ABSTRACT
OBJECTIVE: To evaluate the prevalence and risk factors for unrecognized invasive carcinoma in a series of patients undergoing surgical excision after an office biopsy of vulvar high-grade squamous intraepithelial lesion (VHSIL). METHODS: Two hundred and sixteen consecutive patients treated in a tertiary-level referral center for vulvar disease in north-western Italy were recruited. Patients' records were reviewed by trained personnel. Factors showing a statistically significant (p<0.05) association with detection of stromal invasion at excisional surgery in univariate analysis were further examined in a backward stepwise multiple logistic regression model. RESULTS: The median patient age was 50 years (range, 19–88). More than 25% patients with VHSIL at biopsy had associated cervical/vaginal intraepithelial neoplasia, and more than 35% had a multifocal lesion. Invasive carcinoma was detected in surgical specimens from 24 patients (11%). The depth of stromal invasion varied between 0.1 mm and 3.0 mm with a median of 0.5 mm. In multivariate analysis, the risk of invasive carcinoma detection was greater for patients in the highest tertile of age (p=0.008), for patients with a lesion ≥20 mm in size (p=0.013) and with clitoral involvement (p<0.001), and for patients presenting with a nodular lesion (p=0.078). CONCLUSION: Our study suggests that patient age, lesion size, clitoral involvement and nodular appearance in patients with VHSIL at vulvoscopy-directed biopsy are independently associated with the risk of unrecognized invasive carcinoma.
Subject(s)
Humans , Biopsy , Italy , Logistic Models , Multivariate Analysis , Prevalence , Referral and Consultation , Risk Factors , Squamous Intraepithelial Lesions of the Cervix , Vulvar Diseases , Vulvar NeoplasmsABSTRACT
Objetivo: Analizar los factores asociados con la infección por virus papiloma humano en las descendientes menores de 8 años que conviven con pacientes infectadas con el virus. Métodos: Se realizó un estudio descriptivo, transversal. La muestra fue no probabilística e intencional, la conformaron veintiocho (28) pacientes con diagnóstico de infección por VPH, tipificado por reacción en cadena de polimerasa asentado en su historia clínica y que tuvieran niñas menores de 8 años. Se realizó vulvoscopia a las niñas y toma de muestra por reacción en cadena de polimerasa. Resultados: Se obtuvo que en el 42,9 % la persona responsable de la higiene de la descendiente fue su madre, 89,3 % lavaba su ropa en conjunto con la de la niña (P<0,01). El 71,4 % refirió usar de forma compartida con las niñas toallas, sábanas y jabón de baño. Tanto en las madres como en sus descendientes, el tipo de virus papiloma humano mayormente diagnosticado fue el tipo 6, con predominio estadísticamente significativo de los virus de bajo riesgo en ambos grupos.
Objective: Analize the associated factors with human papilloma virus infection in the descendants who are under the age of 8 years old living with infected patients with the virus. Methods: It was made a descriptive, cross-sectional and non-experimental study. The sample was intentional and non probabilistic, integrated by twenty-eight (28) patients with a diagnosis of human papilloma virus infection, typified by polimerase chain reaction seated in their medical history and that they had girls under the age of 8 years. It was made a vulvoscopy to the children and sampling by polimerase chain reaction. Results: It was found that in 42.9 % the person responsible for the cleanliness of the descendant was her mother, 89.3 % washed their clothes in conjunction with the descendant´s (P<0,01), The 71.4 percent reported use of a shared with girls towels, bed linen and bathroom soap. On both the mother and their descendants, the mostly diagnosed type of human papilloma virus was type 6, with statistically significant predominance of viruses of low risk in both groups.
Subject(s)
Humans , Female , Child , Condylomata Acuminata , Hygiene , Papillomavirus Infections , DNA Virus Infections , Polymerase Chain Reaction , Reproductive Health , Epidemiologic Factors , Virus DiseasesABSTRACT
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.