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.

Basal cell carcinoma of the vulva: A rare case in the postmenopausal woman / Philippine Journal of Obstetrics and Gynecology

@#Basal cell carcinoma (BCC) is a rare tumor of the vulva because BCC is frequently seen in skin sites exposed to sun. Vulvar basal cell carcinoma accounts for < 1% of all BCCs and 2-5% of all vulvar carcinomas. The standard treatment for vulvar BCC is surgical excision and it produces good survival outcomes. This is a case report of an 83 year-old female who presented with a vulvar nodule associated with pruritus and bleeding. Initial vulvar biopsy revealed squamous cell carcinoma (SCCA). Patient underwent concurrent chemoradiation therapy for a Stage IIIB disease. Radical vulvectomy was subsequently done for tumor persistence. Surprisingly, the histopathology report of the persistent vulvar nodule revealed pigmented nodular basal cell carcinoma with lymphovascular invasion (LVSI). Patient was advised postoperative systemic chemotherapy but patient and relatives did not consent for the systemic treatment. Patient had no evidence of disease at 8 months post-surgery.

A case report on primary Cutaneous Mucoepidermoid Carcinoma of the vulva and its clinico-pathologic identity / Philippine Journal of Obstetrics and Gynecology

@#Mucoepidermoid Carcinoma (MEC) is an epithelial malignant tumor that was first described as a salivary gland malignancy. Though common in salivary gland, it is extremely rare in the vulva with only 2 cases reported in the English language literature and none yet in the Philippines. Due to its low incidence, prognosis and definitive management is still unclear. This is a case of a 68-year-old woman with a history of vulvar pruritus and vulvar mass at the left labia majora. Punch biopsy and review of slides revealed Invasive Squamous Cell Carcinoma, Non-Keratinizing type. She underwent Radical Vulvectomy and Bilateral Lymph Groin Dissection; Wide Excision of Perineal Area; Protective Transverse Loop Colostomy; Gracilis Myocutaneous Flap with Identification of Right and Left Median Circumflex Artery with a final histopathology report of Primary Cutaneous MEC of the vulva with lymph node metastasis.

Endoscopic-assisted Small Incision Inguinal Lymphadenectomy for Vulvar Carcinoma / 中国微创外科杂志

Objective To explore the safety and feasibility of endoscopic-assisted inguinal lymphadenectomy via a small incision (3 cm) for vulvar carcinoma . Methods From September 2013 to December 2015, local wide excision and endoscopic-assisted inguinal lymphadenectomy via a 3-cm incision was performed to treat vulvar carcinoma in 6 women.There were 2 cases of unilateral operation and 4 cases of bilateral operations .A small incision (3 cm) was made in the groin.The skin edge was lifted to separate subcutaneous tissue and obtain a surgical exposure .Then endoscopic inguinal lymphadenectomy was conducted . Results The surgeries were successful in all the 6 patients, with no conversion to open surgery or intraoperative secondary injury .The operation time of inguinal lymphadenectomy was 60-90 min (78.3 ±14.7 min), and the blood loss was 20-40 ml (31.6 ±9.8 ml).The number of lymph nodes desected was 3-13 (8.7 ±3.0) in each side.Pathological examinations showed squamous cell carcinoma . The FIGO staging showed 2 cases of stage ⅠB and 4 cases of stage Ⅱ.The postoperative stitches removal time was 7-9 d (7.8 ±0.7 d) .No surgical complications , such as incision disruption , delayed healing , inguinal skin necrosis , or lower extremity lymphedema , were recorded during a 3-12 months (6.5 ±4.4 months) of follow-up.No tumor recurrence or metastasis was found . Conclusions Endoscopic-assisted inguinal lymphadenectomy via mall incision in the treatment of vulvar carcinoma is effect , safe and feasible .It achieves radical effects .

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)

Queratoacantoma de vulva: presentación de un caso / Vulvar keratoacanthoma: presentation of a case

El queratoacantoma de vulva es una entidad rara que podría presentar confusión en su diagnóstico con el carcinoma bien diferenciado de células escamosas. Presentamos un caso de una paciente con diagnóstico de queratoacantoma de vulva tratada con resección quirúrgica de la lesión y su seguimiento posterior.

Vulvar keratoacanthoma is a rare disease that may present confusion in diagnosis with well differentiated squamous cell carcinoma. We report one patient with vulvar keratoacanthoma, treated by resection surgery of the lesion and her outcome.

