Epidemiología del virus del papiloma humano / Epidemiology of human papillomavirus

Resumen La presente revisión narrativa fue realizada con el objeto de investigar y recopilar la información más reciente y relevante sobre la epidemiología del Virus del Papiloma Humano y su relación con las patologías asociadas a él, en especial la patología maligna del área genital femenina. La revisión de la literatura fue realizada electrónicamente en PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, y Google Scholar para los artículos escritos en el idioma inglés. Los portales Scielo, Latindex, Imbiomed-L, Redalyc y Google Scholar fueron revisados en búsqueda de artículos escritos en el idioma español. La búsqueda incluyó las palabras claves: epidemiología del virus del papiloma humano, taxonomía viral, estructura del virus del papiloma humano, clasificación del virus del papiloma, nomenclatura del virus del papiloma humano, patologías asociadas al virus del papiloma humano, virus papiloma humano y cáncer del cuello uterino, virus del papiloma humano y cáncer de vulva, y virus del papiloma humano y cáncer de vagina. Se buscaron, revisaron y analizaron las publicaciones desde enero de 1987 hasta agosto de 2021. Esta revisión narrativa investigó la epidemiología del virus del papiloma humano y sus patologías asociadas, en especial las malignas del área genital femenina.

Abstract The present narrative review was conducted to investigate and to compile the most recent and relevant information about the epidemiology of the Human Papilloma Virus and its relationship with the pathologies associated with it. Literature searches were performed electronically in PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, and Google Scholar for original articles written in the English language and Scielo, Latindex, Imbiomed-L, Redalyc, and Google Scholar for original articles written in the Spanish language. The searches included the keywords: epidemiology of human papillomavirus, viral taxonomy, the structure of human papillomavirus, classification of human papillomavirus, the nomenclature of human papillomavirus, pathologies associated to human papillomavirus, human papillomavirus and cervical, human papillomavirus and vulvar cancer and human papillomavirus and vaginal cancer Publications from January 1987 to August 2021 reviewed. This narrative review researched the epidemiology of the human papillomavirus and its pathologies associated especially the female genital area.

Hidradenoma papilífero de la vulva con componente de carcinoma in situ: reporte de caso y revisión de la bibliografía / Papilliferous hidradenoma of the vulva with carcinoma in situ component: case report and literature review

Resumen ANTECEDENTES: El cáncer de vulva es relativamente raro, representa menos del 1% de los tumores malignos de la mujer; su incidencia aumenta con la edad. La variedad más frecuente es el carcinoma escamoso (80 al 90%), seguido del melanoma. En este reporte se revisa un carcinoma de origen glandular, como el hidradenoma papilífero del tipo glándula mamaria (mammary-like) de la vulva. CASO CLÍNICO: Paciente de 50 años, con una lesión papular en la vulva de dos años de evolución, con crecimiento lento y progresivo, ocasional sensación de masa y dolor, con colposcopia negativa, sin antecedentes de patología mamaria y con una biopsia previa que reportó hidradenoma papilífero vulvar. Se trató con resección completa de la lesión, con anestesia regional, con bordes libres, no se identificó algún componente infiltrante. En la actualidad permanece sin evidencia de recaída ni requerimiento de tratamientos adicionales durante el seguimiento. CONCLUSIÓN: El hidradenoma papilífero es una lesión benigna, poco frecuente, relacionada con las glándulas anogenitales de tipo mammary-like, con buen pronóstico. El tratamiento recomendado es la escisión quirúrgica, que casi siempre es curativa.

Abstract BACKGROUND: Vulvar cancer is relatively rare, representing less than 1% of malignant tumors in women; its incidence increases with age. The most frequent variety is squamous cell carcinoma (80 to 90%), followed by melanoma. In this report we review a carcinoma of glandular origin, such as papilliferous hydradenoma of the vulva of the mammary gland (mammary-like) type. CLINICAL CASE: We present a 50-year-old patient with 2 years evolution of a papular lesion on the vulva with slow and progressive growth, intermitent sensation of mass and pain, with negative colposcopy, no history of breast pathology and with a previous biopsy that reported vulvar papilliferous hydradenoma. She was treated with complete resection of the lesion under regional anesthesia, with free margins, without identifying an infiltrating component and currently without evidence of relapse or requirement of additional treatments. CONCLUSION: Papilliferous hidradenoma is a rare benign lesion related to the mammary-like anogenital glands, with a good prognosis and its recommended treatment is surgical excision, which is generally curative.

