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1.
Oncología (Ecuador) ; 31(3): 243-250, 30-diciembre-2021.
Article in Spanish | LILACS | ID: biblio-1352470

ABSTRACT

Introducción: Los tumores malignos de vulva son tumores raros del tracto genital femenino, que representan menos del 1 % de los tumores malignos del sexo femenino, cerca del 95% de estos son carcinoma escamo celulares, los adenocarcinomas son el tipo histológico menos frecuente, con 36 casos reportados hasta el año 2020. Caso Clínico: Presentamos el caso de una mujer de 36 años con antecedente de histerectomía total por miomatosis, con cuadro clínico de 1 año de evolución caracterizado por una masa indolora en labio mayor izquierdo la cual se somete a biopsia que reporta adenocarcinoma motivo por el cual se somete a vulvectomia radical, en resultado patológico definitivo se confirma el diagnostico de adenocarcinoma de vulva tipo glándula mamaria. Evolución: Se realiza vulvectomía radical + vaciamiento ganglionar inguino-iliaco bilateral. El estu-dio histo-patológico definitivo reveló adenocarcinoma de vulva tipo glándula mamaria pobremente diferenciado G3, Unifocal, con metástasis en 22/25 ganglios derechos y 30/30 izquierdos. Un estu-dio reportó recidiva local extensa, metástasis ganglionares pélvicas, retroperitoneales, mediastinales, axilares, cervicales y pulmonar. Se inició Paclitaxel 137 mg semanal. Se completa quimioterapia hasta 11ra semana posterior a lo cual presentó infección de lecho tumoral y fallece. Conclusión: En el presente caso el curso clínico de adenocarcinoma de vulva tipo glándula mamaria fue agresivo con una supervivencia inferior a 5 meses


Introduction: Malignant tumors of the vulva are rare tumors of the female genital tract, which rep-resent less than 1% of malignant tumors of the female sex, about 95% of these are squamous cell carcinoma, adenocarcinomas are the least frequent histological type, with 36 cases reported until 2020. Clinical Case: We present the case of a 36-year-old woman with a history of total hysterectomy due to myomatosis, with a clinical picture of 1 year of evolution characterized by a painless mass in the left labia majora which undergoes a biopsy that reports adenocarcinoma, which is why undergoes radical vulvectomy, the definitive pathological result confirms the diagnosis of adenocarcinoma of the vulva type mammary gland. Evolution: Radical vulvectomy + bilateral inguino-iliac lymph node dissection was performed. The definitive histopathological study revealed poorly differentiated G3, Unifocal mammary gland adeno-carcinoma of the vulva, with metastases in 22/25 right and 30/30 left lymph nodes. One study reported extensive local recurrence, pelvic, retroperitoneal, mediastinal, axillary, cervical and pulmonary lymph node metastases. Paclitaxel 137 mg weekly was started. Chemotherapy was completed up to the 11th week after which he presented a tumor bed infection and died. Conclusion: In the present case, the clinical course of adenocarcinoma of the vulva type of the mammary gland was aggressive with a survival of less than 5 months.


Subject(s)
Humans , Female , Adult , Vulvar Neoplasms , Case Reports , Medical Oncology , Vulva , Vulvectomy
2.
Rev. bras. cancerol ; 67(2): e-141269, 2021.
Article in Portuguese | LILACS | ID: biblio-1291146

ABSTRACT

Introdução: O tumor fibro-histiocítico plexiforme é uma condição clínica rara, com cerca de 150 casos descritos na literatura. Relato do caso: Paciente, 23 anos, sexo feminino, portadora de lesão nodular em região vulvar sem características de malignidade em exames de ultrassonografia. Realizou acompanhamento clínico, tendo apresentado aumento do tamanho da lesão inicial, sendo optado então por realização de ressecção cirúrgica da lesão. Em estudo histopatológico, evidenciou-se lesão compatível com tumor fibro-histiocítico plexiforme, com margens cirúrgicas livres. No seguimento, a paciente foi encaminhada para avaliação oncológica com a intenção de realizar exames complementares de rastreio e descartar diagnósticos morfologicamente semelhantes. Diante dos exames complementares confirmando o diagnóstico inicial e sem evidência de doença metastática após excisão cirúrgica completa com margens livres, foi iniciado seguimento clínico. Conclusão: Relatar o caso é de extrema importância para divulgar a apresentação clínica, etapas diagnósticas, tratamento proposto e compartilhar informações acerca de evolução clínica apresentada.


Introduction: Plexiform fibrohistiocytic tumor is a rare clinical condition, with about 150 cases described in the literature. Case report: 23-years-old, female patient with nodular lesion in vulva without malignancy characteristics on ultrasound image. She underwent clinical follow-up and after an increase in the size of the lesion, surgical resection was opted. Histopathological findings suggested plexiform fibrohistiocytic tumor, with free surgical margins. In follow up, she was referred to oncological evaluation for screening complementary exams and rule out morphologically similar diagnoses. After the complementary exams confirming the initial diagnosis of plexiform fibrohistiocytic tumor and without evidence of metastatic disease after complete surgical excision with free margins, the patient is in clinical follow-up. Conclusion: Reporting the case is extremely important to disseminate the clinical presentation, diagnostic steps, proposed treatment and share information about the clinical evolution presented.


Introducción: El tumor fibrohistiocítico plexiforme es una condición clínica poco frecuente, con unos 150 casos descritos en la literatura. Reporte del caso: Paciente de 23, sexo feminino, años con lesión nodular en una región vulvar sin características malignas en los exámenes de ultrasonido. Se sometió a un seguimiento clínico, habiendo presentado un aumento en el tamaño de la lesión inicial, y se decidió realizar la resección quirúrgica de la lesión. En un estudio histopatológico, se evidenció una lesión compatible con tumor fibrohistiocítico plexiforme con márgenes quirúrgicos libres. Fue referida para la evaluación oncológica, realizó pruebas complementarias para el cribado y para descartar diagnósticos morfológicamente similares. En vista de las pruebas complementarias que confirman el diagnóstico inicial y sin evidencia de enfermedad metastásica después de una escisión quirúrgica completa con márgenes libres, se inició el seguimiento clínico. Conclusión: Informar del caso es extremadamente importante para difundir la presentación clínica, etapas diagnósticas, tratamiento propuesto y compartir información sobre la evolución clínica presentada.


