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Abu-Rustum NR, Yashar CM, Arend R, Barber E, Bradley K, Brooks R, Campos SM, Chino J, Chon HS, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Gaillard S, Giuntoli R, Glaser S, Holmes J, Howitt BE, Kendra K, Lea J, Lee N, Mantia-Smaldone G, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Podoll M, Rodabaugh K, Salani R, Schorge J, Siedel J, Sisodia R, Soliman P, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian N, Espinosa S. Vulvar Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2024; 22:117-135. [PMID: 38503056 DOI: 10.6004/jnccn.2024.0013] [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: 03/21/2024]
Abstract
Vulvar cancer is annually diagnosed in an estimated 6,470 individuals and the vast majority are histologically squamous cell carcinomas. Vulvar cancer accounts for 5% to 8% of gynecologic malignancies. Known risk factors for vulvar cancer include increasing age, infection with human papillomavirus, cigarette smoking, inflammatory conditions affecting the vulva, and immunodeficiency. Most vulvar neoplasias are diagnosed at early stages. Rarer histologies exist and include melanoma, extramammary Paget's disease, Bartholin gland adenocarcinoma, verrucous carcinoma, basal cell carcinoma, and sarcoma. This manuscript discusses recommendations outlined in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for treatments, surveillance, systemic therapy options, and gynecologic survivorship.
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Affiliation(s)
| | | | | | - Emma Barber
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jordan Holmes
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | - Kari Kendra
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Jayanthi Lea
- UT Southwestern Simmons Comprehensive Cancer Center
| | - Nita Lee
- The UChicago Medicine Comprehensive Cancer Center
| | | | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - John Schorge
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | - Kristine Zanotti
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Lozar T, Keske A, Dube Mandishora RS, Yu Q, Bailey A, Xu J, Tommasino M, McGregor SM, Lambert PF, Gheit T, Fitzpatrick MB. Betapapillomaviruses in p16-Negative Vulvar Intraepithelial Lesions Associated with Squamous Cell Carcinoma. Viruses 2023; 15:1950. [PMID: 37766356 PMCID: PMC10537070 DOI: 10.3390/v15091950] [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: 09/07/2023] [Revised: 09/16/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Approximately 40% of vulvar squamous cell carcinoma (vSCC) cases are etiologically associated with high-risk human papillomaviruses (HPVs) of the alpha genera (α-HPV) that cause other anogenital cancers; however, the etiology of α-HPV-negative vSCC is poorly understood. HPVs of the beta genera (β-HPV) are risk factors for cutaneous squamous cell carcinoma (cSCC) and may be related to carcinomas originating in other cutaneous sites such as the vulva. In this study, we investigate the presence of β-HPVs, with an emphasis on p16-negative squamous lesions adjacent to vSCC. We subjected 28 vulvar squamous intraepithelial lesions adjacent to vSCC for comprehensive HPV genotyping, p16 and p53 immunohistochemistry, and consensus morphology review. Selected cases were subjected to qPCR and RNA in situ hybridization. Clinical data were obtained from medical records. β-HPV DNA was detected in eight of ten p16-negative lesions and three of fourteen p16-positive high-grade squamous intraepithelial lesions. The HPV DNA loads in vulvar squamous intraepithelial lesions ranged between less than 1 HPV DNA copy per cell to more than 100 HPV DNA copies per cell. This is, to the best of our knowledge, the first report of the association of p16-negative vulvar intraepithelial squamous lesions with detection of β-HPVs. These findings expand possible etiologic mechanisms that may contribute to p16-negative lesions of the vulva.
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Affiliation(s)
- Taja Lozar
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; (T.L.)
- University of Wisconsin Carbone Cancer Center, Madison, WI 53705, USA
- University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Aysenur Keske
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Racheal S. Dube Mandishora
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffit Cancer Center, Tampa, FL 33612, USA
- Medical Microbiology Unit, University of Zimbabwe Faculty of Health Sciences, Harare P.O. Box A178, Zimbabwe
| | - Qiqi Yu
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA;
| | - Adam Bailey
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Jin Xu
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | | | - Stephanie M. McGregor
- University of Wisconsin Carbone Cancer Center, Madison, WI 53705, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Paul F. Lambert
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; (T.L.)
- University of Wisconsin Carbone Cancer Center, Madison, WI 53705, USA
| | - Tarik Gheit
- International Agency for Research on Cancer, 69007 Lyon, France
| | - Megan B. Fitzpatrick
- University of Wisconsin Carbone Cancer Center, Madison, WI 53705, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
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Linz VC, Schwanbeck C, Krajnak S, Anic K, Jäkel J, Schwab R, Schmidt M, Schmidberger H, Hasenburg A, Battista MJ. Comparison of cisplatin and mitomycin C/5-FU as radiosensitisers in the treatment of locally advanced vulvar cancer: results of a retrospective, observational, single-institutional cohort study. J Cancer Res Clin Oncol 2023; 149:1391-1399. [PMID: 35451700 PMCID: PMC10020277 DOI: 10.1007/s00432-022-04006-0] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We retrospectively investigated the widely used radiosensitisers cisplatin and mitomycin C/5-fluorouracil (5-FU) in patients with locally advanced vulvar cancer for outcome and toxicity. METHODS We screened the archive for patients treated with chemoradiation for vulvar cancer diagnosed between 01/2010 and 08/2021 at our institution. The impact of both radiosensitisers on prognosis was compared using Kaplan-Meier method and Cox-regression analysis. RESULTS One hundred and forty-three patients with vulvar cancer were screened. Twenty-nine patients received chemoradiation (mitomycin C/5-FU n = 14; cisplatin n = 12; others n = 3) as a primary, neoadjuvant or adjuvant treatment. Median follow-up was 15.5 months. Patients in the cisplatin group were older (mean age 54.4 vs. 70.7; p = 0.004). However, the mitomycin C/5-FU group had more advanced tumour stages. The 2-year recurrence-free survival (RFS) was comparable (44.5% vs. 33.3%; p = 0.932). The 2-year overall survival (OS) showed a numerical but not statistically significant difference in favour of the mitomycin C/5-FU group (59.7% vs. 31.7%; p = 0.37). 64.3% (9 out of 14) patients, who received mitomycin C/5-FU achieved clinical complete response (cCR) compared to 41.7% (5 out of 12) who received cisplatin (p = 0.505). Radiodermatitis was the most common adverse event in both groups (81%) and more severe in the mitomycin C/5-FU cohort. Myelotoxicity was frequently observed in both groups. Eighteen patients received an additional radiation boost with 10.0 (9-16) Gy and showed a significantly prolonged RFS (p = 0.027) and OS (p = 0.003). CONCLUSION Mitomycin C/5-FU may be considered in the treatment of young and healthy patients with locally advanced vulvar cancer.
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Affiliation(s)
- Valerie Catherine Linz
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Carina Schwanbeck
- Department of Radiooncology and Radiotherapy, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Anic
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jörg Jäkel
- Department of Pathology University Medical Center, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Roxana Schwab
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiooncology and Radiotherapy, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marco Johannes Battista
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Petit KN, Petit DM, Bridges AG. Vulvar Lymphangioma Circumscriptum Secondary to Crohn Disease. Mayo Clin Proc 2021; 96:2923-2924. [PMID: 34736616 DOI: 10.1016/j.mayocp.2021.09.001] [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: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Kristin N Petit
- Wright State University Boonshoft School of Medicine, Fairborn, OH
| | - Danielle M Petit
- The Christ Hospital Physicians - Dermatology, Liberty Township, OH
| | - Alina G Bridges
- Dermpath Diagnostics Richfield Laboratory of Dermatopathology, Cincinnati, OH.
