | - Qiri Mu
- Department of Dermatology, International Mongolian Hospital of Inner Mongolia, Hohhot, 010020, China.
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Gallardo M, Chung CG, Kaffenberger B. Tender Nodular Lesions in the Axilla and Vulva. Cutis 2023; 112:E20-E22. [PMID: 37988299 DOI: 10.12788/cutis.0880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Matthew Gallardo
- The Ohio State University Wexner Medical Center, Columbus. Matthew Gallardo is from the College of Medicine. Drs. Chung and Kaffenberger are from the Department of Dermatology. Dr. Chung also is from the Department of Pathology
| | - Catherine G Chung
- The Ohio State University Wexner Medical Center, Columbus. Matthew Gallardo is from the College of Medicine. Drs. Chung and Kaffenberger are from the Department of Dermatology. Dr. Chung also is from the Department of Pathology
| | - Benjamin Kaffenberger
- The Ohio State University Wexner Medical Center, Columbus. Matthew Gallardo is from the College of Medicine. Drs. Chung and Kaffenberger are from the Department of Dermatology. Dr. Chung also is from the Department of Pathology
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Boero V, Brambilla M, Di Loreto E, Cetera GE, Cipriani S, Boggio F, Monti E, Libutti G, Caia C, Parazzini F. Fat Grafting in Vulvar Lichen Sclerosus: Long Term Follow-Up. J Low Genit Tract Dis 2023; 27:365-372. [PMID: 37551790 DOI: 10.1097/lgt.0000000000000766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The rationale for the use of autologous fat grafting in the treatment of vulvar lichen sclerosus (VLS) consists in reduction of inflammation, regeneration of tissues, volume increase, and pain fiber control. The main outcome of this study was the evaluation of patients' satisfaction after treatment. Secondary outcomes included modifications in symptoms, psychosexual wellbeing, vulvar hydration, and histology after surgery. METHODS Eligible for this study were women aged 18-85 years with a histological diagnosis of VLS who underwent at least one autologous vulvar fat grafting at the authors' center, between 2010 and 2019. In 2021, all women underwent a clinical reevaluation, comprehensive of vulvoscopy, vulvar biopsy, and handing out of validated questionnaires. RESULTS Overall, 88.7% of patients declared themselves very satisfied/satisfied with the procedure. All symptoms were improved postsurgery; in particular, the difference was statistically significant for pruritus, burning, and dyspareunia ( p < .05). Sexual function was also improved at time of reevaluation, as were depressive and anxiety symptoms ( p < .05). No cases of vulvar intraepithelial neoplasia or cancer occurred during follow-up and vulvar architecture remained stable, although patients reported a significantly reduced need for topical steroids ( p < .0001). Lastly, in postoperative biopsies, inflammatory infiltrate was stable or reduced, and the distribution of elastic fibers was comparable or restored in most patients. CONCLUSIONS Patient satisfaction with fat grafting is detectable up to 11 years after surgery, and as such, it may represent a valid therapeutic option in selected cases of VLS.
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Affiliation(s)
- Veronica Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Service, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Sonia Cipriani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Francesca Boggio
- Department of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Ermelinda Monti
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Giada Libutti
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milan, Italy
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Wong J, Pina A, Mayrand MH, Rahimi K. Pagetoid Squamous Intraepithelial Neoplasia of the Vulva as a Mimicker of Vulvar Extramammary Paget Disease: Two Cases with Basal Layer Sparing. Int J Surg Pathol 2023; 31:1302-1307. [PMID: 36476167 PMCID: PMC10557358 DOI: 10.1177/10668969221137527] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/03/2022] [Accepted: 10/19/2022] [Indexed: 10/06/2023]
Abstract
Human papillomavirus-associated vulvar intraepithelial neoplasia (high-grade squamous intraepithelial neoplasia [HSIL] or VIN of usual type) is a lesion characterized by atypia extending from the basal layer to the upper epidermis. There are only rare reports of vulvar intraepithelial morphology exhibiting a pagetoid pattern of intraepithelial dissemination. We herein report two cases of vulvar HSIL in which a pagetoid pattern of spread and a largely uninvolved basal layer represented a diagnostic pitfall for extramammary Paget disease. Nuclear atypia reminiscent of HSIL in addition to expression of p16, KRT5/6, and p40 were however in favor of pagetoid HSIL. Although there is morphological and immunohistochemical overlap between these two entities, an accurate diagnosis is important, since an erroneous diagnosis of vulvar extramammary Paget disease may lead to an extensive workup comprising radiological imaging, colonoscopy, and cystoscopy.