Subject(s)
Humans , Female , Adult , Young Adult , Vulvar Neoplasms/diagnosis , Histiocytoma, Malignant Fibrous/diagnosis , Vulvar Neoplasms/surgery , Histiocytoma, Malignant Fibrous/surgery
3.
Medicina (B.Aires) ; 80(2): 127-133, abr. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1125052

ABSTRACT

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.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Vulvar Neoplasms/metabolism , Immunohistochemistry , Carcinoma, Squamous Cell/metabolism , Tumor Suppressor Protein p53/metabolism , Papillomaviridae , Vulvar Neoplasms/diagnosis , Warts , Carcinoma, Squamous Cell/diagnosis , Biomarkers, Tumor , Papillomavirus Infections , Carcinogenesis
4.
Rev. argent. cir. plást ; 26(1): 45-48, ene-mar 2020. fig
Article in Spanish | LILACS | ID: biblio-1120512

ABSTRACT

Luego del tratamiento quirúrgico de la patología maligna y premaligna de la región vulvoperineal nosenfrentamos al desafío de la reconstrucción del defecto de cobertura, el cual en la mayoría de los casos no puede resolverse con un cierre primario. Se presentan 2 casos de reconstrucción con colgajos locales con el objetivo de reparar el defecto, ofrecer un tejido vascularizado, el cual aporta mayor oxigenación, migración celular y un buen resultado estético ­ funcional. La reparación se realizó con colgajos de trasposición dependientes de la arteria pudenda y colgajos de avance y rotación del lado contralateral. Hemos concluido que la confección de colgajos locales en la región vulvar para la reconstrucción de defectos es una opción a tener en cuenta debido al aporte vascular, la presencia de perforantes dependientes de la arteria pudenda, la conservación nerviosa, el bajo índice de morbilidad y el aceptable resultado estético ­ funcional.


After the surgical treatment of the malignant and premalignant pathology of the vulvoperineal region we have the challenge of reconstruction the coverage defect, which in most cases cannot be resolved with a primary closure. We describe 2 cases of reconstruction with local fl aps, the aim is to repairing the defect, off ering a vascularized tissue, which provides more oxygenation, cell migration and a good aesthetic-functional result. The repair was performed with transposition fl aps dependent on the pudendal artery and advance and rotation fl aps of the contralateral side. We concluded that the repairwith local fl aps in the vulvar region for the reconstruction of defects is an option to take into account due to the vascular contribution, the presence of perforators dependent on the pudendal artery, nerve conservation, low morbidity index and acceptable aesthetic result - functional.


Subject(s)
Humans , Female , Middle Aged , Aged , Vulvar Neoplasms/surgery , Reconstructive Surgical Procedures , Free Tissue Flaps/transplantation , Retrospective Studies
5.
São Paulo; s.n; 2020. 87 p. ilust, tabelas.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1178967

ABSTRACT

O carcinoma escamoso de vulva (CEC) é uma neoplasia rara que corresponde a cerca de 3 a 5% dos tumores ginecológicos malignos. Seu surgimento é mais comum entre a sétima e oitava década de vida, entretando, nos últimos anos observou-se um aumento em sua incidência em mulheres jovens, possivelmente decorrente do crescimento do número de infecções por HPV. Duas vertentes dividem o carcinoma de vulva em vias distintas: uma relacionada à presença de infecção por HPV e a outra, associada a mutações no gene p53 e processos inflamatórios crônicos, sendo ambas precedidas por lesões precursoras (lesões intraepiteliais vulvares ­ VINs). O sistema imunológico atua com finalidade garantir a homeostase, entretanto, o contexto de inflamação e infecção costumam estar associadas ao desenvolvimento e progressão do câncer. A análise do microambiente imune do tumoral e seu impacto no resultado clínico podem prover informações preciosas para uma melhor compreensão dos mecanismos celulares envolvidos e evidenciar marcadores com valores preditivos de resposta terapêutica e/ou diagnóstica. Objetivo: Ampliar a caracterização dos componentes celulares do infiltrado inflamatório da primeira linha de defesa (imunidade inata) associados ao tumor em carcinoma vulvar, relacionar esses componentes ao status de infecção pelo HPV. Métodos: Quarenta e quatro amostras de tecido fixados em formalina e incluídas em parafina foram selecionadas de forma retrospectiva dos arquivos do Departamento de Anatomia Patológica do A.C.Camargo Cancer Center no período de 1990 a 2015. Para a identificação dos marcadores imunológicos, foram realizados experimentos de imunohistoquímica e, posteriormente, esses marcadores foram quantificados através do programa APERIO®. Resultados: Com base nos padrões de infiltração de células imunológicas, a maior expressão ocorreu na região peritumoral nas duas vias de CEC vulvar (HPV independente e HPV associado) para os marcadores CD68, granzima B, perforina, S100, CD1a e PD-L1 (p<0,05). A expressão de perforina foi maior em CEC HPV independente nas regiões peri- (p=0,004) e intratumoral (p=0,021). Em CEC HPV independente, a expressão intensa de S100 na região peritumoral foi associada a ausência de metástase linfonodal (p=0,008); a expressão forte de S100 na região intratumoral foi associada a ausência de invasão vascular (p=0,007) e ausência de metástase linfonodal (p=0,043). Na via de CEC HPV associado, a expressão intensa de perforina esteve relacionada a menor profundidade de invasão nas regiões peri- (p=0,013) e intratumoral (p=0,022). As expressões dos marcadores de células inflamatória apresentaram associação com sobrevida global e livre de doença para as vias do CEC de vulva. Em CEC HPV independente, a expressão intensa de CD1a na região intratumoral, correlacionou-se ao menor tempo de sobrevida livre de doença (p=0,045). Na via de CEC HPV associado, o aumento da expressão de CD56 foi associada ao menor tempo de sobrevida global (p=0,043); as expressões aumentadas de CD1a e PD-L1 na região peritumoral se correlacionaram a maior tempo de sobrevida livre de doença (p=0,008 e p=0,021, respectivamente). Conclusão: Esse é um estudo que caracteriza o infiltrado inflamatório tumoral correspondente a primeira linha de defesa (imunidade inata) do organismo nas duas vias do carcinoma escamoso de vulva. Nossos dados sugerem que o principal papel da imunidade inata em ambas as vias de CEC vulvar seja como mecanismo de defesa, na tentativa de impedir a progressão tumoral