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Wanka G, Schmoeckel E, Mayr D, Fuerst S, Kuhn C, Mahner S, Knabl J, Karsten MM, Dannecker C, Heidegger HH, Vattai A, Jeschke U, Jueckstock J. LDOC1 as Negative Prognostic Marker for Vulvar Cancer Patients. Int J Mol Sci 2020; 21:ijms21239287. [PMID: 33291445 PMCID: PMC7730493 DOI: 10.3390/ijms21239287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
So far, studies about targeted therapies and predictive biomarkers for vulva carcinomas are rare. The leucine zipper downregulated in cancer 1 gene (LDOC1) has been identified in various carcinomas as a tumor-relevant protein influencing patients' survival and prognosis. Due to the lack of information about LDOC1 and its exact functionality, this study focuses on the expression of LDOC1 in vulvar carcinoma cells and its surrounding immune cells as well as its correlation to clinicopathological characteristics and prognosis. Additionally, a possible regulation of LDOC1 in vulvar cancer cell lines via the NF-κB signaling pathway was analyzed. Vulvar carcinoma sections of 157 patients were immunohistochemically stained and examined regarding LDOC1 expression by using the immunoreactive score (IRS). To characterize LDOC1-positively stained immune cell subpopulations, immunofluorescence double staining was performed. The effect of the NF-κB inhibitor C-DIM 12 (3,3'-[(4-chlorophenyl)methylene]bis[1 H-indole]) on vulvar cancer cell lines A431 and SW 954 was measured according to MTT and BrdU assays. Baseline expression levels of LDOC1 in the vulvar cancer cell lines A431 and SW 954 was analyzed by real-time PCR. LDOC1 was expressed by about 90% of the cancer cells in the cytoplasm and about half of the cells in the nucleus. Cytoplasmatic expression of LDOC1 was associated with decreased ten-year overall survival of the patient, whereas nuclear staining showed a negative association with disease-free survival. Infiltrating immune cells were mainly macrophages followed by regulatory T cells. Incubation with C-DIM 12 decreased the cell viability and proliferation of vulvar cancer cell line A431, but not of cell line SW 954. LDOC1 expression on mRNA level was twice as high in the cell line A431 compared to the cell line SW 954. Overexpression of LDOC1 was associated with unfavorable overall and disease-free survival. Tumor growth could be inhibited by C-DIM 12 in vitro if the expressed LDOC1 level was high enough.
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Affiliation(s)
- Giulia Wanka
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Elisa Schmoeckel
- Department of Pathology, LMU Munich, Thalkirchner Str. 142, 80337 Munich, Germany; (E.S.); (D.M.)
| | - Doris Mayr
- Department of Pathology, LMU Munich, Thalkirchner Str. 142, 80337 Munich, Germany; (E.S.); (D.M.)
| | - Sophie Fuerst
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Christina Kuhn
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Julia Knabl
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
- Department of Obstetrics, Klinik Hallerwiese, Sankt-Johannis-Mühlgasse 19, 90419 Nürnberg, Germany
| | - Maria Margarete Karsten
- Department of Gynecology and Gynecologic Oncology, Charité University, Charitéplatz 1, 10117 Berlin, Germany;
| | - Christian Dannecker
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglin Street 2, 86156 Augsburg, Germany;
| | - Helene H. Heidegger
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Aurelia Vattai
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglin Street 2, 86156 Augsburg, Germany;
- Correspondence: ; Tel.: +49-821-400-165505
| | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
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DE FLORA S, LA MAESTRA S, CROCETTI E, MANGONE L, BIANCONI F, STRACCI F, BUZZONI C. Estimates of the incidence of infection-related cancers in Italy and Italian regions in 2018. J Prev Med Hyg 2019; 60:E311-E326. [PMID: 31967088 PMCID: PMC6953451 DOI: 10.15167/2421-4248/jpmh2019.60.4.1434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022]
Abstract
Introduction Chronic infections and infestations represent one of the leading causes of cancer. Eleven agents have been categorized by the International Agency for Research on Cancer (IARC) in Group 1, 3 in Group 2A and 4 in Group 2B. We previously estimated that the incidence of cancers associated with infectious agents accounted for the 8.5% of new cancer cases diagnosed in Italy in 2014. Methods In the present study we evaluated the incidence of cancer in Italy and in the 20 Italian regions in 2018, based on the data of Cancer Registries, and calculated the fraction attributable to infectious agents. Results Cancers of infectious origin contributed to the overall burden of cancer in Italy with more than 27,000 yearly cases, the 92% of which was attributable to Helicobacter pylori, human papillomaviruses, and hepatitis B and C viruses. With the exception of papillomavirus-related cancers, the incidence of cancers of infectious origin was higher in males (16,000 cases) than in females (11,000 cases). There were regional and geographical variations of cancers depending on the type of cancer and on the gender. Nevertheless, the overall figures were rather similar, the infection-related cancers accounting for the 7.2, 7.6, and 7.1% of all cancers in Northern, Central, and Southern Italy, respectively. Conclusions The estimate of the incidence of cancers attributable to infectious agents in Italy in 2018 (7.3% of all cancer cases) is approximately half of the worldwide burden, which has been estimated by IARC to be the 15.4% of all cancer cases in 2012.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Aged
- Burkitt Lymphoma/epidemiology
- Burkitt Lymphoma/etiology
- Carcinoma, Hepatocellular/epidemiology
- Carcinoma, Hepatocellular/etiology
- Child
- Child, Preschool
- Epstein-Barr Virus Infections/complications
- Female
- Head and Neck Neoplasms/epidemiology
- Head and Neck Neoplasms/etiology
- Helicobacter Infections/complications
- Helicobacter pylori
- Hepatitis B/complications
- Hepatitis C/complications
- Hodgkin Disease/epidemiology
- Hodgkin Disease/etiology
- Humans
- Incidence
- Infant
- Infant, Newborn
- Infections/complications
- Italy/epidemiology
- Leukemia-Lymphoma, Adult T-Cell/epidemiology
- Leukemia-Lymphoma, Adult T-Cell/etiology
- Liver Neoplasms/epidemiology
- Liver Neoplasms/etiology
- Lymphoma, B-Cell, Marginal Zone/epidemiology
- Lymphoma, B-Cell, Marginal Zone/etiology
- Malaria, Falciparum/complications
- Male
- Middle Aged
- Neoplasms/epidemiology
- Neoplasms/etiology
- Papillomavirus Infections/complications
- Penile Neoplasms/epidemiology
- Penile Neoplasms/etiology
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/etiology
- Sex Distribution
- Stomach Neoplasms/epidemiology
- Stomach Neoplasms/etiology
- Uterine Cervical Neoplasms/epidemiology
- Uterine Cervical Neoplasms/etiology
- Vaginal Neoplasms/epidemiology
- Vaginal Neoplasms/etiology
- Vulvar Neoplasms/epidemiology
- Vulvar Neoplasms/etiology
- Young Adult
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Affiliation(s)
- S. DE FLORA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Correspondence: Silvio De Flora, Department of Health Sciences, University of Genoa, via A. Pastore 1, 161232 Genoa, Italy - E-mail:
| | - S. LA MAESTRA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - E. CROCETTI
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - L. MANGONE
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - F. STRACCI
- Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy
| | - C. BUZZONI
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
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7
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Basile S, Pinelli S, Bottone P, Artini PG, Plotti F, Panici PB. 'Primary gingival and later primary vulval carcinomas arising in lichen planus: report of a case and clinical suggestions for diagnosis of a neglected disease'. Gynecol Endocrinol 2019; 35:938-940. [PMID: 31131667 DOI: 10.1080/09513590.2019.1617265] [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] [Indexed: 10/26/2022] Open
Abstract
Lichen planus (LP) is a chronic immune-mediated dermatosis mainly affecting skin, oral, and genital mucosa. The heterogeneous clinical presentation, spectrum of symptoms depending on subtype and overlap with other vulval and cutaneous disorders can lead to challenging in diagnosis. We report an unusual case of vulval SCC arising within a patient with initial oral mucosal lichen planus who later developed lichen planus of the vulva. Discussion of this case is important as it typifies the difficulties in diagnosis of vulvo-vaginal disorders and potential complications. Evidence is available that lichen planus may be potentially precancerous condition and is associated with SCC development. This case may confirm an inherent oncologic potential of the disease. All efforts must be made by specialists involved in the management of this disease to obtain an early diagnosis, ensure proper treatment and adequate follow up. This highlights the need to perform vulval examination in patients with symptoms or with a history muco-cutaneous LP and if necessary consider referral to specialist center for biopsy and management.