Inmunohistoquímica de p16 y p53 en cáncer de vulva / Immunohistochemistry of p16 and p53 in vulvar cancer

El carcinoma escamoso vulvar puede desarrollarse de manera asociada o independiente a la infección por HPV. La relación entre la patogénesis, la clasificación, el perfil inmunohistoquímico, y el pronóstico ha sido estudiada con algunas discrepancias. El objetivo del trabajo fue observar la concordancia clásicamente descripta que asocia a los carcinomas queratinizantes con la ausencia de infección por HPV y a los carcinomas warty y basaloides con la presencia de dicho virus. Para ello, revisamos la clínica, la morfología y el inmunofenotipo de 39 casos de nuestro hospital. Los tumores fueron clasificados histológicamente en carcinomas escamosos queratinizantes clásicos (30), warty (5) y basaloides (4). En el análisis estadístico la expresión de p16 fue asociada de manera significativa con una edad menor al momento del diagnóstico (p = 0.0025), presencia de lesión intraepitelial escamosa de alto grado (p < 0.0001), coilocitosis (p = 0.02), y subtipo morfológico (p = 0.02); y fue inversamente asociado con la expresión de p53 (p < 0.0001) y con el liquen escleroso (p = 0.0051). Resulta peculiar que, de los casos estudiados, 4 carcinomas queratinizantes coexpresaron p16 y p53. Un solo tumor de tipo warty resultó negativo para p16 y positivo para p53, y 9 queratinizantes resultaron positivos para p16 y negativos para p53. Si bien estos hallazgos indican que con la sola utilización de la hematoxilina y eosina podrían definirse de manera correcta los tumores asociados al HPV, sugerimos fuertemente la realización de inmunohistoquímica, especialmente en carcinomas escamosos queratinizantes en pacientes jóvenes o con historia de HPV.

Squamous cell carcinoma of the vulva may develop in association or independently of HPV infection. The relationship between pathogenesis, classification, immunohistochemical profile and prognosis has been studied in the literature with some discrepancies. The aim of this study was to observe the classical association of keratinizing carcinomas with the absence of HPV infection and warty and basaloid carcinomas with the presence of this virus. Therefore, we reviewed the clinic, morphology, and immunophenotype of 39 cases. The tumors were histologically classified into classic keratinizing squamous carcinoma (30), warty (5) and basaloid (4). In the statistical analysis, diffuse expression with p16 was significantly associated with younger age (p = 0.0025), presence of high-grade intraepithelial lesion (p < 0.0001), koilocytosis (p = 0.02), and morphological subtype (p = 0.02), and was inversely associated with the expression of p53 (p < 0.0001) and the presence of lichen sclerosus (p = 0.0051). It is curious that 4 keratinizing carcinomas of the cases studied presented coexpression of p16 and p53. Only one warty tumor was negative for p16 and positive for p53, and 9 keratinizing tumors were positive for p16 and negative for p53. Although these findings show that the use of hematoxylin and eosin could correctly define tumors associated with HPV, we strongly suggest the performance of immunohistochemistry, especially in squamous keratinizing classic carcinomas in young patients with a history of HPV.