INTRODUCTION: Vulva squamous carcinoma (VSCC) is a rare neoplasm that corresponds around 3 to 5% of malignant gynecological tumors. Its incidence is more common between the seventh and eighth decade of life, however, recently it has increased in young women, possibly due to an increasing number of HPV infections. Two strands divide vulvar carcinoma into different way: one related to the presence of HPV infection and on the other hand, associated with mutations in p53 gene and chronic inflammatory processes, both of them are preceded by precursor lesions (vulvar intraepithelial lesions - VINs). The immune system acts to guarantee homeostasis, however, the context of inflammation and infection is usually associated with the development and progression of cancer. The analysis of the tumor microimmune environment and its impact on the clinical outcome can provide valuable information for a better understanding of the cellular mechanisms involved and evidence markers with predictive values of therapeutic and / or diagnostic response. AIMS: To expand the characterization of the cellular components of the inflammatory infiltrate of the first line of defense (innate immunity) associated with the tumor in vulvar carcinoma, relating these components to the status of HPV infection. METHODS: Forty-four tissue formalin fixed paraffin embedded samples were retrospectively selected from the archives of the Department of Anatomic Pathology of A.C.Camargo Cancer Center from 1990 to 2015. For the identification of immunological markers, experiments were carried out immunohistochemistry and, later, these markers were quantified using the APERIO® program. RESULTS: Based on the infiltration patterns of immune cells, the greatest expression occurred in the peritumoral region in both vulvar CPB pathways (independent HPV and dependent HPV) for the markers CD68, granzyme B, perforin, S100, CD1a and PD-L1 (p < 0.05). Perforin expression was higher in independent VSCC HPV in the peri- (p = 0.004) and intratumoral (p = 0.021) regions. In an independent VSCC HPV, the intense expression of S100 in the peritumoral region was associated with the absence of lymph node metastasis (p = 0.008); the strong expression of S100 in the intratumoral region was associated with the absence of vascular invasion (p = 0.007) and absence of lymph node metastasis (p = 0.043). In the VSCC HPV-dependent pathway, the intense expression of perforin was related to a lesser depth of invasion in the peri- (p = 0.013) and intratumoral (p = 0.022) regions. The expressions of the inflammatory cell markers were associated with global and disease-free survival for the VSCC pathways. In an independent VSCC HPV, the intense expression of CD1a in the intratumoral region, it was correlated with the shorter disease-free survival (p = 0.045). In the VSCC HPV-dependent pathway, increased CD56 expression was associated with shorter overall survival time (p = 0.043); the increased expressions of CD1a and PD-L1 in the peritumoral region correlated with longer disease-free survival (p = 0.008 and p = 0.021, respectively). CONCLUSIONS: Conclusion: This is a study that characterizes the inflammatory tumor infiltrate corresponding to the first line of defense (innate immunity) of the organism in the two pathways of squamous carcinoma of the vulva. Our data suggest that the main role of innate immunity in both pathways of VSCC is a mechanism defense, in an attempt to prevent tumor progression


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Papillomaviridae , Vulvar Neoplasms , Immunohistochemistry , Biomarkers , Systemic Inflammatory Response Syndrome
6.
São Paulo; s.n; 2020. 50 p. ilust.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1178971

ABSTRACT

Introdução: A matriz extracelular (MEC) desempenha um papel importante na função celular, sendo que seu componente mais importante são as fibras de colágeno (COL). Nos últimos anos, a Microscopia de Geração Segundo Harmônico (em inglês, second harmonic generation microscopy; SHG) tem sido utilizada para a análise de COL em vários tipos de cânceres ginecológicos, como o da mama e ovário. Desta forma, tem-se enfatizado o valor da quantificação do colágeno por este método como meio de aprofundar o conhecimento da fisiopatologia e do prognóstico na avaliação destas neoplasias. Objetivo: No presente estudo caracterizamos as fibras de COL utilizando-se a microscopia de SHG objetivando avaliar diferenças entre carcinoma de células escamosas e lesões pré-neoplásicas da vulva, bem como verificar se há relação entre características dessas fibras com parâmetros clinicopatológicos associados a prognóstico. Método: Trata-se de um estudo de coorte horizontal e retrospectivo. Foram incluídos 52 pacientes, entre os anos de 2000 a 2010, sendo 40 com Carcinoma de Células Escamosas (CCE) Vulvar; 12 pacientes com Neoplasia Intraepitelial Vulvar (NIV); e, para o controle de comparação interna, foram considerados tecidos distantes ao tumor sem presença de lesão tumoral e/ou NIV. Para análises laboratoriais, foi selecionado um espécime representativo do processo patológico para revisão diagnóstica; e, posteriormente, submetido ao estudo do COL usando a microscopia de SHG. Os tecidos adjacentes normais e intratumorais foram selecionados em secções, para a avaliação do COL, e corados em Hematoxilina/Eosina (H&E) e analisados por microscopia confocal. Parâmetros relacionados ao colágeno, como quantidade, organização e uniformidade, em áreas de lesões neoplásicas e pré-neoplásicas da vulva, foram comparados com áreas distantes de aspecto normal das mesmas pacientes. Resultado/conclusão: Foi observado um evidente decréscimo nos valores dos parâmetros do COL no estroma associado às lesões pré-neoplásicas e neoplásicas da vulva. Além disto, aumentos na quantidade e uniformidade das fibras do colágeno tumorais se associaram à presença de metástases linfonodais, um reconhecido parâmetro de pior prognóstico no carcinoma de vulva