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Affiliation(s)
- Jahg Wong
- Department of Pathology, Université de Montréal, Montreal, Quebec, Canada
| | - Annick Pina
- Department of Gynecologic Oncology, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Hélène Mayrand
- Department of Obstetrics and Gynecology, Université de Montréal and CRCHUM, Montreal, Quebec, Canada
| | - Kurosh Rahimi
- Department of Pathology, Université de Montréal, Montreal, Quebec, Canada
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Sánchez-Borrego R, de Diego Pérez de Zabalza MV, Alfageme Gullón MJ, Alija Castrillo ML, Sánchez Prieto M, Palacios S, González Calvo AJ, Quijano Martín JJ, Cancelo MJ. Satisfaction and medication adherence in women with vulvovaginal atrophy: the CRETA. Climacteric 2023; 26:437-444. [PMID: 37017707 DOI: 10.1080/13697137.2023.2190508] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/02/2023] [Accepted: 03/07/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE This study aimed to evaluate the self-reported satisfaction of Spanish postmenopausal women currently treated for vulvovaginal atrophy (VVA) symptoms. METHODS The CRETA (CRoss sectional European sTudy on Adherence) is a multicenter cross-sectional study conducted in 29 public and private hospitals in Spain, which enrolled postmenopausal women receiving treatment with ospemifene, local hormone therapy (HT) or vaginal moisturizers for VVA. After the prior informed consent of the patients, sociodemographic and treatment perception data were collected using a structured questionnaire. RESULTS Among 752 women who completed the survey, the satisfaction score was significantly higher for the group treated with ospemifene (mean 8.3 ± 1.4) compared with the local HT group (7.2 ± 1.7) and the vaginal moisturizer group (6.5 ± 2.1) according to a 10-point Likert scale (p < 0.0001). Compared to vaginal moisturizers and local HT, participants treated with ospemifene reported the highest adherence (96.7% vs. 70.2% and 78.6%, respectively) and the lowest number of missed doses in the last month (0.6 ± 1.3 standard deviation [SD] vs. 3.5 ± 4.3 SD and 2.0 ± 2.8 SD, respectively) (p < 0.0001). Ospemifene was significantly perceived as easy to use (83.9% vs. 44.9% and 58.6%, respectively; p < 0.0001), efficacious in reducing the time to relieve symptoms (17.1% vs. 7.0% and 6.7%, p = 0.0005 and p = 0.0006, respectively) and convenient for sexual life (53.1% vs. 25.6% and 42.3%, p < 0.0001 and p = 0.0234, respectively). CONCLUSIONS Among postmenopausal women with VVA, treatment with ospemifene has the most positive perceptions and the highest overall satisfaction level and could be an optimal therapeutic approach, maximizing patient adherence.
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Affiliation(s)
- R Sánchez-Borrego
- Department of Obstetrics and Gynecology, Teknon Clinic, Barcelona, Spain
| | | | - M J Alfageme Gullón
- Department of Obstetrics and Gynecology, Hospital Quirón Torrevieja y Alicante, Alicante, Spain
| | | | - M Sánchez Prieto
- Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Barcelona, Spain
| | - S Palacios
- Department of Obstetrics and Gynecology, Palacios Institute of Women's Health, Madrid, Spain
| | | | | | - M J Cancelo
- Department of Obstetrics and Gynecology, University Hospital of Guadalajara, Guadalajara, Spain
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Ozaki Y, Tomoe H, Shimomura M, Ninomiya N, Sekiguchi Y, Sato Y, Nagao K, Takahashi Y, Takahashi S. Female sexual dysfunction and lower urinary tract symptoms associated with vulvovaginal atrophy symptoms: Results of the GENJA study. Int J Urol 2023; 30:860-865. [PMID: 37287405 DOI: 10.1111/iju.15216] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the main symptoms of female sexual dysfunction (FSD) and lower urinary tract symptoms associated with vulvovaginal atrophy (VVA) symptoms as the core symptoms of genitourinary syndrome of menopause. METHODS We extracted the data of 4134 Japanese women aged 40-79 years who participated in the GENitourinary syndrome of menopause in JApanese women (GENJA) study. All participants responded to web-based questionnaires assessing their health situation, including the Vulvovaginal Symptoms Questionnaire, the Female Sexual Function Index (FSFI), and the Core Lower Urinary Tract Symptom Score. Multivariable regression and multivariable logistic regression analyses were applied to analyze the association between VVA symptoms and FSD, and between VVA symptoms and lower urinary tract symptoms. RESULTS Multivariable regression analysis revealed that VVA symptoms were associated with lower scores for arousal, lubrication, orgasm, satisfaction, and pain domains in the FSFI in sexually active women (p < 0.01). Regression coefficients were higher for lubrication and pain domains than for the other domains. Multivariable logistic regression analysis revealed that women reporting VVA symptoms were more likely to have increased daytime urinary frequency, nocturia, urgency, slow stream, straining to void, feeling of incomplete emptying, bladder pain, and feeling a bulge/lump from or in the vagina (p < 0.05). Adjusted odds ratios were particularly high for straining to void, feeling of incomplete emptying, and bladder pain. CONCLUSIONS Vulvovaginal atrophy symptoms were significantly associated with decreased lubrication and dyspareunia in FSD, and urinary symptoms of straining to void, feeling of incomplete emptying, and bladder pain.