Reconstrucción vulvar con colgajo fasciocutáneo del surco glúteo / Vulvar reconstruction with fasciocutaneous fl ap of the gluteal fold

Introducción. La reconstrucción inmediata de la región vulvar posterior a vulvectomía radical por patología oncológica representa un desafío para el cirujano plástico dado el tamaño del defecto que genera dicha cirugía, en relación con la complejidad que posee la región anatómica a tratar. Material y métodos. Se presenta el caso de una paciente de sexo femenino de 74 años de edad con antecedentes de resección local de tumor vulvar asociado a radioterapia adyuvante en otra Institución, 5 años previos a la consulta. Actualmente presenta recidiva de su enfermedad. Se aborda de forma multidisciplinaria y se realiza vulvectomía radical más reconstrucción inmediata del defecto con dos colgajos del surco glúteo. Resultado. Una vez realizada la cirugía, la paciente fue dada de alta de la Institución al séptimo día posoperatorio y fue instruida para evitar sentarse durante 7 días más. Al 12 día posoperatorio presentó una dehiscencia parcial de la herida en región subglútea derecha, la cual se resolvió suturándola nuevamente. Al cumplirse 1 mes de la cirugía, la paciente se encontró satisfecha con el resultado estético y en condiciones de volver a su vida normal desde el punto de vista funcional y estético. Conclusión. El presente trabajo confirma que la utilización del colgajo fasciocutáneo del surco glúteo es una buena elección para la reconstrucción de la región vulvar, tanto estética como funciona

Background. The immediate reconstruction of the vulvar region after radical vulvectomy due to oncological pathology represents a challenge for the plastic surgeon do to the size of the defect generated by said surgery, in relation to the complexity of the anatomical region to be treated. Material and Methods. We present the patient 74-years-old woman with a history of local resection of vulvar tumor associated with adjuvant radiotherapy in another Institution and currently she has recurrence of the disease. Is addressed by a multidisciplinary team and radical vulvectomy is performed with immediate reconstruction of the defect with two gluteal fold fl aps. Results. Once the surgery was performed, the patient was discharged from the Institution on the seventh postoperative day and was instructed to avoid sitting for 7 days. On the 12th postoperative day, she presented a partial dehiscence of the wound, which was resolved by suturing it. One month after surgery, the patient was satisfi ed with the aesthetic result and able to return to her normal life from a functional point of view. Conclusion. The present work confi rms that the use of the fasciocutaneous fl ap of the gluteal fold is a very good option for the vulvar regionreconstruction, not only functionally as aesthetically

Cáncer de vulva. Repercusiones del tratamiento quirúrgico: experiencia con 151 pacientes / Vulvar cancer. Impact of surgical treatment: experience with 151 patients

Resumen Objetivo: Reportar la experiencia institucional en el tratamiento quirúrgico de pacientes con cáncer de vulva de acuerdo con la clasificación vigente de la Federación Internacional de Ginecología y Obstetricia (FIGO). Materiales y métodos: Análisis retrospectivo de expedientes de pacientes con diagnóstico de carcinoma vulvar operadas con o sin coadyuvancia en el servicio de Oncología del Hospital General de México en un lapso de 34 años. Para el análisis estadístico se utilizó el programa Epi Info versión 7.2. Resultados: Se incluyeron 151 pacientes: 24 (16%) con lesiones preinvasoras o con mínima invasión, se intervinieron con escisiones locales o vulvectomías simples; 16 (15%) con cánceres invasores en quienes se efectuó cirugía conservadora de la vulva con o sin disección ganglionar unilateral. En 94 (62%) se efectuaron vulvectomías con linfadenectomías: 47 con cirugías en bloque y 47 mediante incisiones separadas. En 11 (%) pacientes se practicaron cirugías ultrarradicales: 6 resecciones abdominoperineales y 5 exenteraciones pélvicas. De 127 pacientes que tuvieron seguimiento, 62 (49%) evolucionaron 30 meses en promedio sin evidencia de enfermedad. Se incluyen 21/23 (91%) lesiones tempranas (VIN 2,3 y I- A); 37/49, (76%) de las invasoras en estadios IB-II; 13/41, (32%) de los estadios III (p = 0.00007) y 3/14 (21%) de los IV-A. Conclusiones: Si bien la tendencia actual se orienta a individualizar el tratamiento quirúrgico de pacientes con cáncer de vulva invasor, en esta serie solo en 15% fueron cirugías conservadoras. La metástasis ganglionar fue el factor pronóstico más desfavorable.