Background: The extracellular matrix (ECM) plays an important role in cellular function, being collagen fibers its most important component. Over the last few years, second harmonic generation (SHG) microscopy has been used for the analysis of collagen fibers in several types of cancers, including breast and ovarian cancer. The value of collagen parameters obtained using this technique has been advocated to gain insights on the physiopathology and on the prognostic evaluation of cancer. Objective: Herein, we have characterized collagen fibers using the SHG microscopy, to evaluate differences between vulvar cancer and preneoplastic lesions, and to find possible associations between characteristics of collagen fibers with clinicopathological parameters related to prognosis. Methods: This is a retrospective and horizontal cohort study. Were included 52 patients, between the years 2000 to 2010, 40 of whom with Vulva Squamous Cell Carcinoma (VSCC); 12 patients with Vulvar Intraepithelial Neoplasia (VIN); and, for the control of internal comparison, tissues distant to the tumor without tumor lesion and / or VIN were considered. For laboratory analysis, a specimen representative of the pathological process was selected for diagnostic review and subsequently subjected to the study of collagen using SHG microscopy. The normal and intratumoral adjacent tissues were selected in sections, for collagen evaluation, and stained in Hematoxylin/Eosin (H&E) and analyzed by confocal microscopy. Collagen parameters, quantity, organization, and uniformity, of stroma adjacent to neoplastic or preneoplastic lesions were compared with values obtained in normal appearing tissue distant from those lesions from the same patients. Results/Conclusion: There was an evident decrease in the values of collagen fiber parameters in the stroma associated to tumors. Increased quantity and uniformity of tumor associated collagen fibers were associated with the presence of lymph node metastases, which suggest a prognostic value of such parameters in the evaluation of vulvar cancer


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Precancerous Conditions , Vulvar Neoplasms , Collagen , Extracellular Matrix , Second Harmonic Generation Microscopy , Neoplasm Metastasis
7.
Article in English | WPRIM | ID: wpr-876559

ABSTRACT

@#Extramammary Paget’s disease (EMPD) of the vulva is a rare vulvar neoplasm but commonly arises during the postmenopausal period. Intraepithelial Paget’s disease may persist for prolonged periods without demonstrating invasion but with high rates of recurrence. Appearance of Paget’s disease in a split-thickness skin graft, is associated with an occurrence outside the grafted area. It demonstrates retrodissemination as the pathologic process hypothesized in the spread of the disease within the skin via lymphatics and vessels creating tissue bridges between sites of involvement. We present a case of an 81-year-old female, the patient came in for complaints of vulvar pruritus beginning at the left inguinal area three years prior to her diagnosis. She consulted with a dermatologist and was initially treated with steroids and emollients. Persistence of symptoms and enlargement of the lesion prompted a vulvar punch biopsy which showed Paget’s disease and referral to the Gynecologic Oncology service. Wide local excision with split-thickness skin grafting was performed. However, one year after her surgery, patient noted vulvar pain and palpable vulvar lesions. Biopsy was done which showed Extramammary Paget’s Disease recurrence. Patient underwent repeat wide local excision with frozen section, and split-thickness skin grafting. With the aid of frozen section, the intraepithelial involvement was noted to spread beyond the grossly apparent lesion. After 6 months post re-excision, patient noted vulvar pruritus and palpable vulvar lesions. Biopsy was done which showed Extramammary Paget’s Disease recurrence. Due to the proximity of the lesion to the sphincter and need for a colostomy, the patient did not consent for re-excision. Imiquimod 5% was chosen as the mode of treatment. The challenges of interventions are to remove or treat disease that may not be visible, without overtreatment and to minimize morbidity from radical surgery. Surgery remains the primary management for EMPD of the vulva. Imiquimod 5% can be used in recurrences. Despite the advances in the knowledge and management of vulvar Paget’s disease the high rate of recurrent disease remains a challenge for optimal management and would require frequent and long-term follow-up.


Subject(s)
Paget Disease, Extramammary , Female , Vulvar Neoplasms
9.
Article in English | WPRIM | ID: wpr-719246

ABSTRACT

OBJECTIVE: To evaluate the impact of age-adjusted Charlson comorbidity index (ACCI) in predicting disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) among surgically treated patients with vulvar carcinoma. The secondary aim is to evaluate its impact as a predictor of the pattern of recurrence. METHODS: We retrospectively evaluated data of patients that underwent surgical treatment for vulvar cancer from 1998 to 2016. ACCI at the time of primary surgery was evaluated and patients were classified as low (ACCI 0–1), intermediate (ACCI 2–3), and high risk (>3). DFS, OS and CSS were analyzed using the Kaplan-Meir and the Cox proportional hazard models. Logistic regression model was used to assess predictors of distant and local recurrence. RESULTS: Seventy-eight patients were included in the study. Twelve were classified as low, 36 as intermediate, and 30 as high risk according to their ACCI. Using multivariate analysis, ACCI class was an independent predictor of worse DFS (hazard ratio [HR]=3.04; 95% confidence interval [CI]=1.54–5.99; p < 0.001), OS (HR=5.25; 95% CI=1.63–16.89; p=0.005) and CSS (HR=3.79; 95% CI=1.13–12.78; p=0.03). Positive nodal status (odds ratio=8.46; 95% CI=2.13–33.58; p=0.002) was the only parameter correlated with distant recurrence at logistic regression. CONCLUSION: ACCI could be a useful tool in predicting prognosis in surgically treated vulvar cancer patients. Prospective multicenter trials assessing the role of ACCI in vulvar cancer patients are warranted.