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Affiliation(s)
- Yumi Ozaki
- Department of Urology, Tokai Central Hospital, Gifu, Japan
| | - Hikaru Tomoe
- Department of Urology and Pelvic Reconstructive Surgery, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | | - Yoshikazu Sato
- Department of Urology, Sanjukai Hospital, Sapporo, Japan
| | - Koichi Nagao
- Department of Urology, Toho University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Thurman A, Hull L, Stuckey B, Hatheway J, Mauck C, Zack N, Friend D. Pharmacokinetics, safety and preliminary pharmacodynamic evaluation of DARE-VVA1: a soft gelatin capsule containing tamoxifen for the treatment of vulvovaginal atrophy. Climacteric 2023; 26:479-488. [PMID: 37288962 DOI: 10.1080/13697137.2023.2211763] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to measure safety, systemic pharmacokinetics and preliminary efficacy of a vaginal tamoxifen capsule (DARE-VVA1) among postmenopausal women with moderate-to-severe vulvovaginal atrophy. METHODS This was a randomized, placebo-controlled, double-blind, phase 1/2 study of DARE-VVA1, in four doses (1, 5, 10 and 20 mg). RESULTS Seventeen women were enrolled and 14 completed the 8-week treatment. DARE-VVA1 was safe. All adverse events were of mild or moderate severity and distributed similarly among active and placebo groups. Plasma tamoxifen concentrations were highest among women using DARE-VVA1 20 mg, but the maximum mean (standard deviation) plasma tamoxifen concentrations on day 1 (2.66 ± 0.85 ng/ml) and day 56 (5.69 ± 1.87 ng/ml) were <14% of those measured after one oral tamoxifen dose. Active study product users had significant decreases from pre-treatment baseline in vaginal pH and proportion of vaginal parabasal cells (p = 0.04 for both endpoints), with women randomized to the 10 mg or 20 mg dose experiencing the largest treatment impact. The severity of vaginal dryness and dyspareunia decreased significantly from baseline with active study product use (p = 0.02 for both endpoints). CONCLUSIONS DARE-VVA1 is safe and results in minimal systemic exposure to tamoxifen. Preliminary efficacy data support further development of this product.
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Affiliation(s)
- A Thurman
- Daré Bioscience, Inc., San Diego, CA, USA
| | - L Hull
- PARC Clinical Research and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - B Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, WA, Australia
| | - J Hatheway
- Daré Bioscience, Inc., San Diego, CA, USA
| | - C Mauck
- Daré Bioscience, Inc., San Diego, CA, USA
| | - N Zack
- Daré Bioscience, Inc., San Diego, CA, USA
| | - D Friend
- Daré Bioscience, Inc., San Diego, CA, USA
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Rao S, Mustari AP, Saikia UN, Sendhil Kumaran M. Grotesque vulva - a clinician's diagnostic dilemma. Int J Dermatol 2023; 62:e557-e560. [PMID: 37208995 DOI: 10.1111/ijd.16715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/12/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Sophia Rao
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akash P Mustari
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Schmidt E. A practical guide to managing genitourinary syndrome of menopause in primary care. JAAPA 2023; 36:17-23. [PMID: 37561653 DOI: 10.1097/01.jaa.0000947048.98796.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
ABSTRACT Females spend a third to half of their life in menopause, and the number of US females in menopause is growing. A high percentage of postmenopausal females experience bothersome, sometimes debilitating genitourinary symptoms, which can affect quality of life. The genitourinary syndrome of menopause (GSM) describes the condition previously referred to as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy. Of concern, many patients with symptoms of GSM have never been asked about nor have they initiated conversations about these concerns with a healthcare provider. This article addresses the need to improve screening, identification, and patient-centered management in primary care of females with GSM.