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Affiliation(s)
- Stefano Basile
- Department of Obstetrics and Gynecology II, Pisa University Hospital , Pisa , Italy
| | - Sara Pinelli
- Department of Obstetrics and Gynecology II, Pisa University Hospital , Pisa , Italy
| | - Pietro Bottone
- Department of Obstetrics and Gynecology II, Pisa University Hospital , Pisa , Italy
| | - Paolo Giovanni Artini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa , Pisa , Italy
| | - Francesco Plotti
- Department of Gynecology, Campus Biomedico University of Rome , Rome , Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecologic-Obstetrical and Urologic Sciences, Sapienza University Hospital of Rome , Rome , Italy
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Abstract
The pathogenesis of vulvar squamous neoplasia has 2 pathways: human papillomavirus (HPV)-dependent and HPV-independent. The HPV-dependent pathway in the vulva follows the same progression as HPV-dependent lesions elsewhere in the gynecologic tract-HPV infection results in high-grade squamous intraepithelial lesion with subsequent progression to basaloid squamous cell carcinoma. The HPV-independent pathway is more complex, with a variety of precursor lesions and molecular alterations. Although the most recognized form of HPV-independent vulvar lesion is differentiated vulvar intraepithelial neoplasia, recent explorations have elucidated new precursors. This review provides an update on HPV-independent risk factors and precursor lesions for squamous cell carcinoma of the vulva.
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Affiliation(s)
- Jaclyn C Watkins
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, MCN C-3306A, 1161 21st Avenue South, Nashville, TN 37232-2582, USA.
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Abstract
Vulvar lichen sclerosus is an important skin disease that is common in women in their 50 s and beyond; however, it can also affect females of any age, including children. If not treated, it has the potential to cause significant and permanent scarring and deformity of the vulvar structure. In addition, if untreated, it is associated with a 2-6% lifetime risk of malignant squamous neoplasia of the vulva. Lichen sclerosus has been considered a difficult to manage condition; however, both serious complications can potentially be prevented with early intervention with topical corticosteroid, suggesting that the course of the disease can be treatment modified.
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Affiliation(s)
- Andrew Lee
- Department of Dermatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Sydney Medical School Northern, The University of Sydney, St Leonards, NSW, Australia
- Department of Dermatology, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- Sydney Medical School Northern, The University of Sydney, St Leonards, NSW, Australia.
- Department of Dermatology, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.
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Suk R, Mahale P, Sonawane K, Sikora AG, Chhatwal J, Schmeler KM, Sigel K, Cantor SB, Chiao EY, Deshmukh AA. Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers. JAMA Netw Open 2018; 1:e181999. [PMID: 30646145 PMCID: PMC6324459 DOI: 10.1001/jamanetworkopen.2018.1999] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE In the last 4 decades, survival among patients with human papillomavirus (HPV)-associated cancers has improved, while the incidence of these cancers has increased among younger cohorts. Among survivors of HPV-associated cancers, persistent HPV infection may remain a risk factor for preventable HPV-associated second primary cancers (HPV-SPCs). OBJECTIVES To investigate the risk of HPV-SPCs among survivors of HPV-associated index cancers and to test the hypothesis that the HPV-SPC risk among these persons has increased over the last 4 decades. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 9 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HPV-associated (cervical, vaginal, vulvar, oropharyngeal, anal, and penile) cancers diagnosed from January 1, 1973, through December 31, 2014. The dates of analysis were July 1, 2017, to January 31, 2018. MAIN OUTCOMES AND MEASURES The HPV-SPC risk was quantified by calculating standard incidence ratios (SIRs) and excess absolute risks (EARs) per 10 000 person-years at risk (PYR). The HPV-SPC risk by time was estimated using Poisson regression. RESULTS From 113 272 (73 085 female and 40 187 male) survivors of HPV-associated cancers, 1397 women and 1098 men developed HPV-SPCs. The SIRs for HPV-SPCs were 6.2 (95% CI, 5.9-6.6) among women and 15.8 (95% CI, 14.9-16.8) among men. The EARs were 18.2 per 10 000 PYR for women and 53.5 per 10 000 PYR for men. Among both women and men, those who had index oropharyngeal cancers had the highest HPV-SPC risk (SIR, 19.8 [95% CI, 18.4-21.4] and EAR, 80.6 per 10 000 PYR among women; SIR, 18.0 [95% CI, 16.9-19.1] and EAR, 61.5 per 10 000 PYR among men). Women who had index cervical cancers and men who had index anal cancers had the lowest HPV-SPC risk (SIR, 2.4 [95% CI, 2.2-2.7] and EAR, 4.5 per 10 000 PYR among women; SIR, 6.5 [95% CI, 4.7-8.8] and EAR, 18.5 per 10 000 PYR among men). Both women and men who had index HPV-associated cancers of any kind had a significantly higher risk of oropharyngeal HPV-SPCs. Over the last 4 decades, the risk of developing most types of HPV-SPCs after index cervical, vaginal, and vulvar cancers increased. CONCLUSIONS AND RELEVANCE According to this study, the HPV-SPC risk among survivors of HPV-associated cancers is significant, implying that persistent HPV infection at multiple sites may be associated with HPV-SPCs. These findings have the potential to inform surveillance recommendations for survivors of HPV-associated cancers.
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Affiliation(s)
- Ryan Suk
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Kalyani Sonawane
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Andrew G. Sikora
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott B. Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth Y. Chiao
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ashish A. Deshmukh
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
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Swarts DRA, Voorham QJM, van Splunter AP, Wilting SM, Sie D, Pronk D, van Beurden M, Heideman DAM, Snijders PJF, Meijer CJLM, Steenbergen RDM, Bleeker MCG. Molecular heterogeneity in human papillomavirus-dependent and -independent vulvar carcinogenesis. Cancer Med 2018; 7:4542-4553. [PMID: 30030907 PMCID: PMC6144162 DOI: 10.1002/cam4.1633] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/21/2018] [Accepted: 05/31/2018] [Indexed: 01/22/2023] Open
Abstract
Vulvar squamous cell carcinoma (VSCC) and precancerous vulvar intraepithelial neoplasia (VIN) can develop through human papillomavirus (HPV)-dependent and -independent pathways, indicating a heterogeneous disease. Only a minority of VIN progress, but current clinicopathological classifications are insufficient to predict the cancer risk. Here we analyzed copy number alterations (CNA) to assess the molecular heterogeneity of vulvar lesions in relation to HPV and cancer risk. HPV-status and CNA by means of whole-genome next-generation shallow-sequencing were assessed in VSCC and VIN. The latter included VIN of women with associated VSCC (VINVSCC ) and women who did not develop VSCC during follow-up (VINnoVSCC ). HPV-testing resulted in 41 HPV-positive (16 VINVSCC , 14 VINnoVSCC , and 11 VSCC) and 24 HPV-negative (11 VINVSCC and 13 VSCC) lesions. HPV-positive and -negative VSCC showed a partially overlapping pattern of recurrent CNA, including frequent gains of 3q and 8q. In contrast, amplification of 11q13/cyclinD1 was exclusively found in HPV-negative lesions. HPV-negative VINVSCC had less CNA than HPV-negative VSCC (P = .009), but shared chromosome 8 alterations. HPV-positive VINnoVSCC had less CNA than VINVSCC (P = .022). Interestingly, 1pq gain was detected in 81% of HPV-positive VINVSCC and only in 21% of VINnoVSCC (P = .001). In conclusion, HPV-dependent and -independent vulvar carcinogenesis is characterized by distinct CNA patterns at the VIN stage, while more comparable patterns are present at the cancer stage. Cancer risk in VIN seems to be reflected by the extent of CNA, in particular chromosome 1 gain in HPV-positive cases.
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Affiliation(s)
- Dorian R. A. Swarts
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Quirinus J. M. Voorham
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Present address:
Quirinus J. M. Voorham,Stichting PALGAHoutenThe Netherlands
| | - Annina P. van Splunter
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Saskia M. Wilting
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Present address:
Saskia M. Wilting,Department of Medical OncologyErasmus Medical CenterRotterdamThe Netherlands
| | - Daoud Sie
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Divera Pronk
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Present address:
Divera Pronk,Hartwig Medical FoundationAmsterdamThe Netherlands
| | - Marc van Beurden
- Department of GynecologyAntoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Daniëlle A. M. Heideman
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Peter J. F. Snijders
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Chris J. L. M. Meijer
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Renske D. M. Steenbergen
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Maaike C. G. Bleeker
- Cancer Center AmsterdamDepartment of Pathology, VU University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
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12
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Abstract
A study of 350 women with lichen sclerosus, originally made to elucidate the relationship between lichen sclerosus and autoimmunity, led to the amassing of a considerable amount of clinical material. Our review is confined to those with anogenital lesions (342), supplemented by some new cases (15), giving a total of 357 women with biopsy proven lichen sclerosus. It demonstrates the wide age range of the condition, the association with morphoea and lichen planus and the occurrence of squamous cell carcinoma in some cases. It also shows that inappropriate surgery has continued to be carried out for benign disease.