Subject(s)
Aged , Comorbidity , Disease-Free Survival , Humans , Logistic Models , Multicenter Studies as Topic , Multivariate Analysis , Prognosis , Proportional Hazards Models , Prospective Studies , Recurrence , Retrospective Studies , Vulvar Neoplasms
10.
Rev. chil. obstet. ginecol. (En línea) ; 84(2): 142-146, 2019. graf
Article in Spanish | LILACS | ID: biblio-1013824

ABSTRACT

RESUMEN El fibroadenoma vulvar es un tumor benigno poco frecuente con muy pocos casos descritos en la literatura. Por lo general, se diagnostica entre los 20 y 70 años. Tiene un buen pronóstico y rara vez recurre después de la escisión. Presentamos un caso de fibroadenoma vulvar, en una mujer de 33 años, manifestado como un tumor localizado, bien definido de partes blandas en el labio mayor izquierdo. La lesión fue extirpada completamente y la histología confirmó un fibroadenoma con marcador de estrógeno positivo.


ABSTRACT Vulvar fibroadenoma is a rare benign tumor with few cases reported in the literature. It usually occurs between 20 and 70 years of age. It has a good prognosis and rarely recurs following excision. We present a case of vulvar fibroadenoma as a localized, well-defined soft tissue mass in the left labium majus of a 33-year-old woman. The mass was excised completely, and histology demonstrated a fibroadenoma positive for estrogen receptor.


Subject(s)
Humans , Female , Adult , Vulvar Neoplasms/diagnosis , Fibroadenoma/diagnosis , Vulvar Neoplasms/pathology , Biopsy , Neoplasms, Fibroepithelial , Fibroadenoma/pathology , Diagnosis, Differential
11.
Clinics ; 74: e1218, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019711

ABSTRACT

OBJECTIVES: Despite the number of surgical advances and innovations in techniques over time, radical vulvectomy frequently results in substantial loss of tissue that cannot be primarily closed without tension, the mobilization of surrounding tissues or even the rotation of myocutaneous flaps. The aim of this study was to evaluate the feasibility of leaving the surgical vulvar open wound for secondary healing in situations where primary closure of the vulvar wound is not possible. METHODS: This case-control pilot study analyzed 16 women with a diagnosis of squamous cell carcinoma of the vulva who first underwent inguinofemoral lymphadenectomy, 6-week sessions of chemotherapy and 25 daily sessions of radiotherapy. Afterward, excision of the vulvar lesion with free margins was performed between January 2011 and July 2017. Twelve patients underwent primary closure of the wound (control), and in 4 patients, the surgical wound was left open for secondary healing by means of a hydrofiber (case). The inclusion criteria were a) FIGO-2009 stage II up to IIIC; b) squamous cell carcinoma; and c) no evidence of pelvic or extrapelvic disease or pelvic nodal involvement. The exclusion criteria were extrapelvic disease or pelvic nodal involvement, another primary cancer, or a poor clinical condition. ClinicalTrials.gov: NCT02067052. RESULTS: The mean age of the patients at the time of the intervention was 62.1. The distribution of the stages was as follows: II, n=6 (37 %); IIIA, n=1 (6%), IIIB, n=1 (6%) and IIIC, n=8 (51%). The mean operative time was 45 minutes. The hospital stay duration was 2 days. Full vulvar healing occurred after an average of 30 days in the control group and after an average of 50 days in the case group. CONCLUSION: A secondary healing strategy may be an option for the treatment of vulvar cancer in situations of non-extensive surgical wounds when primary closure of the wound is not possible.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Vulvar Neoplasms/surgery , Wound Healing , Carcinoma, Squamous Cell/surgery , Surgical Wound/therapy , Pilot Projects , Reproducibility of Results , Risk Factors , Treatment Outcome , Wound Closure Techniques , Surgical Wound/pathology
12.
Rev. chil. obstet. ginecol. (En línea) ; 84(2): 130-135, 2019. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-1013822

ABSTRACT

RESUMEN El dermatofibrosarcoma protuberans (DFSP) es un sarcoma fusocelular de grado intermedio de malignidad con máxima incidencia en adultos entre 20 y 40 años y de localización habitualmente troncular (cabeza, cuello extremidades superiores). Se presentan tres casos de DFSP de localización excepcional a nivel vulvar. Las pacientes fueron tratadas con vulvectomía respetando márgenes de seguridad pero, debido a la idiosincrasia del tumor, presentaron recidivas locales que precisaron de una nueva cirugía. En su posterior seguimiento no presentaron recaídas y se encuentran libres de enfermedad.


ABSTRACT Dermatofibrosarcoma protuberans (DFSP) is an intermediate grade spindle-cell sarcoma with a highest incidence in adults between 20 and 40 years old and a trunk location (head, neck and arms). We introduce three case reports of vulvar DFSP considered unusual because of their location. The patients were conducted a free-margin vulvectomy but, due to the nature of the tumor, local reappearances required a second surgery. In the subsequent follow-up they did not suffer from any tumor relapse and they are currently disease-free.