Abstract Objective: The present study is a review of our experience of the surgical options for vulvar cancer using The International Federation of Gynecology and Obstetrics (FIGO) classification. Materials and methods: Retrospective analysis of records of patients diagnosed with vulvar carcinoma operated with or without coadyuvance in the Oncology service of the General Hospital of Mexico in a span of 34 years. For the statistical analysis, the Epi Info version 7.2 program was used. Results: Patients were divided into groups, those with pre-invasion or minimal invasion disease were resolved with local excision or simple vulvectomy 24 (16%). Patients with invasive cancer were treated with conservative surgery with or without unilateral lymph node dissection 16 (15%); radical vulvectomy with inguino femoral lymphadenectomy 94 (62%) (47 block surgeries and 47 with separate incision); ultra-radical surgery 11 (7%) (6 abdomino-perineal resections and 5 pelvic exenterations). 127 patients had follow-up and 62 of them had a disease-free survival rate of 30 months (48.8%). The overall survival in pre-invasion or minimal invasion disease were 91.3% (21/23), in stage IB-II 75.5% (37/49), in stage III 31.7% (13/41) (p=0.00007) and in stage IVA 21.4% ( 3/14 ). Conclusions: Although a more individualized and less radical treatment is suggested, in this series only 14.5% of patients, could be resolved with conservative surgery. In addition, the lymph node status was the most important prognostic factor for survival.

Carcinoma basocelular invasivo de vulva en una adulta / Basal cellular invasive vulvar carcinoma in an adult woman

Se presenta el caso clínico de una fémina de 32 años con seropositividad del virus de inmunodeficiencia humana desde hacía 2 años, quien acudió a la consulta de Ginecología del Hospital Gubernamental de Mbabane, en Suazilandia, por presentar una lesión en el labio mayor derecho de la vulva, unido a prurito y adenopatías en la región inguinal derecha. La paciente fue evaluada en la consulta de Oncología, donde se le diagnosticó un carcinoma basocelular invasivo de vulva, clasificado en estadio III luego de realizar los exámenes complementarios necesarios; posteriormente fue remitida a Sudáfrica para recibir radioterapia y quimioterapia combinadas.

The case report of a 32 years female patient is presented with seropositivity of the human immunodeficiency virus for 2 years who came to the Gynecology Service of Mbabane Government Hospital, in Swaziland, due to a lesion in the right major lip of the vulva, together with pruritus and adenopathies in the right inguinal region. The patient was examined in the Oncology Service, where a basal cellular invasive vulvar carcinoma was diagnosed. It was classified in stage III after carrying out the necessary laboratory exams; later on she was transferred to South Africa to receive combined radiotherapy and chemotherapy.

Cáncer de vulva y su tratamiento en Alicante, España (2000-2013) / Vulvar carcinoma and treatment (200-2013)

Introducción: en los últimos años se ha incrementado el número de carcinomas de vulva, sobre todo en pacientes menores de 50 años, asociado al incremento del número de casos de neoplasia vulvar intraepitelial. Objetivo: describir nuestra casuística de lesiones invasivas vulvares. Métodos: se realiza una revisión retrospectiva de todas las neoplasias de vulva atendidas en el servicio de Obstetricia y Ginecología del Hospital General Universitario de Elche, Alicante, España desde 2000 hasta 2013. Resultados: esta serie comprende 38 casos. El carcinoma epidermoide fue la neoplasia más frecuente (78,9 por ciento). La supervivencia fue del 65 por ciento al finalizar el segundo año. La edad, el estado ganglionar, la presencia de márgenes afectos y el estadio tumoral, fueron predictores estadísticamente significativos para la supervivencia global. Conclusiones: la afectación ganglionar es un factor pronóstico importante para la supervivencia global. La elección de una técnica quirúrgica más conservadora disminuye la estancia hospitalaria sin modificar las tasas de recidivas ni la supervivencia(AU)