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Affiliation(s)
- R H Thomas
- Salisbury District Hospital, Wiltshire, England
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14
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Affiliation(s)
- C Nally
- Department of Surgery, Royal Marsden Hospital, London
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15
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Jones SEF, Hibbitts S, Hurt CN, Bryant D, Fiander AN, Powell N, Tristram AJ. Human Papillomavirus DNA Methylation Predicts Response to Treatment Using Cidofovir and Imiquimod in Vulval Intraepithelial Neoplasia 3. Clin Cancer Res 2017; 23:5460-5468. [PMID: 28600473 DOI: 10.1158/1078-0432.ccr-17-0040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/28/2017] [Accepted: 06/05/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Response rates to treatment of vulval intraepithelial neoplasia (VIN) with imiquimod and cidofovir are approximately 57% and 61%, respectively. Treatment is associated with significant side effects and, if ineffective, risk of malignant progression. Treatment response is not predicted by clinical factors. Identification of a biomarker that could predict response is an attractive prospect. This work investigated HPV DNA methylation as a potential predictive biomarker in this setting.Experimental Design: DNA from 167 cases of VIN 3 from the RT3 VIN clinical trial was assessed. HPV-positive cases were identified using Greiner PapilloCheck and HPV 16 type-specific PCR. HPV DNA methylation status was assessed in three viral regions: E2, L1/L2, and the promoter, using pyrosequencing.Results: Methylation of the HPV E2 region was associated with response to treatment. For cidofovir (n = 30), median E2 methylation was significantly higher in patients who responded (P ≤ 0.0001); E2 methylation >4% predicted response with 88.2% sensitivity and 84.6% specificity. For imiquimod (n = 33), median E2 methylation was lower in patients who responded to treatment (P = 0.03; not significant after Bonferroni correction); E2 methylation <4% predicted response with 70.6% sensitivity and 62.5% specificity.Conclusions: These data indicate that cidofovir and imiquimod may be effective in two biologically defined groups. HPV E2 DNA methylation demonstrated potential as a predictive biomarker for the treatment of VIN with cidofovir and may warrant investigation in a biomarker-guided clinical trial. Clin Cancer Res; 23(18); 5460-8. ©2017 AACR.
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Affiliation(s)
- Sadie E F Jones
- School of Medicine, Cardiff University, Cardiff, United Kingdom.
| | | | - Christopher N Hurt
- Wales Cancer Trials Unit (WCTU), School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Dean Bryant
- University of Southampton, Southampton, United Kingdom
| | | | - Ned Powell
- School of Medicine, Cardiff University, Cardiff, United Kingdom
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16
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Clark JM, Hopkins MP, Krol E, Chase D, Sparks D. Recurrent Vulvar Carcinoma in a Skin Graft: A Case Reiort and Review of the Literature. Conn Med 2017; 81:165-167. [PMID: 29772163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In recentyears, theincidence ofvul- var carcinoma has increased over 400%, specifically in the population of young women. We present a patient with an extensive history of recurrent vulvar carcinoma in situ who underwent multiple surgi- cal procedures and subsequent reconstruction with a skin graft, who then returned with a rare recur- rence in the graft. Multiple hypotheses have been proposedto explain the recurrence ofthis type ofcar- cinoma; however, none provides a solid explanation. It has been noted that the increase in the incidence of vulvar cancer correlates with the increased incidence of HPV infection; the relationship between the two has been well-established. In conclusion, we recommend close and long-term follow-up for high-risk patients with this type of neoplasm.
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17
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杨 欢, 付 贞, 唐 华, 李 成. [Establishment of a SD rat model of vulvar lichen simplex chronicus and detection of the expression of protease activated receptor 2]. Nan Fang Yi Ke Da Xue Xue Bao 2017; 37:30-35. [PMID: 28109095 PMCID: PMC6765760 DOI: 10.3969/j.issn.1673-4254.2017.01.06] [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] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To establish a SD rat model of vulvar lichen simplex chronicus (LSC) and investigate the expression of protease activated receptor 2 (PAR2) in the genital skin. METHODS Seventy female SD rats were randomly divided into group A (blank control group, n=10), group B (with application of acetone solution 3 times per week for 10 weeks, n=10), group C (with chronic mechanical irritation 3 times per week for 10 weeks, n=10), and group D (with topical treatment with 0.5= 7,12-Dimethylbenzanthracene [DMBA] in acetone solution and chronic mechanical irritation 3 times per week for 10 weeks, n=40). The changes of the genital skin changes were observed regularly and the expression of PAR2 in groups A and D was detected with immunohistochemistry, Western blotting and qRT-PCR. RESULTS In group D, LSC occurred in 23 rats (57.5=) at 8 weeks and in 38 rats (95=) at 10 weeks; 8 rats (20=) showed papilloma at 12 weeks. Acetone treatment or chronic mechanical irritation did not cause LSC in the rats. Immunohistochemistry, Western blotting and qRT-PCR showed significantly increased expressions of PAR2 in group D at both the protein and mRNA levels as compared with those in group A (P<0.05). CONCLUSION 0.5= DMBA in acetone solution along with chronic mechanical irritation can induce LSC in female SD rats, and PAR2 is closely related with the occurrence and progression of LSC.
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Affiliation(s)
- 欢 杨
- />重庆医科大学生物医学工程学院//省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室//重庆市生物医学工程学重点实验室//重庆市微无创医学协同创新中心,重庆 400016State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine; Chongqing Medical University, Chongqing 40016, China
| | - 贞花 付
- />重庆医科大学生物医学工程学院//省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室//重庆市生物医学工程学重点实验室//重庆市微无创医学协同创新中心,重庆 400016State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine; Chongqing Medical University, Chongqing 40016, China
| | - 华均 唐
- />重庆医科大学生物医学工程学院//省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室//重庆市生物医学工程学重点实验室//重庆市微无创医学协同创新中心,重庆 400016State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine; Chongqing Medical University, Chongqing 40016, China
| | - 成志 李
- />重庆医科大学生物医学工程学院//省部共建国家重点实验室培育基地-重庆市超声医学工程重点实验室//重庆市生物医学工程学重点实验室//重庆市微无创医学协同创新中心,重庆 400016State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine; Chongqing Medical University, Chongqing 40016, China
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18
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Leonard S, Pereira M, Fox R, Gordon N, Yap J, Kehoe S, Luesley D, Woodman C, Ganesan R. Over-expression of DNMT3A predicts the risk of recurrent vulvar squamous cell carcinomas. Gynecol Oncol 2016; 143:414-420. [PMID: 27623253 DOI: 10.1016/j.ygyno.2016.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cancer initiation and progression has been linked to aberrant expression of the DNA methyltransferases (DNMT), the enzymes which establish and maintain DNA methylation patterns throughout the genome. In this study, we investigated if DNMT expression in vulvar squamous cell carcinomas (VSCC) was related to clinical outcome. METHODS DNMT1, DNMT3A and DNMT3B expression was measured in a subset of cases drawn from a cohort of consecutive women treated for primary VSCC at the Pan Birmingham Gynaecological Cancer Centre between 2001 and 2008. Univariable and multivariable competing risk modelling was performed to identify whether DNMT expression was associated with local disease recurrence or disease morbidity. RESULTS Over-expression of DNMT3A in the invasive component of the tumour was seen in 44% of tumours and was associated with an increased risk of local vulvar recurrence (LVR) (HR=4.51, p=0.012). This risk was found to increase further after adjustment for disease stage (HR=6.00, p=0.003) and groin node metastasis (HR=4.81, p=0.008). Over-expression of DNMT3B was associated with an increased risk of LVR (HR=5.69 p=0.03), however this ceased to be significant after adjustment for groin node metastasis. In a subset analysis, over-expression of DNMT3A was found to be significantly more common in VSCCs that stained negative for CDKN2A. CONCLUSIONS These observations are consistent with the possibility that epigenetic changes contribute to vulvar neoplasia and DNMT3A over-expression may be useful in predicting local disease recurrence.
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Affiliation(s)
- Sarah Leonard
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Merlin Pereira
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Richard Fox
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Naheema Gordon
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Jason Yap
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Sean Kehoe
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - David Luesley
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Ciaran Woodman
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Raji Ganesan
- Birmingham Women's NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2TG, United Kingdom.