Subject(s)
Humans , Female , Adult , Middle Aged , Skin Neoplasms/surgery , Skin Neoplasms/diagnosis , Vulvar Neoplasms/surgery , Vulvar Neoplasms/diagnosis , Dermatofibrosarcoma/surgery , Dermatofibrosarcoma/diagnosis , Skin Neoplasms/pathology , Vulvar Neoplasms/pathology , Mohs Surgery , Dermatofibrosarcoma/pathology , Diagnosis, Differential , Vulvectomy
13.
Medisur ; 16(6): 974-979, nov.-dic. 2018. ilus
Article in Spanish | LILACS | ID: biblio-976223

ABSTRACT

El fibroadenoma vulvar es una lesión extremadamente rara. Se presenta como una masa unilateral, de tamaño variable, asintomático y ocasionalmente asociado a otras lesiones vulvares o extravulvares y existe gran controversia sobre su origen. Estas lesiones necesitan del examen histopatológico para llegar al diagnóstico definitivo. El comportamiento de este tumor es similar al mamario. La escisión generalmente tiene un buen pronóstico y rara vez recidiva. Presentamos un caso donde se diagnosticó histopatológicamente esta lesión en una mujer de 26 años de edad con masa tumoral en la vulva, a la que se le realizó excéresis quirúrgica.


Vulvar fibroadenoma is extremely rare. It presents as a unilateral mass of variable size, asymptomatic and occasionally associated to other vulvar and extra-vulvar lesions. There is a great controversy about their origin. These lesions need a histo-pathological exam to reach a concluding diagnosis. Its behavior is similar to the breast tumor. Its removal generally has a good prognosis and there is rarely a relapse. This is a case of a 26 year old woman who was histo-pathologically diagnosed a vulvar tumor. A surgical removal was performed.


Subject(s)
Humans , Female , Vulvar Neoplasms/surgery , Vulvar Neoplasms/diagnosis , Fibroadenoma/surgery , Fibroadenoma/diagnosis
14.
Rev. cuba. obstet. ginecol ; 44(4): 1-8, oct.-dic. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1093614

ABSTRACT

El adenoma pleomórfico (AP) es el tumor benigno más prevalente de las glándulas salivales mayores; sin embargo, esta no es su localización anatómica exclusiva. Las células mioepiteliales, tapizan la membrana basal de las porciones terminales de diferentes tejidos glandulares exocrinos incluyendo los salivales, lacrimales, mamarios y sudoríparos; por esta razón, no es insólito que este tumor se origine en tejidos glandulares diferentes a los salivales. El adenoma pleomórfico de la vulva es un hallazgo infrecuente, con pocos casos reportados en la literatura, siendo este caso el primero reportado en Colombia y Latinoamérica(AU)


Pleomorphic Adenoma is the most prevalent benign tumor among the major salivary glands; nevertheless, this is not the exclusive anatomic localization. Myoepithelial cells cover the basal membrane of the terminal portions of different exocrine glandular tissues including the salivary glands, lacrimal glands, mammary tissue and sweat glands. Consequently, it is not rare that this kind tumor originate in tissues different from the salivary glands. The vulvar pleomorphic adenoma is an uncommon finding, with few reported cases in literature. Actuality this the first case reported in Colombia and Latin America(AU)


Subject(s)
Humans , Female , Adult , Vulvar Neoplasms/diagnostic imaging , Adenoma, Pleomorphic/pathology , Adenoma, Pleomorphic/epidemiology , Adenoma, Pleomorphic/diagnostic imaging
15.
An. bras. dermatol ; 93(3): 426-428, May-June 2018. graf
Article in English | LILACS | ID: biblio-949873

ABSTRACT

Abstract: Fabry disease is a rare lysosomal storage disorder, inherited in an X-linked manner. It is characterized by the deficiency of the enzyme alpha-galactosidase, leading to a buildup of glycosphingolipids in the cells. Angiokeratoma is one of the cutaneous manifestations of this condition, and it helps making the diagnosis. The typical site involves the genital area in men and lumbosacral, buttocks and trunk region in both sexes. We report a case of genital angiokeratoma in a woman with Fabry disease. The diagnosis is through molecular analysis and, when made early, starting treatment reduces the morbidity and mortality of the disease. Thus, the dermatologist has an important role in the identification of angiokeratoma as a cutaneous marker, and the knowledge of its different presentations is essential for the early diagnosis and management of Fabry disease.


Subject(s)
Humans , Female , Middle Aged , Skin Neoplasms/diagnosis , Vulvar Neoplasms/diagnosis , Fabry Disease/diagnosis , Angiokeratoma/diagnosis , Physician's Role , Skin Neoplasms/pathology , Vulvar Neoplasms/pathology , Diagnosis, Differential , Enzyme Replacement Therapy , Dermatologists , Angiokeratoma/pathology
16.
Rev. cuba. obstet. ginecol ; 44(1): 1-8, ene.-mar. 2018. ilus
Article in Spanish | LILACS | ID: biblio-978439

ABSTRACT

El cáncer de vulva es una neoplasia relativamente rara, supone 5 por ciento de todos los cánceres ginecológicos. Su etiología, en general, se desconoce, pero existen pruebas que categorizan el virus del papiloma humano como un factor causal. En Cuba representa menos de 1 por ciento de todos los tumores malignos de la mujer, con su máxima aparición en la pos menopausia. Presentamos un caso de carcinoma escamoso de vulva diagnosticado en la atención primaria de salud. Se trata de una fémina de 65 años de edad, mestiza, fumadora inveterada, primeras relaciones sexuales a los 20 años, múltiples parejas sexuales, la mayoría desprotegidas, citología realizada en el año 2014 negativa, quien acudió a su consultorio, perteneciente al Policlínico Docente Efraín Mayor Amaro, del Cotorro, por presentar aumento de volumen en sus genitales, en ocasiones le producía prurito. Al examen físico se constató lesión verrugosa en el labio mayor derecho de aproximadamente 4 cm de diámetro, de contornos irregulares, no dolorosa a la palpación. Se interconsulta con Ginecología donde se indica exámenes complementarios, que demostraron en la citología actual, una displasia leve, NIC I, HPV. En consulta de Patología de cuello se realiza biopsia por ponche que se informa como: Carcinoma escamoso moderadamente diferenciado verrugoso. Posteriormente fue remitida a consulta de oncología para tratamiento quirúrgico, siguiendo los protocolos marcado por el comité oncológico de la Federación Internacional de Ginecólogos y Obstetras (FIGO). Se reafirma que el diagnóstico temprano es importante, debiéndose realizar mediante evaluación clínico e histopatológica, garantizando su tratamiento oportuno(AU)