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Affiliation(s)
- Elizabeth Schmidt
- Elizabeth Schmidt is an associate professor and director of the PA program at Butler University in Indianapolis, Ind. The author has disclosed no potential conflicts of interest, financial or otherwise
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Okafor AG, Renshaw IL, Fadare O. High-grade Squamous Intraepithelial Lesion of the Vulva with Obscuring Edema: A Potential Diagnostic Pitfall in Vulvar Biopsies. Int J Surg Pathol 2023; 31:1110-1114. [PMID: 36154514 DOI: 10.1177/10668969221102553] [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] [Indexed: 11/15/2022]
Affiliation(s)
- Alozie G Okafor
- Department of Pathology, University of California San Diego, San Diego, CA, USA
| | | | - Oluwole Fadare
- Department of Pathology, University of California San Diego, San Diego, CA, USA
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Iwai Y, Fujiwara H. Fluorescence imaging of lymphangioma circumscriptum of the vulva with aminolevulinic acid and target-type narrow band ultraviolet light. Photodiagnosis Photodyn Ther 2023; 43:103671. [PMID: 37356698 DOI: 10.1016/j.pdpdt.2023.103671] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
Lymphangioma circumscriptum of the vulva is a rare lymphatic disorder. Defining the precise location of the lesion is required to select an appropriate treatment. Herein we present photodynamic diagnosis of lymphangioma circumscriptum of the vulva with aminolevulinic acid and target-type narrow band ultraviolet light device.
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Affiliation(s)
- Yuki Iwai
- Department of Dermatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minamiuonuma, Niigata 949-7302, Japan.
| | - Hiroshi Fujiwara
- Department of Dermatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minamiuonuma, Niigata 949-7302, Japan
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Kovacevic N, Cilensek I, Merlo S, Segedin B. Modern approach to the management of genitourinary syndrome in women with gynecological malignancies. Radiol Oncol 2023; 57:292-298. [PMID: 37494601 PMCID: PMC10476906 DOI: 10.2478/raon-2023-0038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The term genitourinary syndrome of menopause was first used in 2014 by the North American Menopause Society and the International Society for the Study of Women's Sexual Health to describe conditions previously known as atrophic vaginitis, urogenital atrophy, or vulvovaginal atrophy. It is a complex, chronic, progressive condition characterized by a wide range of signs and symptoms affecting sexual function and the tissues of the urinary and genital tracts. The main cause of genitourinary syndrome of menopause is estrogen deficiency caused by ovarian removal or dysfunction. The most bothersome symptoms are vaginal dryness, decreased vaginal lubrication, and pain during penetration and intercourse. They all have a negative impact on the quality of life. CONCLUSIONS The main goal of treatment is to relieve the symptoms. Treatment modalities are pharmacological or non-pharmacological. The first-line treatment for mild to moderate symptoms is the use of personal lubricants and moisturizers, but the gold standard is estrogen replacement therapy. Hormone therapy may not be an option for women with hormone-dependent cancer.
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Affiliation(s)
- Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Health Care Angela Boškin, Jesenice, Slovenia
| | - Ines Cilensek
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Segedin
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Bruce KH, Alabaster A, Tran AQM. Vulvar cancer survival by primary treatment modality: A retrospective cohort study. Gynecol Oncol 2023; 176:173-178. [PMID: 37562168 DOI: 10.1016/j.ygyno.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To compare survival and complications for women with vulvar cancer treated with primary radiation vs surgery. METHODS Retrospective cohort study of Kaiser Permanente members diagnosed with vulvar squamous cell carcinoma (SCC) between 2008 and 2018 and treated with primary surgery (PS only), surgery with adjuvant radiation (PS + RT), or primary radiation (PRT). Primary outcomes were 1- and 3-year overall (OS) and progression-free (PFS) survival. Multivariable regression adjusted for age, stage, comorbidities, and smoking. RESULTS We included 201 women: 114 PS only (56.7%), 36 PS + RT (17.9%), and 51 PRT (25.4%). PS only patients had less advanced disease. Crude 1- and 3-year OS were 96.5% and 82.6% for PS only compared to 72.2% and 48.3% for PS + RT and 72.6% and 53.9% for PRT (p < 0.001). There were no statistical differences in hazard of death when controlling for stage and other covariates (PRT vs PS only: aHR 1.35, 95% CI 0.61-2.99; PS + RT vs PS only: aHR 1.28, 95% CI 0.60-2.75; PS + RT vs PRT: aHR 0.95, CI 0.48-1.90). Older age and stage III disease were poor prognostic factors. Risk of lymphedema was elevated with PS + RT (36.1% vs 20.2% for PS only and 9.8% for PRT, p = 0.011). Wound infection was more likely in surgical groups, whereas hospital readmission and blood transfusion were more common with PRT. CONCLUSIONS Vulvar cancer survival was not statistically different among women treated with primary radiation compared to primary surgery when controlling for stage. Surgery followed by adjuvant radiation demonstrated elevated rates of lymphedema. Primary radiation therapy may be an acceptable alternative to primary surgery in women who are likely to need adjuvant therapy.