Introduction: In recent years it the number of vulvar carcinomas has increased, especially in patients younger than 50, associated with the increase of number of cases of vulvar intraepithelial neoplasia. Objective: Describe our casuistic of vulvar neoplasia in the last 14 years and Determine prognostic variables for survival. Methods: Aretrospective review of all vulvar malignancies is conducted for those treated at Obstetrics and Gynecology Department of Elche University General Hospital, Alicante, Spain, from 2000 to 2013. Results: Our series included 38 patients. The most frequent neoplasm was squamous cell carcinoma (78.9 percent). Global survival at 2 years was 65 percent. Age, lymph node metastasis, involvement of resection margins and tumor stage, were statistically significant predictors for overall survival. Conclusions: Inguino-femoral lymph node status is an important prognostic factors for overall survival. Conservative surgery improves postoperative morbidity without modifying outcomes(AU)

Tendências e projeções da mortalidade pelos cânceres específicos ao gênero no Brasil / Trends and projections of mortality for specific cancers gender in Brazil

Os cânceres que acometem os órgãos genitais masculinos e femininos, em conjunto com o câncer de mama, são responsáveis por cerca de 20% dos óbitos por câncer no mundo. Conhecer os padrões de mortalidade por esses cânceres no Brasil, as mudanças que se produziram ao longo do tempo, os grupos mais vulneráveis e a carga de mortalidade que se apresentará no futuro são elementos básicos para a estruturação das ações assistenciais e de vigilância do câncer. O objetivo desse estudo foi analisar as tendências de mortalidade pelos cânceres que acometem órgãos que são específicos a cada gênero e projetar a mortalidade por esses cânceres até o ano de 2030, para o Brasil, regiões e estados da federação. Trata-se de um estudo ecológico de base populacional que analisou os óbitos, ocorridos no período 1996 a 2010, decorrentes dos cânceres de colo do útero, corpo do útero, mama feminina, ovários, vulva, vagina, próstata, pênis e testículos, registrados no Sistema de Informação sobre Mortalidade; as informações sobre população foram obtidas do Instituto Brasileiro de Geografia e Estatística. Foi aplicada a Regressão loglineal (Joinpoint regression) com taxas padronizadas (população mundial: ASR-W) para estimar o Annual Percentage Change (APC), o Average Annual Percentage Change (AAPC), o intervalo de confiança 95% e os pontos de inflexão da curva; as projeções foram calculadas através do programa Nordpred, inscrito no programa R, utilizando o modelo idade-período-coorte, analisando posteriormente se as mudanças que se produzirão no futuro serão decorrentes da exposição aos fatores de risco e/ou da estrutura da população exposta ao risco. Todas as análises também foram aplicadas para o conjunto de todos os óbitos por câncer (com exceção dos cânceres de pele não-melanoma).

Para o Brasil, a mortalidade pelos cânceres de pênis (APC=1,5% IC95% 0,7;2,3 p<0,05), testículos (APC=1,6% IC95% 0,5;2,8 p<0,05) e ovários (APC=0,8% IC95% 0,1; 1,5 p<0,05), mostraram tendência de aumento, enquanto os cânceres de vulva e vagina (APC=-0,1% IC95% -0,9; 0,7 p=0,8), corpo de útero (APC= -0,3 IC95% -1,0; 0,5 p=0,4), mama (APC=0,4% IC95% -0,2;1,0 p=0,2) e de próstata (AAPC= 1,1% IC95% -0,2; 2,4 p=0,1) apresentaram tendência de estabilidade. A mortalidade por câncer de colo de útero apresentou tendência de redução (APC=-1,7% IC95%-2,2; -1,1 p<0,05). A análise do agrupamento de todos os óbitos por câncer observou tendência de aumento na mortalidade para o sexo masculino até o ano de 2006 (APC= 1,2% IC95% 0,6;1,8 p<0,01), seguido de um período de estabilidade. Para o sexo feminino, a tendência é de estabilidade (APC=0,4% IC95% -0,2;-1,8 p=0,2). As taxas de mortalidade para todos os cânceres analisados mostraram, de maneira geral, tendência de redução nas regiões sul e sudeste, tendência de aumento nas regiões norte e nordeste, e estabilidade para a região centro oeste. Na projeção da mortalidade para o ano 2030, as regiões norte e nordeste responderão pelas maiores taxas de mortalidade para os cânceres analisados; todavia, para as demais regiões, será observada redução nas taxas em comparação com o último período observado. Destacase o câncer de testículo, para o qual será observado aumento de 33% na carga da mortalidade até o ano 2030. Para os demais cânceres, não serão observadas variações consideráveis nas taxas de mortalidade para o Brasil entre o último período observado e o último período projetado. A estrutura e o tamanho da população brasileira serão os fatores que explicarão os padrões de mortalidade por esses cânceres no futuro, embora para a região nordeste, as variações serão explicadas, em maior medida, pelo aumento do risco para esses cânceres.