Vulvar cancer is a relatively rare neoplasm, accounting for 5 percent of all gynecological cancers. The etiology is unknown, but there are tests that categorize by preference the human papillomavirus (HPV) as a causal factor. In Cuba, it represents less than 1 percent of all malignant tumors in women, and the maximum appearance in post menopause. We present the case of a patient over 65 years of age, mestizo, and incorrigible smoker. She had her first sexual intercourses at age 20, most of them unprotected, she had multiple sexual partners. The cytology performed in 2014 was negative. She came to consultation due to an increase in the volume of her genitals, which sometimes caused itching. In pathology consultation, punch biopsy is performed, which is reported as moderately differentiated verrucous squamous carcinoma. She was then taken on an Oncology consult for surgical treatment, following the protocols marked by the oncologic committee of the International Federation of Gynecologists and Obstetrics (FIGO). Early diagnosis is important and should be carried out through clinical and histopathologically evaluation to ensure timely treatment(AU)


Subject(s)
Humans , Female , Aged , Vulvar Neoplasms/surgery , Carcinoma, Squamous Cell/epidemiology , Pruritus Vulvae/epidemiology , Vulvar Neoplasms/pathology , Vulvectomy/methods
17.
Article in Chinese | WPRIM | ID: wpr-771474

ABSTRACT

OBJECTIVE@#To establish a SD rat model of vulvar squamous intraepithelial lesions.@*METHODS@#Seventy female SD rats were randomized into 4 groups, namely the blank control group (=10), mechanical irritation group (=10), acetone solution group (=10), and mechanical irritation with DMBA acetone solution group (=40, model group), and the corresponding treatments were administered 3 times a week for 14 weeks. The changes of the vulvar skin of the rats were observed regularly until the 18th week. The expression of mutant p53 (mtp53) and vascular endothelial growth factor (VEGF) proteins were detected using immunohistochemistry and Western blotting, and the expressions of mtp53 and VEGF mRNA were detected with qRT- PCR in the blank control group and model group.@*RESULTS@#No significant differences were found in the morphological or histopathological changes of the skin among the blank control group, mechanical irritation group and acetone solution group. In the model group, low-grade squamous intraepithelial lesions (LSIL) occurred in 28 rats (70%) and high-grade squamous intraepithelial lesions (HSIL) in 11 rats (27.5%) at 14 weeks, with a success rate of 97.5% in inducing vulvar squamous intraepithelial lesions. Compared with the blank control group, the rats in the model group showed significantly increased expressions of mtp53 and VEGF at both the protein level ( < 0.05) and the mRNA level ( < 0.05).@*CONCLUSIONS@#DMBA in acetone solution combined with mechanical irritation can induce vulvar squamous intraepithelial lesions in female SD rats.


Subject(s)
9,10-Dimethyl-1,2-benzanthracene , Acetone , Animals , Blotting, Western , Carcinogens , Disease Models, Animal , Female , Friction , Immunohistochemistry , Precancerous Conditions , Metabolism , Pathology , Random Allocation , Rats , Rats, Sprague-Dawley , Skin , Pathology , Solvents , Tumor Suppressor Protein p53 , Metabolism , Vascular Endothelial Growth Factor A , Metabolism , Vulvar Neoplasms , Metabolism , Pathology
18.
Article in English | WPRIM | ID: wpr-717071

ABSTRACT

OBJECTIVE: We aimed to identify the minimum tumor-free margin distance conferring long-term oncological safety in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB/II vulvar squamous cell carcinoma (VSCC). METHODS: This was a retrospective cohort study in patients with stage IB/II VSCC treated at a single institution in Turin, Italy. The main aim was to identify the minimum tumor-free margin distance that confers oncological safety in early-stage VSCC. Patients were divided in groups according to tumor-free histological margin distance to compare survival outcomes. Overall survival (OS), disease-specific survival (DSS), and recurrence rate (RR) were estimated by the Kaplan-Meier method for the newly proposed and the currently recommended 8 mm margin cut-off. Log-rank test was used to compare survival between groups. RESULTS: One hundred and fourteen patients met the study criteria. Median age was 68 years and median follow-up was 80 months. The minimum margin distance that conferred long-term oncological safety was 5 mm. OS, DSS were significantly lower in the < 5 mm group when compared with the ≥ 5 mm group (p = 0.002 and p = 0.033, respectively) although no difference in RR was observed between groups. Analysis at the 8-mm cut-off indicated there is no difference in OS, DSS, or RR between groups. CONCLUSION: FIGO stage IB/II VSCC patients' prognosis is affected by margin distance. Long-term survival is significantly reduced in patients with tumor-free margins < 5 mm, even in the absence of lymph node metastasis. Thus, these patients should be offered further surgical or adjuvant treatment.