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Affiliation(s)
- Kelly H Bruce
- Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, United States of America.
| | - Amy Alabaster
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States of America
| | - Arthur-Quan M Tran
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, United States of America
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Nappi RE, Panay N, Palacios S, Banerji V, Hall G, Particco M, Atkins D. Using advanced analytics to help identify women who are more likely to have a severe subjective experience of vulvovaginal atrophy: a modeling study. Gynecol Endocrinol 2023; 39:2245479. [PMID: 37582396 DOI: 10.1080/09513590.2023.2245479] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/03/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVE To develop a model to identify women likely to be severely impacted by vulvovaginal atrophy (VVA), based on their experience of symptoms and non-clinical factors. METHODS Multivariate statistics and machine-learning algorithms were used to develop models using data from a cross-sectional, observational, multinational European survey. A set of independent variables were chosen to assess subjective VVA severity and its impact on daily activities. RESULTS A final composite model was selected that included three categories of variables: clinical severity, patient demographics/clinical characteristics and Day-to-Day Impact of Vaginal Aging (DIVA) variables related to emotion/mood, impact on lifestyle and frequency of sex. The model accurately classified 71% of women. Three DIVA variables (feeling bad about yourself, desire/interest in sex, physical comfort related to sitting) explained much of the variation in the dependent variable of the model. Over 90% of the impact of VVA relates to certain psychosocial and behavioral aspects that can be identified without the need to consider physical signs/symptoms. CONCLUSION Non-clinical factors can contribute significantly to the overall VVA burden.Questions used in developing the composite model could form the basis of an instrument to help screen women prior to clinical consultation and improve VVA management.
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Affiliation(s)
- Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- Research Center of Reproductive Medicine, Unit of Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Nicholas Panay
- Queen Charlotte's & Chelsea and Westminster Hospitals, Imperial College London, UK International Centre for Hormone Health, London, UK
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Wasserman MC, Rubin RS. Urologic view in the management of genitourinary syndrome of menopause. Climacteric 2023; 26:329-335. [PMID: 37104711 DOI: 10.1080/13697137.2023.2202811] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Genitourinary syndrome of menopause (GSM) has a variety of effects on the urinary system and is an important consideration in the care provided to perimenopausal and postmenopausal patients when addressing urinary pathology. Here we discuss the common pathologies of the urinary system related to GSM including lower urinary tract symptoms and recurrent urinary tract infections. Female sexual dysfunction is not to be excluded as a critical part of a urologist's management of GSM but will be discussed elsewhere in this issue.
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Affiliation(s)
- M C Wasserman
- Female Pelvic Medicine and Reconstructive Surgery, NYU Langone Health, New York, NY, USA
| | - R S Rubin
- Department of Urology, Georgetown University Hospital, Washington DC, USA
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Pyle HJ, Evans JC, Vandergriff TW, Mauskar MM. Vulvar Lichen Sclerosus Clinical Severity Scales and Histopathologic Correlation: A Case Series. Am J Dermatopathol 2023; 45:588-592. [PMID: 37462209 DOI: 10.1097/dad.0000000000002471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
ABSTRACT Several vulvar lichen sclerosus (VLS) clinical severity scales have recently been proposed. In this prospective case series, we characterized histopathology in the context of clinical severity in 6 treatment-naïve postmenopausal patients with VLS. The Vulvar Quality of Life Index (VQLI) and an adaptation of the 2018 International Society for the Study of Vulvovaginal Disease Delphi consensus VLS severity score were administered. Vulvar skin punch biopsies were obtained to measure inflammatory density, constituent inflammatory cells, thickness of the stratum corneum and other epidermal layers, dermal edema, and dermal sclerosis. Clinicopathologic correlations were assessed. Two cases demonstrated sparse inflammatory densities, 1 case demonstrated patchy and nodular inflammatory density, 1 case demonstrated dense lichenoid inflammatory density, and 2 cases demonstrated dense lichenoid and epitheliotropic inflammatory densities. Those patients who reported severe pruritus demonstrated the greatest lymphocytic inflammatory densities on histopathological examination. Both cases of ulceration or erosion were associated with severe VQLI scores. Severe VQLI scores were also associated with trends for higher average thickness of the epidermal layers and of dermal sclerosis. Altogether, histopathologic grading of biopsy sites may reflect clinical severity in patients with VLS.