Conclui-se, portanto, que existe uma marcante desigualdade na distribuição da mortalidade pelos cânceres específicos ao gênero no Brasil, onde as regiões mais pobres apresentam um quadro de aumento significativo do número de óbitos ao longo de uma série histórica, e que em 2030, essas regiões responderão pelas maiores taxas de mortalidade no país, com ênfase para os cânceres de pênis, testículos e ovários. (AU)

Cancers that attack male and female genital organs, along with breast cancer, are responsible for approximately 20% of cancer-related deaths in the world. Knowledge on the mortality patterns for these cancers in Brazil, the changes produced throughout time, the most vulnerable groups and the mortality burden in the future are basic elements for structuring assistance and vigilance actions for cancer. The objective of this study was to analyze the mortality trends of cancers that attack gender-specific organs, and project mortality until the year 2030, for Brazil, its geographic regions, and federation states. A population-based ecological study is presented herein, which analyzed deaths occurring within the period 1996-2010, due to cancers of the uterine cervix, uterine corpus, female breast, ovary, vulva, vagina, prostrate, penis and testicles, registered in the Mortality Information System. Data on population was obtained from the Brazilian Institute of Geography and Statistics. Joinpoint regression was applied with standardized rates (world population: ASR-W) to estimate the Annual Percentage Change (APC), the Average Annual Percentage Change (AAPC), the confidence interval 95% and the inflection points of the curve. The projections were calculated by the Norpred program, inscribed within the R program, utilizing the age-period-cohort model, with posterior analysis of whether the changes produced in the future will be consequences of exposition to risk factors and/or structure of the population exposed to risk. The analyses were also applied to the set of all cancer-related deaths (with exception for non-melanoma skin cancers). For Brazil, mortality due to cancers of penis (APC=1.5% CI95% 0.7;2.3 p<0.05), testicles (APC=1.6% CI95% 0.5;2.8 p<0.05) and ovary (APC=0.8% CI95% 0.1; 1.5 p<0.05) showed increasing trends, while cancers of vulva and vagina (APC=-0.1% IC95% -0.9; 0.7 p=0.8), uterine corpus (APC=-0.3 CI95% - 1.0; 0.5 p=0.4), breast (APC=0.4% CI95% -0.2;1.0 p=0.2) and prostrate (AAPC= 1.1% CI95% -0.2; 2.4 p=0.1) presented stable trends. Mortality due to cervical cancer presented reducing trends (APC=-1.7% ICI95%-2.2; -1.1 p<0.05). Analysis of the grouping of all cancer-related deaths presented increasing mortality trends for the male gender until the year 2006 (APC= 1.2% CI95% 0.6; 1.8 p<0.01), followed by a stability period. For females, the trend was stable (APC=0.4% CI95% -0.2;-1.8 p=0.2). The mortality rates for all analyzed cancers revealed, generally, reducing trends for the South and Southeast regions, increasing trends for the North and Northeast regions, and stability for the Midwest region. Mortality projections for the year 2030 indicate that the North and Northeast regions will suffer the highest mortality rates for the analyzed cancers; however, for the remaining regions, reduced rates will be observed in comparison with the last period analyzed. It must be highlighted that, for testicle cancer, there will be an increase of 33% in mortality burden until the year 2030. For the remaining cancers, significant variations will not be observed in mortality rates for the last observed period and the last projected period in Brazil. The structure and size of the Brazilian population are the factors explaining the mortality patterns for these cancers in the future, although for the Northeast region, the variations will be explained mostly by the increase in risk for these cancers. It is concluded that there is a pronounced inequality in the distribution of gender-specific cancer mortality in Brazil, where the poorer regions present a significant increasing situation of the number of deaths throughout a historical series. In 2030, these regions will present the highest mortality rates in the country, with emphasis on penis, testicle and ovarian cancers. (AU)