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19
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Abstract
Many women know about the risks of lung cancer and cardiovascular disease that stem from tobacco use, but many don't realize there are several other potential health consequences of smoking. Nurses should utilize every opportunity to educate women about the various health risks of smoking. Promotion of smoking cessation now may help women prevent numeroushealth problems later.
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20
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Abstract
Lichen sclerosus (LS) is a chronic inflammatory disorder of the skin and mucosa, presenting to genitourinary physicians and dermatologists. It affects both sexes and all age groups. Although the exact aetiology is uncertain, genetic predisposition, infections and autoimmune factors have been implicated in its pathogenesis. Symptoms include pruritis and soreness, but asymptomatic presentations are not uncommon. The classical clinical picture is of atrophic white plaques in the anogenital region. Histopathology is specific with basal cell degeneration, upper dermal oedema, homogenization of collagen and a chronic inflammatory infiltrate. Short courses of potent topical corticosteroids form the mainstay of treatment. The condition tends to be remitting and relapsing, with spontaneous regressions reported in a few. In men, the term balanitis xerotica obliterans is sometimes used to describe late and severe LS of the penis. Scarring and progression to squamous cell carcinomas can occur in chronic LS, resulting in significant morbidity. A multi-disciplinary approach to care and the need for long-term monitoring cannot be over-emphasized.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK.
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22
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Lagerstedt M, Huotari-Orava R, Nyberg R, Mäenpää JU, Snellman E, Laasanen SL. Reduction in ERRα is associated with lichen sclerosus and vulvar squamous cell carcinoma. Gynecol Oncol 2015; 139:536-40. [PMID: 26499936 DOI: 10.1016/j.ygyno.2015.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/23/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and inflammatory processes in both normal and cancer cells. Chronic inflammation induced by lichen sclerosus (LS) or human papilloma virus (HPV) precedes vulvar squamous cell carcinoma (vulvar SCC). We investigated the expression of ERRα, ERRβ and ERRγ in normal vulvar skin, LS as well as LS-dependent and LS-independent/HPV-related vulvar SCC. METHODS A total of 203 samples were analyzed for ERRα, ERRβ and ERRγ by using immunohistochemistry. These included 37 normal vulvar skin samples, 110 LS samples, 6 vulvar intraepithelial neoplasia (VIN) samples and 50 vulvar SCC samples. RESULTS A substantial reduction in or disappearance of ERRα was detected in all vulvar SCC samples. A total of 79% of childhood-onset LS and 51% of adulthood-onset LS lesions showed decreases in ERRα staining. A gradual reduction in ERRα cytoplasmic staining was observed from healthy vulvar skin to precursor lesions and further to SCC. Nuclear ERRα staining was observed in 8/33 (24%) LS-dependent and 10/17 (59%) LS-independent SCC samples. CONCLUSIONS ERRα, a key regulator of cell energy metabolism, may play a role in the pathogenesis of both LS and vulvar SCC.
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Affiliation(s)
- M Lagerstedt
- Department of Dermatology, Tampere University Hospital, Finland; School of Medicine, University of Tampere, Finland.
| | - R Huotari-Orava
- School of Medicine, University of Tampere, Finland; Fimlab Laboratories, Tampere, Finland
| | - R Nyberg
- Department of Obstetrics and Gynecology, Tampere University Hospital, Finland
| | - J U Mäenpää
- School of Medicine, University of Tampere, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, Finland
| | - E Snellman
- Department of Dermatology, Tampere University Hospital, Finland; School of Medicine, University of Tampere, Finland
| | - S-L Laasanen
- Department of Dermatology, Tampere University Hospital, Finland
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Hill-Daniel J, Roett MA. Genital Cancers in Women: Vulvar Cancer. FP Essent 2015; 438:31-48. [PMID: 26569049] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Vulvar cancer is uncommon, accounting for 0.3% of all new US cancer diagnoses. The majority of cases are squamous cell carcinoma. Malignant melanoma is the second most common type. Other cases are related to chronic inflammatory skin disorders such as lichen sclerosus. Vulvar intraepithelial neoplasia (VIN) is a precursor to squamous cell vulvar cancer. It may be the usual type associated with human papillomavirus (HPV) infection, or the differentiated type often associated with chronic skin disorders. Risk factors for VIN are HPV infection, cigarette smoking, chronic skin disorders, and immunosuppression. Symptoms of vulvar cancer include pruritus, bleeding, skin color change, skin lesions, and dysuria. VIN and vulvar cancer are diagnosed by skin biopsy. Treatment of VIN includes wide local excision, via surgical removal or with laser or ultrasonic surgical aspiration procedures. Medical therapy with imiquimod also may be used. Prognosis is good with early detection; the 5-year survival rate for stage I cancer is greater than 85%. Advanced disease has a poor prognosis, with a 5-year survival rate in stage IV disease as low as 5%. Although screening for vulvar cancer is not recommended, clinicians should evaluate and biopsy any suspicious vulvar lesions. Current efforts at prevention are aimed at HPV vaccination.
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Affiliation(s)
- Jamie Hill-Daniel
- Georgetown University-Providence Hospital Family Medicine Residency, 4000 Reservoir Road NW, Washington, DC 20007
| | - Michelle A Roett
- Fort Lincoln Family Medicine Center, 4151 Bladensburg Road, Colmar Manor, MD 20722
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Ghisu GP, Fink D. [Burning Vulva: Significance of Surgery in Inflammatory and Precancerous Vulvar Pathologies]. Praxis (Bern 1994) 2015; 104:689-693. [PMID: 26081381 DOI: 10.1024/1661-8157/a002043] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vuval pathologies manifested by allodynia and burning sensations can be due to infection, inflammatory dermatoses or other causes. Infective as well as certain inflammatory diseases, e.g. drug eruptions, allergic eczemas, irritative dermatitis/vulvitis, Behcet's Syndrome and pemphigus/pemphigoid usually respond well to conservative treatment. The category of inflammatory diseases also contains pathologies that in certain circumstances do require a surgical intervention, e.g. Lichen ruber planus/Lichen sclerosus, Condyloma, scars, premalignant lesions (VIN, genital M. Paget) and cancer. Vulodynia also can cause some stinging to the vulvar skin. The surgical aspects relating to the treatment of the benign and premalignant pathologies indicated above are mentioned in this mini-review.
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Malinova M. [AN HPV-ASSOCIATED DISEASES AND CERVICAL CANCER AND PROPHYLACTIC HUMAN PAPILLOMAVIRUS (HPV) VACCINES]. Akush Ginekol (Sofiia) 2015; 54 Suppl 1:25-31. [PMID: 26137767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Human papillomavirus (HPV) infection is the central cause of invasive cervical cancer (ICC) and its precursor lesions. Both vaccines can prevent most cases of cervical cancer. In addition, both can prevent vaginal and vulvar cancer in women, and HPV-related cancers. HPV4 can prevent genital warts in women and men. Routine vaccination of 12-year-old girls with HPV4 vaccine appears to be cost-effective in addition to providing both short-term and long-term health gains.
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Sofoudis C, Kalampokas T, Boutas I, Kalampokas E, Salakos N. Morbus Bourneville: a case report and review of the literature. CLIN EXP OBSTET GYN 2014; 41:95-97. [PMID: 24707696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Tuberous sclerosis (TS) or tuberous sclerosis complex (TSC), also known as Bourneville disease or Bourneville-Pringle disease, is an autosomal dominant disorder classically characterized by the presence of hamartomatous growths in multiple organs. A combination of symptoms may include seizures, developmental delay, behavioral problems, skin abnormalities, and lung and kidney diseases. The authors present a case of a 18 year-old female patient with a history of TS, epileptic episodes, mental retardation, and papillary formations in multiple organs located at the abdominal, axillary, cervical, facial, and genital region.
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Dong Y, Zhang XM, Zhao F, Wang CC, Bi H, Li T. [Vulvar intraepithelial neoplasia]. Zhonghua Bing Li Xue Za Zhi 2013; 42:557-561. [PMID: 24246927] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Shen L, Zeng F, Hong L, Zhang G, Mai R. Vulvar melanoma and endometrial polyp following breast carcinoma: a case report. EUR J GYNAECOL ONCOL 2013; 34:197-9. [PMID: 23781599 DOI: pmid/23781599] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors describe the occurrence of a 55-year-old female patient presenting with a vulvar melanoma, endometrial polyp, and a prior history of breast carcinoma excised from the left chest wall, radiotherapy, chemotherapy, and tamoxifen maintenance for two years. This case exemplified second primary vulvar melanoma following breast cancer and supported that radiotherapy might play a role in the onset of secondary cancer. This case report also emphasizes the onset of endometrial polyp induced by tamoxifen.