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Affiliation(s)
- Hunter J Pyle
- Departments of Dermatology; Pathology; and Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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Aminimoghaddam S, Sarchami N, Mahboub SS. Second recurrence of aggressive vulvar angiomyxoma: a case report. J Int Med Res 2023; 51:3000605231189366. [PMID: 37551697 PMCID: PMC10411273 DOI: 10.1177/03000605231189366] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023] Open
Abstract
Aggressive angiomyxoma is a rare benign tumor with diverse clinical and radiologic presentations, making its differential diagnosis challenging. Here we report the second recurrence of an aggressive angiomyxoma of the vulva in a 33-year-old woman who presented with pain and swelling. Clinical examination revealed a well-circumscribed large palpable mass extending from the inferior part of the right labia major into the right side of the gluteus. A second recurrence of aggressive angiomyxoma was suspected based on the patient's history, clinical examination, and magnetic resonance imaging report, and the patient underwent surgical resection with a negative margin. Histological evaluation of the extracted lesion confirmed the diagnosis of aggressive angiomyxoma. At the 1-year follow-up, the patient was recurrence-free. The present report urges more awareness regarding the aggressiveness of angiomyxoma of the vulva. Closer attention should be given to margin-free removal of such tumors, and patients should be routinely followed up for at least 2 years postoperatively for early diagnosis of recurrence, thereby reducing the risk of morbidity.
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Affiliation(s)
- Soheila Aminimoghaddam
- Department of Obstetrics and Gynecology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Sarchami
- Department of Obstetrics and Gynecology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sarah Sadat Mahboub
- Department of Obstetrics and Gynecology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Mitchell CM, Larson JC, Reed SD, Guthrie KA. The complexity of genitourinary syndrome of menopause: number, severity, and frequency of vulvovaginal discomfort symptoms in women enrolled in a randomized trial evaluating treatment for genitourinary syndrome of menopause. Menopause 2023; 30:791-797. [PMID: 37402281 PMCID: PMC10472975 DOI: 10.1097/gme.0000000000002212] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
OBJECTIVE The aim of the study is to describe the location, severity, and frequency of genitourinary symptoms in postmenopausal women enrolled in a randomized trial of treatment for vulvovaginal discomfort. METHODS This is a post hoc analysis of enrollment responses for participants in the MsFLASH Vaginal Health Trial. Participants were asked about the severity (0-3), frequency (in days per week) and location (vulvar or vaginal) of itch, dryness, pain/soreness, irritation, as well as severity and frequency of pain with penetration, vaginal discharge, urinary incontinence, and urinary urgency. RESULTS A total of 302 participants were enrolled, with a mean age of 60.9 ± 4.1 years. The mean number of moderate-severe vulvovaginal symptoms experienced by trial participants in the month before enrollment was 3.4 ± 1.5, with a range from 1 to 7. The most commonly reported symptom across all severity categories was vaginal dryness (285/302, 94%), but the one most frequently rated as severe was pain with vaginal penetration (121/302, 40%). Vaginal dryness was the symptom with highest frequency; 53% of participants with that symptom reported experiencing it ≥4 d/wk. For vaginal symptoms, 80% of participants (241/302) reported that at least one of these symptoms occurred during or after sex while only 43% (158/302) reported that at least one vulvar symptom occurred during or after sex. Urinary incontinence (202/302, 67%) and urinary frequency (128/302, 43%) were the two most commonly reported urinary issues. CONCLUSIONS Our data highlight the complexity of genitourinary syndrome of menopause symptoms in quantity, severity, and frequency, suggesting that measuring distress, bother, or interference may be the most comprehensive measure.
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Affiliation(s)
- Caroline M Mitchell
- From the Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Joseph C Larson
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA
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Ogata D, Nishio S, Hatta N, Kaji T, Fujii K, Mikami M, Kiyohara Y, Enomoto T. Clinicopathological demographics of malignant melanomas of the vulva and vagina in Japan. Melanoma Res 2023; 33:300-308. [PMID: 37162526 PMCID: PMC10309107 DOI: 10.1097/cmr.0000000000000894] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/25/2023] [Indexed: 05/11/2023]
Abstract
Malignant vulvar melanoma (VuM) and vaginal melanoma (VaM) represent a unique subgroup of rare malignant melanomas with critical biological properties that differ from other cancers. In Japan, adequate surveys have yet to be conducted. This study aimed to elucidate the clinicopathological demographics and outcomes of VuM and VaM in Japan. This retrospective observational study included women with invasive VuM or VaM identified from older medical records in Japan. We collected clinical data and used the Kaplan-Meier method to analyze progression-free survival (PFS) and overall survival (OS). Univariate and multivariate regression models were used to identify factors significantly related to survival. We identified 217 patients, 109 (50.2%) with VuM and 108 (49.8%) with VaM. The median PFS was 16.8 months in patients with VuM [95% confidence interval (CI), 23.1-87.7] and 15.6 months in those with VaM (95% CI, 8.4-12.6). The median OS was 43.9 months (95% CI, 60-138) and 31.1 months (95% CI, 24.8-45.3) in patients with VuM and VaM, respectively. Multivariate analysis showed that a disease stage higher than stage III, based on the American Joint Committee on Cancer (AJCC) guidelines, was associated with poorer PFS [hazard ratio (HR), 2.063; 95% CI, 0.995-4.278] and an unknown surgical margin was the only independent factor influencing OS (HR, 2.188; 95% CI, 1.203-3.977). The overall outcomes of invasive VuM and VaM in Japan remain poor. AJCC staging and surgical margins were significant predictors of survival.