Enfermedad de Paget extensa de la vulva: Presentación de un caso y propuesta de manejo conservador / Extensive Paget's disease of the vulva: Case report and a conservative management proposal

La enfermedad de Paget extramamaria (EPE) es una patología maligna observada, sobre todo, en áreas donde existe alta densidad de glándulas apocrinas. Presentamos el caso clínico de una paciente de 68 años de edad, atendida en la Clínica de Colposcopia del Servicio de Oncología, del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, con diagnóstico de enfermedad de Paget a nivel vulvar, vagina, región de periné y región perianal, manejada con sesiones de vaporización con láser, con evolución satisfactoria. Dado que es una enfermedad poco frecuente, más común en el sexo femenino y en la raza blanca, con mayor incidencia en la séptima década de la vida, como es el caso de nuestra paciente, el objetivo de este trabajo es presentar una revisión de la evaluación clínica, haciendo énfasis en el diagnóstico diferencial, uso de colposcopia para diagnóstico y tratamiento conservador fraccionado con vaporización de láser. La baja incidencia de la enfermedad de Paget de la vulva, vagina, periné y región perianal, así como la ausencia de informes sobre la posibilidad de tratamiento no quirúrgico, motivan a informar a la comunidad científica sobre el manejo con vaporización láser, con la intención de evitar la morbilidad que puede traer consigo el manejo quirúrgico convencional.

Extramammary Paget's disease (EPD) is a malignant disease observed, especially in areas with high density of apocrine glands. We report a case of a patient of 68 years old, attended at the Colposcopy Clinic of Oncology, National Institute of Perinatology Isidro Espinosa de los Reyes, diagnosed with Paget's disease of the vulva, vagina, perineum region and perianal region, and managed with laser vaporization sessions with satisfactory outcome. Since it is a rare disease, more common in females and in whites, with the highest incidence in the seventh decade of life, as is the case of our patient, propose in this paper to present a review of the clinical evaluation with emphasis on the differential diagnosis, use of colposcopy for diagnosis and dividing up conservative treatment with laser vaporization of the disease. The low incidence of Paget's disease of the vulva, vagina, perineum and perianal region, and the absence of reports on the possibility of nonsurgical treatment encouraged to inform the scientific community about the management with laser vaporization, with the intention of avoiding morbidity that can lead to the conventional surgical maneuvers.

Série de casos de neoplasia intraepitelial vulvar tratados com imiquimode / Case series of vulvar intraepithelial neoplasia treated with imiquimod

O termo neoplasia intraepitelial vulvar (NIV) inclui as lesões precursoras do câncer de vulva, sendo divididas em NIV escamosa e não escamosa. A NIV escamosa compreende a NIV tipo usual, a qual se encontra relacionada à infecção pelo HPV, à multicentricidade de lesões, à atividade sexual e ao fumo,sendo mais frequentemente observada em mulheres jovens. Já a NIV diferenciada está relacionada ao líquen escleroso, não estando associada à infecção induzida por HPV, nem ao comportamento sexual, acometendo pacientes mais idosas. A NIV não escamosa está relacionada à doença de Paget e ao melanoma in situ. O tratamento padrão da NIV é cirúrgico e consiste na excisão ampla da lesão com margem de segurança. Este estudo objetiva avaliar ouso do imiquimode creme a 5% no tratamento da NIV tipo usual de forma isolada e/ou, associado ao procedimento cirúrgico. O imiquimode já é utilizadocom eficácia no tratamento de lesões condilomatosas genitais. Além disso, tem-se mostrado eficaz em lesões de NIV tipo usual.