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Affiliation(s)
- L Shen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Nguessan KLP, Mian DB, Kasse K, Boni S. Vulvar squamous cell carcinoma developing in a young black African HIV woman. EUR J GYNAECOL ONCOL 2013; 34:496-499. [PMID: 24475594] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Vulvar cancers are uncommon, represented in 90% of cases by squamous cell carcinoma (SCC). The reduction of the frequency and the severity proceed by recognition of precancerous or beginning lesions. They occur most often in the third age in postmenopausal women. The diagnosis is almost difficult and often late and therefore prognosis is severe. Conditions for diagnosis and treatment are difficult in underdeveloped countries due to the inaccessibility of proper equipment in the healthcare system. The authors report a case of SCC diagnosed late in a young human immunodeficiency virus (HIV) women who have been treated with neoadjuvant chemotherapy and radical surgery of the vulva.
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Affiliation(s)
- K L P Nguessan
- Department of Gynecology and Obstetrics, University Hospital of Cocody, Abidjan, Republic of Ivory Coast
| | - D B Mian
- Department of Gynecology and Obstetrics, University Hospital of Cocody, Abidjan, Republic of Ivory Coast
| | - K Kasse
- Department of Gynecology and Obstetrics, University Hospital of Cocody, Abidjan, Republic of Ivory Coast
| | - S Boni
- Department of Gynecology and Obstetrics, University Hospital of Cocody, Abidjan, Republic of Ivory Coast
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Frega A, Sopracordevole F, Assorgi C, Lombardi D, DE Sanctis V, Catalano A, Matteucci E, Milazzo GN, Ricciardi E, Moscarini M. Vaginal intraepithelial neoplasia: a therapeutical dilemma. Anticancer Res 2013; 33:29-38. [PMID: 23267125] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vaginal intraepithelial neoplasia (VaIN) represents a rare and asymptomatic pre-neoplastic lesion. Its natural history and potential evolution into invasive cancer are uncertain. VaIN can occur alone or as a synchronous or metachronous lesion with cervical and vulvar HPV-related intra epithelial or invasive neoplasia. Its association with cervical intraepithelial neoplasia is found in 65% of cases, with vulvar intraepithelial neoplasia in 10% of cases, while for others, the association with concomitant cervical or vulvar intraepithelial neoplasias is found in 30-80% of cases. VaIN is often asymptomatic and its diagnosis is suspected in cases of abnormal cytology, followed by colposcopy and colposcopically-guided biopsy of suspicious areas. In the past, high-grade VaIN and multifocal VaIN have been treated by radical surgery, such as total or partial upper vaginectomy associated with hysterectomy and radiotherapy. The need to maintain the integrity of reproductive capacity has determined the transition from radical therapies to conservative ones, according to the different patients' characteristics.
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Affiliation(s)
- Antonio Frega
- Department of Gynecological, Obstetric and Urological Sciences, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
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Agu PU, Okeke TC, Ezugwu EC, Obi SN. Large vulvar lipoma following episiotomy: a case report. Niger J Med 2012; 21:357-358. [PMID: 23304937] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Vulvar lipomas are rare few cases have been reported in the world literature. We document a case of large soft vulvar mass following episiotomy in a 23-year-old primipara. The mass was excised and histologic examination confirmed lipoma.
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Affiliation(s)
- P U Agu
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
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Sander BB, Damsgaard K. [Lichen sclerosus--a neglected disease]. Ugeskr Laeger 2011; 173:2951-2954. [PMID: 22094215] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a small review of lichen sclerosus in women and an update on the newest knowledge, e.g. on calcineurin inhibitors as a choice of treatment. The goal is to put more focus on the disease in Denmark because it is so often diagnosed only with a great delay. We further emphasize the importance of follow-up on these patients, due to the risk of cancer, the great influence of the disease on quality of life and the risk of structural changes in the vulva region.
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Ikeda M, Muramatsu T, Shida M, Hirasawa T, Ishimoto H, Izumi SI, Mikami M. Surgical management of vulvar lymphangioma circumscriptum: two case reports. Tokai J Exp Clin Med 2011; 36:17-20. [PMID: 21547888] [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] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/01/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the efficacy of major labiaectomy as a surgical management of vulvar lymphangioma circumscriptum, we report two cases of this rare clinical entity. CASE REPORTS Two female patients, aged 56 and 68 years, presented with persistent edema of the lower limbs, papule-like condyloma of the labia majora, and lymph oozing from these papules of the vulva, which had developed 24 and 10 years, respectively, after radical hysterectomy with adjuvant pelvic radiation therapy for cervical cancer. After major labiaectomy was performed, symptoms in the first case, of extensive resected skin margin, improved clearly, in the second case, vulvar lymphangioma circumscriptum was more severe than in the first case, and a small amount of lymph oozing occurred from residual papules of the labia majora. In both cases, histology revealed lymphangioma circumscriptum of the vulva. CONCLUSION Major labiaectomy is an effective therapy for vulvar lymphangioma circumscriptum. Particularly, in the case which was extensive and deep resected skin margin, symptoms such as papules of the labia majora and lymph oozing from these papules of the vulva associated with lymphangioma seemed to be clearly improved.
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Affiliation(s)
- Masae Ikeda
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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Abstract
A flap is described for recreation of the labia majora. The flap was designed for a young woman who developed vulvar squamous cell carcinoma in-situ after immunosuppression for treatment of juvenile rheumatoid arthritis. The patient underwent removal of the labia majora, and was reconstructed with a bi-lobed abdominal flap tunneled through the mons pubis. The flap produced a normal genital contour and has functioned well to seven years follow-up.
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Affiliation(s)
- Daniel F Haynes
- Department of Surgery, East Tennessee State University, 325 North State of Franklin Road, Johnson City, TN 37604, USA.
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Abstract
Lichen sclerosus (LS) is an inflammatory skin disease predominantly affecting the anogenital region. If untreated, progressive sclerosis results in scarring with distortion of the normal architecture. LS occurs more commonly in women than men but may occur in all age groups, including adolescents and prepubertal children. Its exact prevalence is unknown, but estimates range from 1:60 to 1:1000. In this article, LS is discussed in detail with respect to disease management in adults and children, risk of malignancy, and association with other diseases.
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Affiliation(s)
- Ruth Murphy
- Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, UK.
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Hata H, Aoyagi S, Iitani MM, Homma E, Shimizu H. Squamous cell carcinoma in a chronic genital ulcer in Behçet's disease. Acta Derm Venereol 2010; 90:539-40. [PMID: 20814642 DOI: 10.2340/00015555-0902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yang Y, Gao YL, Yu AJ, Zhang JJ. [Clinical analysis of 13 cases with vaginal intraepithelial neoplasia]. Zhonghua Fu Chan Ke Za Zhi 2010; 45:197-200. [PMID: 20450756] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the pathogenesis, high risk factors, clinical characteristics, methods of diagnosis and treatment, and prognosis of vaginal intraepithelial neoplasia (VAIN). METHODS The clinical data of thirteen cases of VAIN treated in Zhejiang Provincial Cancer Hospital dated Mar. 2002 through Dec. 2008 were reviewed and analyzed retrospectively. RESULTS Twelve of 13 VAIN cases were performed the human papillomavirus (HPV) detection with 92% (11/12) HPV positive rate. None of the cases shown specific clinical manifestation. Among the 13 cases, 6 of them accompanied with cervical cancer, 4 cases with cervical intraepithelial neoplasia (CIN), and 3 cases with vulvar intraepithelial neoplasma (VIN). Five cases synchronously diagnosed with cervical lesion and 3 with vulva lesion were underwent surgery, while the other 5 cases were diagnosed metachronously. Among 8 cases underwent surgery, 1 case with CIN underwent argon plasma coagulation (APC) after surgery, 1 case with the positive edge of VIN underwent APC. During follow up, 1 case with locally advanced cervical cancer underwent radiotherapy again, 3 cases with VAIN received APC, while 1 cervical cancer cases with VAIN received no treatment. The average follow-up time was 25.6 months (range 6-87 months). Two cases died of cervical cancer metastasis. The other 11 cases were normal and still alive. None of them progressed to invasive carcinoma. CONCLUSIONS The main reason of VAIN is HPV infection. There are not specific clinical manifestations, usually diagnosed when reviewing cervical or vulva lesions and rarely progressed to invasive carcinoma. The main treatment of VAIN is surgery with the adjuvant treatment of APC.