Clinical application of sartorius tendon transposition during radical vulvectomy: a case control study of 58 cases at a single institution / 부인종양

OBJECTIVE: The aim of this study was to investigate the clinical effects of sartorius tendon transposition versus sartorius transposition during bilateral inguinal lymphadenectomy of radical vulvectomy. METHODS: A total of 58 vulvar cancer patients who had surgery from May 2007 to October 2013, in which 30 patients received sartorius transposition and 28 patients received sartorius tendon transposition. All patients were matched by age, body mass index, stage, histology, and grade. Intraoperative variables and postoperative complications, recurrence, progression-free survival (PFS), and overall survival (OS) and postoperative life quality were compared and analyzed. RESULTS: No significant differences were found at median surgical times and amounts of bleeding (p=0.316 and p=0.249, respectively), neither at the incidences of groin cellulitis and lymphocele (p=0.673 and p=0.473, respectively), but the recovery times of the inguinal wounds were shorter (p=0.026) and the incidences of wound break and chronic lymphedema were significantly decreased in the tendon transposition group (p=0.012 and p=0.022, respectively). Postoperative quality of life in tendon transposition group was significantly improved as indicated by the EORTC QLQ-C30 questionnaire. Recurrences were similar (p=0.346) and no significant differences were found at PFS and OS (p=0.990 and p=0.683, respectively). CONCLUSION: Compared to sartorius transposition, sartorius tendon transposition during inguinal lymphadenectomy led to improved patient recovery, reduced postoperative complications, and improved life quality without compromising the outcomes.

Misdiagnosed Rhabdomyosarcoma of the Vulva

Vulvar carcinoma is a rare disease that accounts for 5% of gynecologic cancers. Sarcomas of the vulva are extremely rare, and account for only 1% to 3% of all vulvar malignancies. We report of a case of a 26 years woman with a vulva mass. Excision was done and histopathologic result showed rhabdomyosarcoma.

Prognostic factors associated with local recurrence in squamous cell carcinoma of the vulva / 부인종양

OBJECTIVE: To analyze the prognostic factors related to the recurrence rate of vulvar cancer. METHODS: Retrospective study of 87 patients diagnosed of vulvar squamous cell carcinoma diagnosed at a tertiary hospital in Madrid between January 2000 and December 2010. RESULTS: The pathological mean tumor size was 35.1+/-22.8 mm, with stromal invasion of 7.7+/-6.6 mm. The mean free margin after surgery was 16.8+/-10.5 mm. Among all patients, 31 (35.6%) presented local recurrence (mean time 10 months; range, 1 to 114 months) and 7 (8%) had distant metastases (mean time, 5 months; range, 1 to 114 months). We found significant differences in the mean tumor size between patients who presented a relapse and those who did not (37.6+/-21.3 mm vs. 28.9+/-12.1 mm; p=0.05). Patients with free margins equal or less than 8 mm presented a relapse rate of 52.6% vs. 43.5% of those with free margin greater than 8 mm (p=0.50). However, with a cut-off of 15 mm, we observed a local recurrence rate of 55.6% vs. 34.5%, respectively (p=0.09). When the stromal invasion cut-off was >4 mm, local recurrence rate increased up to 52.9% compared to 37.5% when the stromal invasion was 4 mm, high risk predictors of local recurrence rate.

Squamous cell carcinoma of the vulva in a virgin patient with Turner syndrome / 부인종양

Two types of gynecologic tumors are commonly described in the Turner syndrome, the first one is gonadoblastoma, which occurs in patients with Y chromosome abnormalities, and the second one is endometrial carcinoma which is mostly related with exogenous estrogen usage. Here, we describe an extremely rare case of squamous cell carcinoma of the vulva in a virgin woman with Turner syndrome. A 35-years old single, virgin woman referred to our Oncology Department with warty, necrotized, exophytic 6-7 cm vulvar mass. She had a history of primary amenorrhea and mosaic Turner syndrome was determined in her karyotype analysis. Biopsy specimen of the vulvar mass revealed squamous cell carcinoma of the vulva, and total vulvectomy with inguinal femoral lymphadenectomy was performed. The postoperative course was uneventful and there has been no recurrence of the disease up to date. Women with Turner syndrome have streak ovaries that produce very low estrogen and the squamous cell carcinoma of the vulva may have developed at an early age with Turner syndrome because of this low estrogen value similar to postmenopausal women. The current case is a special case due to its age of occurrence, virgin and Turner syndrome status.

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).

Adenoid cystic carcinoma of the Bartholin's gland: report of two cases and review of the literature / 대한산부인과학회지

Adenoid cystic carcinoma (ACC) of the Bartholin's gland is a rare malignancy of the female genital tract and there have been 62 cases of ACC of the Bartholin's gland in the literature. We report two cases of ACC of the Bartholin's. There is no consensus on optimal treatment of ACC of the Bartholin's gland. Most commonly, wide local excision and radical vulvectomy with or without lymph node dissection, are performed. More long-term follow up is recommended to evaluate optimal primary treatment and roles of radiotherapy and chemotherapy because ACC of the Bartholin's gland recur and metastasize long after primary treatment.