Subject(s)
Carcinoma, Squamous Cell , Cohort Studies , Epithelial Cells , Follow-Up Studies , Gynecology , Humans , Italy , Lymph Nodes , Methods , Neoplasm Metastasis , Obstetrics , Prognosis , Recurrence , Retrospective Studies , Vulvar Neoplasms
19.
São Paulo; s.n; 2018. 78 p. figuras, tabelas.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1099800

ABSTRACT

Introdução: A identificação de receptores da família ERBB no câncer de vulva são pouco estudados e pode contribuir para o melhor conhecimento da doença e possível desenvolvimento de novas estratégias de tratamento. Objetivos: 1. Avaliar a expressão imunoistoquímica e o papel prognóstico dos receptores da família ERBB no carcinoma epidermóide da vulva com metástase em linfonodos; 2. Correlacionar a expressão imunoistoquímica dos receptores da família ERBB com variáveis clínico-patológicas. Pacientes e métodos: Análise retrospectiva de 110 pacientes com carcinoma epidermóide da vulva com metástase inguinal tratadas no A.C.Camargo Cancer Center, entre janeiro de 1980 e fevereiro de 2010. Foram analisadas características clínicas, patológicas e de seguimento. A avaliação da expressão imunoistoquímica dos receptores da família ERBB foi realizada no tumor primário e nos linfonodos metastáticos. Resultados: Com relação às expressões imunoistoquímicas dos marcadores estudados nos tumores primários houve expressão de EGFR, HER2, HER3 e HER4 em 28,8% 2,8%, 3% e 76,8% dos casos, respectivamente. Em relação às expressões imunoistoquímicas de EGFR e HER4 nos linfonodos inguinais metastáticos, foi positiva em 48,1% e 69,6% dos casos, respectivamente. Não houve expressão imunoistoquímica de HER2 e HER3 nos linfonodos inguinais metastáticos. Não foram encontradas relações entre as expressões imunoistoquímicas de EGFR, HER-2, HER-3 e HER-4 entre os tumores primários e as metástases linfonodais. A expressão imunoistoquímica de HER-4 foi mais frequente em tumores <4cm (95%). Não houve relação estatisticamente significativa entre as expressões de EGFR, HER2 e HER3 e as variáveis anatomopatológicas. Conclusões: Houve expressão de EGFR, HER2, HER3 e HER4 nos tumores primários. A expressão imunoistoquímica de HER4 foi mais frequente em tumores <4cm . A expressão imunoistoquímica de receptores da família ERBB não teve impacto em sobrevida (AU)


Introduction: The identification of ERBB receptors in vulvar cancer is poorly studied and may contribute to a better knowledge of the disease and possible development of new treatment strategies. Objectives: 1. To evaluate the immunohistochemical expression and the prognostic role of ERBB family receptors in squamous cell carcinoma of the vulva with lymph node metastasis; 2. Correlate the immunohistochemical expression of the ERBB family of receptors with clinical-pathological variables. Patients and methods: Retrospective analysis of 110 patients with squamous cell carcinoma of the vulva with inguinal metastasis treated at the A.C.Camargo Cancer Center between January 1980 and February 2010. Clinical, pathological and follow-up characteristics were analyzed. The evaluation of the immunohistochemical expression of ERBB family receptors was performed on the primary tumor and metastatic lymph nodes. Results: Regarding the immunohistochemical expressions of the markers studied in the primary tumors, EGFR, HER2, HER3 and HER4 were expressed in 28.8%, 2.8%, 3% and 76.8% of the cases, respectively. Regarding the immunohistochemical expression of EGFR and HER4 in the metastatic inguinal lymph nodes, it was positive in 48.1% and 69.6% of the cases, respectively. There was no immunohistochemical expression of HER2 and HER3 in metastatic inguinal lymph nodes. No relationships were found between the immunohistochemical expressions of EGFR, HER-2, HER-3 and HER-4 between primary tumors and lymph node metastases. The immunohistochemical expression of HER-4 was more frequent in tumors <4cm (95%). There was no statistically significant relationship between EGFR, HER2 and HER3 expression and anatomopathological variables. Conclusions: There was expression of EGFR, HER2, HER3 and HER4 in primary tumors. The immunohistochemical expression of HER4 was more frequent in tumors 4cm. The immunohistochemical expression of ERBB family receptors had no impact on survival (AU)


Subject(s)
Humans , Female , Vulvar Neoplasms , Immunohistochemistry , Carcinoma, Squamous Cell , ErbB Receptors , Lymph Nodes , Neoplasm Metastasis , Retrospective Studies
20.
Rev. chil. obstet. ginecol. (En línea) ; 82(4): 460-465, oct. 2017. graf
Article in Spanish | LILACS | ID: biblio-899929

ABSTRACT

El tumor de células granulares es una neoplasia de la piel y los tejidos blandos muy poco frecuente, benigna y de crecimiento lento, pero con altas tasa de recurrencia. La localización más frecuente en el aparato genital es en la vulva. Se debe realizar diagnóstico diferencial con otras lesiones vulvares, debido al manejo distinto de esta tumoración. El diagnóstico generalmente es histológico, ya que clínicamente es muy difícil diferenciarlo de otras tumoraciones a nivel vulvar. El tratamiento recomendado es la exéresis quirúrgica, con márgenes de seguridad. En caso de bordes afectos, se recomienda realizar una reescisión, por la frecuencia de recurrencia local y porque ésta puede ser el primer indicador de una conducta agresiva. Presentamos un caso clínico a nivel vulvar, con el objetivo de destacar la importancia de realizar un diagnóstico correcto, para un buen manejo clínico y seguimiento. Las formas malignas suponen menos del 3% de estos tumores y son muy agresivas


The granular cell tumor is a neoplasm of the skin and soft tissue very rare, benign and slow growing, but with high recurrence rate. The most frequent location in the genital tract is in the vulva. Differential diagnosis should be made with other vulvar lesions, due to differences in the management of this tumor. The diagnosis is usually histological, since it is clinically difficult to differentiate it from other tumors at the vulvar level. The recommended treatment is surgical excision, with safety margins. In case of affected borders, it is recommended to perform a resection, due to the local recurrence and this may be the first indicator of aggressive behavior. We present a clinical case at the vulvar level, in order to emphasize the importance of making a correct diagnosis, for a good clinical management and follow-up. Malignant forms account for less than 3% of these tumors and are very aggressive.


Subject(s)
Humans , Female , Aged , Vulvar Neoplasms/surgery , Vulvar Neoplasms/diagnosis , Granulosa Cell Tumor/surgery , Granulosa Cell Tumor/diagnosis , Vulvar Neoplasms/pathology , Granulosa Cell Tumor/pathology
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