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Affiliation(s)
- Yue Yang
- Department of Gynecology Oncology, Zhejiang Provincial Cancer Hospital, Hangzhou 310022, China.
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Bafna UD, Devi UMA, Naik KA, Hazra S, Sushma N, Babu N. Carcinoma of the vulva: a retrospective review of 37 cases at a regional cancer centre in South India. J OBSTET GYNAECOL 2009; 24:403-7. [PMID: 15203581 DOI: 10.1080/01443610410001685547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 10/26/2022]
Abstract
A retrospective review of 37 cases of carcinoma of the vulva presenting between 1996 and 2000 has been carried out. Thirty-three cases were managed with curative intent and four cases with advanced loco-regional disease were managed with palliative intent. The surgical treatment consisted of wide excision in one case, radical vulvectomy (RV) in six cases, radical vulvectomy and bilateral groin node dissection (RV+BGND) in 25 cases and radical vulvectomy and unilateral groin node dissection in one case. Nine of these 33 women also received adjuvant chemotherapy preoperatively in the hope of achieving better tumour-free surgical margins. Eight cases had a partial response and one case achieved complete response; the surgical margins were free in all these patients. One case received neoadjuvant radiotherapy to the vulva and pelvis followed by RV+BGND, which revealed no residual tumour. Overall, 26/33 cases had groin/inguinal node dissection and 23 (88.4%) of them had groin wound dehiscence. Thirteen of these 26 patients (50%) had inguinal node metastases (Stage III, four patients; Stage IV, nine patients). All the patients with negative nodes were free of disease while three of four patients with Stage III and two of nine patients with Stage IV with nodal metastases remained free of disease. The only patient with Stage III disease plus inguinal node metastases who recurred had multiple positive nodes with extracapsular spread. It appears that although bilateral involvement of the inguinal lymph nodes carries a worse prognosis, unilateral involvement with or without vaginal involvement carries an excellent prognosis provided multiple nodes are not involved. The role of neoadjuvant chemotherapy as compared to neoadjuvant radiotherapy, in locally advanced tumours, needs to be explored further.
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Affiliation(s)
- U D Bafna
- Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka State, India.
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Affiliation(s)
- J Amu
- Department of Obstetrics and Gynaecology, Watford General Hospital, Watford, UK.
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40
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Kong WM, Sun JH. [Vulvar intraepithelial neoplasia and vaginal intraepithelial neoplasia]. Zhonghua Fu Chan Ke Za Zhi 2009; 44:161-162. [PMID: 19570436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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41
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Zhang GY, Wu LY, Li B, Yang L, Zhao D, Yu GZ. [Clinical analysis of 35 cases of vulvar intraepithelial neoplasia grade III]. Zhonghua Fu Chan Ke Za Zhi 2009; 44:163-166. [PMID: 19570437] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the etiology, clinicopathological characteristics, treatment and prognosis of VINIII. METHODS Thirty-five patients with VINIII admitted in Cancer Hospital of Chinese Academy of Medical Sciences between 1993 and 2008 were analyzed retrospectively. RESULTS All 35 patients attended to hospital with the symptoms of pruritus vulvae and lumps. Among of them, there were 28 (80%) cases whose lesions presented as multiple plaques, while 7 (20%) cases lesion were monofocal. Fifteen out of 35 cases had coexistent with human papillomavirus (HPV) related lesions, and there were the evidence of HPV in 22 patients whose pathologic sections revealed koilocytes. 34 cases (97%) except one received different types of surgical resections, including wide local resection (14/34), simple vulvectomy (16/34) and simple vulvectomy plus perianal skin resection (4/34), while there two cases shown positive cut-edges and one of them received radiotherapy postoperatively. Four out of the 34 cases recurred locally in 2, 4, 6 and 22 months and received surgical treatment again or laser therapy, respectively. The median follow-up period was 66 months (range 1-166), and none of them were died of the disease itself except one case died of the concurrent cervical cancer. Among 26 cases received the investigation of the quality of life, there were nine cases (35%) suffered from sexual dysfunction after the operation, and one of them received vulvoplasty. CONCLUSIONS VINIII has good prognosis. The development of VINIII may be related to the infection of HPV, because most of them concurrent with HPV diseases. Its primary treatment is surgical resection, while affecting on the quality of life.
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Affiliation(s)
- Gong-yi Zhang
- Department of Gynecologic Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
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Olejek A, Kozak-Darmas I, Kellas-Sleczka S, Jarek A, Wiczkowski A, Krol W, Stencel-Gabriel K. Chlamydia trachomatis infection in women with lichen sclerosus vulvae and vulvar cancer. Neuro Endocrinol Lett 2009; 30:671-674. [PMID: 20035265] [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] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 05/15/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Chronic infections in the urogenital area often precede or coexist with vulvar cancer. A strong connection between some tumours and the-appearance of Chlamydia trachomatis infection has been observed, but there is little information concerning a connection of that infection with vulvar cancer and lichen sclerosus vulvae (LS). The aim of this study was the analysis of frequency of antigens appearance and antibodies of IgM and IgG Chlamydia trachomatis in patients with vulvar cancer and LS and we wanted to find the correlation between Chlamydia trachomatis infection and vulvar cancer and LS. METHODS 80 women treated in the Clinic of Vulva Diseases at the Department and Clinical Ward of Gynaecology, Obstetrics and Oncological Gynaecology in Bytom, in the Silesian Medical University in Katowice were divided into two groups - 30 were treated for vulvar cancer and 50 were treated because of LS. We took bacterial smears vagina and cervical smears for presence of Chlamydia trachomatis antigens and peripheral blood to mark antibodies of IgM and IgG Chlamydia trachomastis. RESULTS Chlamydia trachomatis antigen was found in 20% women with vulvar cancer and in 12% women with LS (p>0.05). In 13,3% cases with vulvar cancer we observed IgM Chlamydia trachomatis antibodies. In the group with LS IgM antibodies appeared in 16% women (p>0.05). In 50% patients with vulvar cancer in blood serum we observed IgG Chlamydia trachomatis antibodies, and in 16% women with LS (p<0.001). CONCLUSIONS Previous Chlamydia trachomatis infection can lead to vulvar carcinogenesis.
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Affiliation(s)
- Anita Olejek
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, Poland.
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Guida M, Paladini D, Greco E, Di Spiezio Sardo A, Coppola C, Nappi C. Pregnancy-induced symptomatic pelvic and extra-pelvic cavernous hemangiomatosis. CLIN EXP OBSTET GYN 2009; 36:55-57. [PMID: 19400421] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Pregnancy-induced pelvic and extra-pelvic cavernous hemangiomatosis is a serious condition, associated with considerable maternal and fetal risks. This report describes the ultrasound (US) features and the clinical management of such rare condition in a young caucasian woman. CASE A 20-year-old woman was referred to our department following the occurrence of swelling in her inguinal and vulvar area together with lipotimic episodes. Diffuse cavernous hemangiomatosis of the pregnant uterus associated with vaginal, inguinal and vulvar varicosities was diagnosed clinically and by 2D and 3D US. The patient underwent expectant management of the gestation, under close US monitoring of both superficial and inner varicosities, careful surveillance of the maternal and fetal condition and prophylaxis for thrombotic complications with medical therapy. A cesarean section was performed at 37 weeks of gestation because of the worsening of her lipotimic episodes and her unfavorable Bishop's score. CONCLUSION This is the first report in which pregnancy-induced varicose disease involved contemporarily uterine, vaginal, inguinal, and vulvar veins totally sparing the lower extremities. This case suggests that, under close monitoring, a conservative approach can be adopted in such conditions. Vaginal delivery is to be preferred, but if cesarean section is required, the surgery should be performed under general anesthesia and packed red cells and plasma units should always be available.