The term vulvar intraepithelial neoplasia (VIN) includes the precursor lesions of vulvar cancer, being divided into squamous VIN and non-squamous VIN. The squamous VIN refers to the usual type VIN, which is related to HPV infection, multicentricity of lesions, sexual activity and smoking beingmore frequently observed in young woman. The VIN differentiated type, which is related to vulvar dermatoses, such as lichen sclerosus, is not associated with HPV-induced infection or sexual behavior and affects older patients. Thenon-squamous VIN is related to Paget's disease and melanoma in "situ".The standard VIN's treatment is a surgical wide excision of the lesion with a safety margin. This study aims to test the use of imiquimod 5% cream in thetreatment of usual type VIN isolated, and/or associated with surgical procedure. The imiquimod is already successfully used in the treatment of genital condylomatous lesions. Moreover, it has been shown to be effective in usual type VIN lesions.

Carcinoma de Células escamosas de vulva. Presentación de 28 pacientes / Squamous cell carcinoma of the vulva. Experience in 28 patients

Introducción. El carcinoma de células escamosas de la vulva constituye el 1 al 4 % de los tumores en la mujer, y ocupa el cuarto lugar de las neoplasias del tracto genital femenino. Objetivos. Determinar la incidencia de carcinoma epidermoide de vulva, e identificar el grado de invasión. Material y métodos. Se realizó un estudio retrospectivo, observacional de las pacientes atendidas en el consultorio de patología vulvar durante 4 años y 8 meses. Se estudiaron 28 mujeres con diagnóstico clínico e histopatológico de carcinoma de células escamosas. Resultados. Del total de pacientes evaluadas en el consultorio, 6,17% (28) presentó carcinoma de células escamosas. La edad promedio fue de 62,5 años. De las 28 pacientes, el 64,28% (18) presentó carcinoma de células escamosas invasor y el 35,7% (10) VIN, cuatro desarrollados a partir de liquen escleroso, tres con displasia epitelial (VIN diferenciado) y tres con diagnóstico de papulosis bowenoide (VIN usual). Todas las pacientes refirieron como signo predominante prurito y el tabaquismo se detectó en el 60% de los casos. Conclusiones. Se presentan 28 casos de carcinoma epidermoide vulvar: el 64,2 % fue invasor y el 35,7% neoplasia intraepitelial (VIN). De ésta el 70% correspondió a VIN diferenciado y el 30% restante a VIN usual. Esta casuística nos ha permitido conocer la incidencia de neoplasia epitelial vulvar en nuestro medio además de poder diferenciar los grados de invasión y factores patogénicos.

Introduction. The squamous cell carcinoma of the vulva constitutesbetween 1 and 4% of cancers affecting women, occupying fourthplace among neoplasias of the female genital tract.Objetives. To determine the incidence of squamous cell carcinomaof the vulva and identify grade of invasion.Material and methods. An observational retrospective study wasconducted, in which 28 patients were studied with clinical and pathologicaldiagnosis of squamous cell carcinoma of the vulva.Results. Of the total genital carcinomas in our hospital, the vulvarcarcinomas accounted for 6.17% of the genital tract tumours. Of the28 patients included in the study, 18 invasive carcinomas (64.28%)were detected and 10 vulvar intraepidermal neoplasia (VIN 35.7%).The average age of incidence was 62.5 years. The predominantsymptom was pruritus, and the most significant signs were tumour.In the 10 patients that were diagnosed with VIN, 4 developed froma lichen sclerosus, 3 from epithelial dysplasia and 3 with papulosisbowenoide. 60% of patients were smokers.Conclusions. 28 cases of epidermoide carcinoma of the vulva werestudied resulting in 64.2% invasive and 35.7% VIN. Of the latter, 70%corresponded to differentiated VIN and 30% usual VIN. This casuistryhas permitted us to observe the incidence of squamous cell carcinomain our region, and allowed us to differentiate the grades of invasionand pathogenic factors (Dermatol Argent 2009;15(5):344-349).