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Affiliation(s)
- Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka
| | - Naohito Hatta
- Department of Dermatology, Toyama Prefectural Central Hospital, Toyama
| | - Tatsuya Kaji
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kanagawa
| | - Kazuyasu Fujii
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University Hospital, Kanagawa
| | | | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan
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Elshennawy RA, Aird C, Boyle W, Yap J, Williams A, Ganesan R. Nonsquamous Malignancies of Vagina and Vulva: 23-Year Experience at a Tertiary Center in the United Kingdom. Int J Gynecol Pathol 2023; 42:327-337. [PMID: 36731045 DOI: 10.1097/pgp.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Under 10% of gynaecological cancers are diagnosed in the vulva and vagina, mostly squamous cell carcinomas. Melanoma, Paget disease, basal cell carcinomas, and other cancers can present with vulval/vaginal symptoms. The pathology information system of a tertiary referral center for vulvo-vaginal cancers was searched for cancers of the vulva and vagina from 1996 to 2019. Squamous carcinomas were excluded, and the remaining entities were catalogued. A total of 221 nonsquamous cancers were found, including 135 vaginal and 86 vulval cases. One hundred eight cases of metastatic carcinomas from the endometrium, cervix, ovary, bowel, bladder, kidney, and breast formed the largest category. Basal cell carcinomas constituted the second largest category. Others included melanomas, Paget disease, and adenoid cystic carcinomas. Primary adenocarcinomas included porocarcinoma, mammary type carcinoma, enteric type carcinoma, clear cell carcinoma, Bartholin gland adenocarcinoma and malignant transformation of hidradenoma papilliferum. The vulva and vagina can harbor a wide range of nonsquamous malignancies. The most challenging of these are adenocarcinomas which can be metastatic from other sites. The dominance of metastatic carcinomas in this series is likely to reflect consultation practice of specialist pathologists.
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Pinto V, Dellino M, Cicinelli R, Micheletti L, Ingravallo G, Cazzato G, Cascardi E, Cicinelli E. Multiple Vulvar Polyps in Pregnancy: A Benign Disease With a Challenging Diagnosis. J Low Genit Tract Dis 2023; 27:302-305. [PMID: 37201551 DOI: 10.1097/lgt.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Vincenzo Pinto
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
| | - Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
| | - Rossana Cicinelli
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
| | | | - Giuseppe Ingravallo
- Pathology Section, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Gerardo Cazzato
- Pathology Section, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | | | - Ettore Cicinelli
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
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Gaspard U, Taziaux M, Jost M, Coelingh Bennink HJ, Utian WH, Lobo RA, Foidart JM. A multicenter, randomized, placebo-controlled study to select the minimum effective dose of estetrol in postmenopausal participants (E4Relief): part 2-vaginal cytology, genitourinary syndrome of menopause, and health-related quality of life. Menopause 2023; 30:480-489. [PMID: 36809193 PMCID: PMC10155698 DOI: 10.1097/gme.0000000000002167] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/14/2022] [Indexed: 02/23/2023]
Abstract
OBJECTIVE A phase 2 study showed that 15 mg estetrol (E4) alleviates vasomotor symptoms (VMS). Here, we present the effects of E4 15 mg on vaginal cytology, genitourinary syndrome of menopause, and health-related quality of life. METHODS In a double-blind, placebo-controlled study, postmenopausal participants (n = 257, 40-65 y) were randomized to receive E4 2.5, 5, 10, or 15 mg or placebo once daily for 12 weeks. Outcomes were the vaginal maturation index and maturation value, genitourinary syndrome of menopause score, and the Menopause Rating Scale to assess health-related quality of life. We focused on E4 15 mg, the dose studied in ongoing phase 3 trials, and tested its effect versus placebo at 12 weeks using analysis of covariance. RESULTS Least square (LS) mean percentages of parabasal and intermediate cells decreased, whereas superficial cells increased across E4 doses; for E4 15 mg, the respective changes were -10.81% ( P = 0.0017), -20.96% ( P = 0.0037), and +34.17% ( P < 0.0001). E4 15 mg decreased LS mean intensity score for vaginal dryness and dyspareunia (-0.40, P = 0.03, and -0.47, P = 0.0006, respectively); symptom reporting decreased by 41% and 50%, respectively, and shifted to milder intensity categories. The overall Menopause Rating Scale score decreased with E4 15 mg (LS mean, -3.1; P = 0.069) and across doses was associated with a decreasing frequency and severity of VMS ( r = 0.34 and r = 0.31, P < 0.001). CONCLUSIONS E4 demonstrated estrogenic effects in the vagina and decreased signs of atrophy. E4 15 mg is a promising treatment option also for important menopausal symptoms other than VMS.