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Affiliation(s)
- M Guida
- Department of Obstetrics and Gynecology, University of Naples Federico II, Naples, Italy
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Hussain SK, Madeleine MM, Johnson LG, Du Q, Malkki M, Wilkerson HW, Farin FM, Carter JJ, Galloway DA, Daling JR, Petersdorf EW, Schwartz SM. Cervical and vulvar cancer risk in relation to the joint effects of cigarette smoking and genetic variation in interleukin 2. Cancer Epidemiol Biomarkers Prev 2008; 17:1790-9. [PMID: 18628433 DOI: 10.1158/1055-9965.epi-07-2753] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cigarette smoking is an established cofactor to human papillomavirus (HPV) in the development of cervical and vulvar squamous cell carcinoma (SCC), and may influence risk through an immunosuppressive pathway. Genetic variation in interleukin 2 (IL2), associated in some studies with the inhibition of HPV-targeted immunity, may modify the effect of smoking on the risk of HPV-related anogenital cancers. We conducted a population-based case-only study to measure the departure from a multiplicative joint effect of cigarette smoking and IL2 variation on cervical and vulvar SCC. Genotyping of the four IL2 tagSNPs (rs2069762, rs2069763, rs2069777, and rs2069778) was done in 399 cervical and 486 vulvar SCC cases who had been interviewed regarding their smoking history. Compared with cases carrying the rs2069762 TT genotype, we observed significant departures from multiplicativity for smoking and carriership of the TG or GG genotypes in vulvar SCC risk [interaction odds ratio (IOR), 1.67; 95% confidence interval (CI), 1.16-2.41]. Carriership of one of three diplotypes, together with cigarette smoking, was associated with either a supramultiplicative (TGCT/GGCC; IOR, 2.09; 95% CI, 0.98-4.46) or submultiplicative (TTCC/TGTC; IOR, 0.37; 95% CI, 0.16-0.85 or TGCT/TGCC; IOR, 0.37; 95% CI, 0.15-0.87) joint effect in vulvar cancer risk. For cervical SCC, departure from multiplicativity was observed for smokers homozygous for the rs2069763 variant allele (TT versus GG or GT genotypes; IOR, 1.87; 95% CI, 1.00-3.48), and for carriership of the TTCC/TTCC diplotype (IOR, 2.08; 95% CI, 1.01-4.30). These results suggest that cervical and vulvar SCC risk among cigarette smokers is modified by genetic variation in IL2.
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Affiliation(s)
- Shehnaz K Hussain
- Program in Epidemiology, Division of Public Health Sciences, University of Washington, Seattle, WA, USA.
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Raspollini MR, Asirelli G, Moncini D, Taddei GL. A comparative analysis of lichen sclerosus of the vulva and lichen sclerosus that evolves to vulvar squamous cell carcinoma. Am J Obstet Gynecol 2007; 197:592.e1-5. [PMID: 17714682 DOI: 10.1016/j.ajog.2007.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 12/20/2006] [Revised: 01/31/2007] [Accepted: 04/05/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether the premalignant change in lichen sclerosus (LS) could be identified with immunohistochemical analyses. STUDY DESIGN Eight cases of histologically diagnosed vulvar LS, which showed, after a period of 10 months-9 years, an evolution to carcinoma of the vulva that was histologically documented, were compared with 8 cases of vulvar LS, for which follow-up information was available for at least 9 years. The proliferative index and the expression of tumor suppressors p16 and p53 were analyzed. RESULTS The difference of MIB1 labeling index of evolving or unchanged LS cases was significant (P = .005). The difference in the p53 of evolving or unchanged LS cases shows a trend towards association (P = .08). Both LS cases (evolving or unchanged) did not show p16 positive staining. CONCLUSION The evaluation of MIB1 and p53 may identify those vulvar LS cases with a high likelihood of evolving into squamous cell carcinoma, which would need careful periodic checks or adjunctive biopsies. The study must be confirmed by a larger number of cases to substantiate this observation.
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Affiliation(s)
- Maria Rosaria Raspollini
- Department of Human Pathology and Oncology, University of Florence School of Medicine, Florence, Italy.
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Amouri M, Masmoudi A, Boudaya S, Amouri A, Ben Ali I, Bouassida S, Guermazi M, Turki H. Acquired lymphangioma circumscriptum of the vulva. Dermatol Online J 2007; 13:10. [PMID: 18319007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Lymphangiomas are rare benign proliferations of the lymphatic system. Acquired lymphangioma circumscriptum of the vulva is induced by impaired lymph flow. We describe a new case of lymphangioma circumscriptum resulting from tuberculosis involving a lymph node. A 45-year-old female presented with swelling of the vulva for the past 8 years. She had a history of multiple left inguinal swellings successfully treated with four antituberculosis drugs. Her vulval swelling did not respond and was diagnosed as acquired lymphangioma circumscriptum. She becomes the fifth reported case of acquired lymphangioma circumscriptum of the vulva with tubercular lymphadenitis. The single antituberculosis treatment is insufficient to control lymphangioma. Ablative methods seem encouraging.
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Affiliation(s)
- Meriem Amouri
- Department of dermatology, Hédi Chaker Hospital, Sfax, Tunisia
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Abstract
BACKGROUND As the first generation of women who received cosmetic breast implants ages, questions remain about cancer risk. This study is an update of the Los Angeles Augmentation Mammaplasty Study and examines cancer risk among women with long-term exposure to breast implants. METHODS The authors conducted a record linkage cohort study of patients with cosmetic breast implants by abstracting from records of the private practices of 35 board-certified plastic surgeons in Los Angeles County, California. They included 3139 Caucasian women who received cosmetic breast implants between 1953 and 1980. Spanish-surnamed women, nonresidents of Los Angeles County, and patients with prior subcutaneous mastectomy or breast cancer were excluded. Cancer outcomes through 1994 were ascertained through record linkage with the Los Angeles County Cancer Surveillance Program. RESULTS With a mean follow-up period of 15.5 years, 43 cases of breast cancer were observed, compared with 62.6 expected, based on Los Angeles County population-based incidence rates (standardized incidence ratio, 0.69; 95% CI, 0.50 to 0.93). Significant increases were observed for cancer of the lung and bronchus (standardized incidence ratio, 2.14; 95% CI, 1.42 to 3.09) and vulvar cancer (standardized incidence ratio, 3.47; 95% CI, 1.39 to 7.16). CONCLUSIONS The breast cancer results of this study are consistent with the previous reports of the Los Angeles study as well as with several other long-term cohort studies. Lung cancer has previously been found to be increased in this cohort and also in some, but not most, other studies. The increased risk of vulva cancer has previously been observed in this cohort and just one other.
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Affiliation(s)
- Dennis M Deapen
- Los Angeles, Calif. From the Department of Preventive Medicine, Division of Plastic Surgery, and Keck School of Medicine, University of Southern California
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49
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Van Rossum MM, van der Avoort IAM, de Hoop D, Dukel L, van der Vleuten CJM, de Hullu JA. [Lichen sclerosus]. Ned Tijdschr Geneeskd 2007; 151:1225-31. [PMID: 17583090] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Lichen sclerosus is a chronic disorder of skin and mucosa which affects patients of all age groups, particularly women, but also men. It is most commonly seen on the female genital skin, but it also occurs on extragenital areas. Most patients complain of itching and, less frequently, a burning sensation, dyspareunia, dysuria and painful defecation are reported. The cause of lichen sclerosus is largely unknown. However, it has been suggested that a genetic predisposition to inflammatory disorders, an immunological constitution, hormonal influences and local factors might play a role. Anogenital lichen sclerosus is associated with an increased incidence of malignancies, especially vulvular squamous-cell carcinomas. The life-time risk of developing this carcinoma is about 5%. Extragenital lichen sclerosus and lichen sclerosus in children do not seem to be correlated with malignancy. Potent local corticosteroids form the mainstay of treatment for lichen sclerosus. The condition is characterised by remissions and exacerbations. Long-term follow-up is required for the early diagnosis of malignant changes.
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Affiliation(s)
- M M Van Rossum
- Afd. Dermatologie, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen.
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50
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Abstract
Although the presence of racial differences in vulvar squamous cell carcinomas has been suggested, fully analyzed data concerning such tumors in Japanese women have not been reported. A total of 21 vulvar squamous cell carcinomas of Japanese women who lived in north-east Japan, were studied with respect to histological subtype, HPV, p53 and p16(INK4a). The majority of tumors consisted of keratinizing and non-keratinizing types (16/21, 76%), all of which were negative for HPV. The remaining five tumors of basaloid, warty or verrucous types were positive for HPV. HPV-negative tumors showed a trend of greater accumulation of gene abnormalities, including p53 gene mutation, than HPV-positive ones. p16(INK4a) overexpression was shown to not always be a marker for vulvar squamous cell carcinoma in Japanese women with activated high-risk HPV.
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Affiliation(s)
- Mitsumasa Osakabe
- Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan.
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