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Affiliation(s)
- Ulysse Gaspard
- From the Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium
| | | | - Maud Jost
- Estetra SRL, Mithra Pharmaceuticals, Liège, Belgium
| | | | - Wulf H. Utian
- Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Jean-Michel Foidart
- From the Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium
- Estetra SRL, Mithra Pharmaceuticals, Liège, Belgium
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Al-Janabi S, Kasius JC, Jaspars EH, Snijders MLH. Primary Cutaneous Neuroendocrine Tumor of the Vulva: A Case Report. Int J Gynecol Pathol 2023; 42:278-281. [PMID: 36044320 DOI: 10.1097/pgp.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary cutaneous neuroendocrine tumors (CNET) are extremely rare. Only a few cases have been reported so far. CNET have an indolent clinical course and usually present as a single flesh-colored nodule with a predilection for the scalp and trunk in elderly patients. While primary CNET have characteristic histological and immunohistochemical features akin to other low-grade neuroendocrine tumors elsewhere in the body, diagnosing these tumors on skin biopsies can be challenging as they are particularly mistaken for other, more commonly diagnosed, entities. In the current report we present a unique case of primary CNET of the vulva. The clinical presentation will be discussed as well as the histopathologic and immunohistochemical features and most importantly the possible pitfalls in microscopic examination.
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Xavier J, Figueiredo R, Vieira-Baptista P. Vulvar High-Grade Squamous Intraepithelial Lesion and the Risk of Recurrence and Progression to Cancer. J Low Genit Tract Dis 2023; 27:125-130. [PMID: 36794761 DOI: 10.1097/lgt.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE This study aimed to analyze which clinical characteristics are associated with recurrence and progression of vulvar high-grade squamous intraepithelial lesion (vHSIL). MATERIALS AND METHODS This was a retrospective cohort study, including all women with vHSIL followed in 1 center between 2009 and 2021. Women with a concomitant diagnosis of invasive vulvar cancer were excluded. Medical records were reviewed for demographic factors, clinical data, treatment type, histopathologic results, and follow-up information. RESULTS A total of 30 women were diagnosed with vHSIL. The median follow-up time was 4 years (range = 1-12 years). More than half of the women (56.7% [17/30]) underwent excisional treatment, whereas 26.7% (8/30) underwent combined (excisional plus medical) treatment, and 16.7% (5/30) only had medical treatment (imiquimod). Six women had recurrence of vHSIL (20% [6/30]), with a mean time to recurrence of 4.7 ± 2.88 years. The progression rate to invasive vulvar cancer was 13.3% (4/30), with a mean time to progression of 1.8 ± 0.96 years. Multifocal disease was associated with progression to vulvar cancer ( p = .035). We did not identify other variables associated with progression; no differences were found between women with and without recurrences. CONCLUSIONS Multifocality of the lesions was the only variable associated with progression to vulvar cancer. This reinforces the idea that these lesions are a challenge in both treatment and surveillance, involving a more difficult therapeutic decision with greater associated morbidity.
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Affiliation(s)
- Joana Xavier
- Department of Gynaecology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rita Figueiredo
- Department of Gynaecology, Centro Hospitalar Universitário São João, Porto, Portugal
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50
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Fuller AE, Dunsmoor-Su R. Complex vulvar and vaginal disease in menopause. Curr Opin Obstet Gynecol 2023; 35:164-168. [PMID: 36924412 DOI: 10.1097/gco.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW Menopause is a time of vulvar and vaginal changes that are physiologic and are often symptomatic. These changes can impact up to 50% of women in menopause. There are also several vulvar dermatoses that are more common after menopause and should be recognized early to allow for symptomatic treatment. Some of these conditions can lead to squamous cell carcinoma over time, and early recognition and appropriate treatment reduce this risk. Treatment for women with symptomatic vulvar and vaginal conditions is important for maintaining the quality of life. RECENT FINDINGS There are multiple review articles, small case series, and small comparative trials, but definitive trials are unavailable for most of these conditions. SUMMARY Current research on pathophysiology and treatment is limited to all of these conditions, and more focus on these life-altering conditions is warranted.
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Affiliation(s)
- Ashley E Fuller
- Swedish Medical Group Women's Wellness and GYN Specialty Services
- Seattle Clinical Research Center, Seattle, Washington, USA
| | - Rebecca Dunsmoor-Su
- Swedish Medical Group Women's Wellness and GYN Specialty Services
- Seattle Clinical Research Center, Seattle, Washington, USA
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