Carcinoma espinocelular de la vulva: caso clínico / Squamous cell carcinoma of the vulva: case report

Antecedentes: El carcinoma espinocelular (CEC) es una neoplasia epitelial maligna. La mayor parte se concentra en 4 áreas: cáncer de piel no melanoma, de cabeza y cuello, esofágico y pulmonar. El riesgo de metástasis de CEC es de 0,3-3,7 por ciento. El CEC vulvar representa aproximadamente un 3-5 por ciento de los cánceres ginecológicos. Caso clínico: Mujer de 86 años con prurito genital de larga data. Evaluada en varias oportunidades, siendo tratada como Herpes genital con valaciclovir, y Liquen Escleroso y Atrófico (LEA) con corticoides tópicos y tacrolimus con mala respuesta. Consultó por intenso prurito y nuevas lesiones vulvares. Al examen físico, destacaban 2 nódulos ulcerados en región periclitorídea izquierda e introito. La biopsia confirmó CEC bien diferenciado infiltrante. El TAC de abdomen y pelvis descartó metástasis. Se realizó radioterapia por 7 semanas. Por persistencia de la lesión, ingresó a cuidados paliativos. Dos años después la paciente está en buenas condiciones. Discusión: El CEC representa el 95 por ciento de las neoplasias vulvares. Existen 2 tipos: CEC en mujeres jóvenes, asociado a infección por virus papiloma humano de alto riesgo y CEC en mujeres mayores en relación a LEA. El 45-61 por ciento de los CEC de vulva se asocian a LEA preexistente, por lo que se recomienda el seguimiento de pacientes portadoras de LEA cada 6 meses. Conclusión: Es importante realizar biopsias de lesiones vulvares con mala respuesta a tratamiento, sobre todo si se asocia a LEA.

Background: Squamous cell carcinoma (SCC) is a malignant epithelial neoplasm. SCC can be divided into 4 groups: non-melanoma skin cancer (NMSC), head and neck, esophageal and lung cancer. The risk for metastasis of SCC is 0.3-3.7 percent. Vulvar SCC is approximately 3-5 percent of all gynecological cancers. Case report: An 86-year old woman with a history of several years of genital pruritus and many consultations for this reason, prior treatments included valacyclovir for genital herpes; topical corticosteroids and tachrolymus for lichen sclerosus et atrophicus (LEA) with poor response. She presented with pruritus and new vulvar lesions. Physical examination showed two ulcerated nodules on the left periclitorid region and the introitus. The biopsy confirmed an infiltrating well-differentiated SCC. CT-scans discarded metastases. She received 7 weeks of radiotherapy. Due to persistence of the tumor the patient entered palliative care. Two years afterwards the patient is in good condition. Discussion: SCC represents 95 percent of vulvar malignancies. There are 2 types: SCC in young women, associated with high-risk human papilloma virus infection and SCC in elder women associated to the preexistence of LEA. 45-61 percent of vulvar SCC is associated in with preexisting LEA. Patients with LEA should be followed every 6 months. Conclusion: It is important to perform biopsies of vulvar lesions that have poor response to treatment, especially if they are associated with LEA.

Expression of Epidermal Growth Factor Receptor in Malignant Epidermal Tumors / 대한피부과학회지

BACKGROUND: Epidermal growth factor(EGF) usually stimulate she growth and proliferation of a variety of cell types in vitro and in vivo through binding to a peific cell surface receptor, a 170- kilodalton glycoprotein. The EGF receptor (EGFR) may be respansi ile for deranged keratinocyte proliferation and differentiation. OBJECTIVE: Our purpose was to investigate the pattern of EGFR expression in malignant epidermal tumors. METHODS: We performecl immunohistochemical studies to reveal immunoreactivity of EGFR in 7 basal cell carcinomas, 6 squamous cell carcinomas, and five nomal control skin using the Uectastain ABC immunoperoxidase stain system. RESULTS: In normal skin, EGFR showed strong staining of basal cells and lower keratinocytes of the stratum malpighii. As squaous cells matured, staining gradually beame weaker. In all cases of basal cell carcinoma studied, there was loss of membrane labelling of the tumor cells and but in half the cases there was little or no siaining of the lesional cells. In squamous cell carcinomas, variable patterns were seen. The better differentiated tumors showed an essentially no mal pattern of EGFR expression. However, less well differentiated areas showed loss of membrane staining, cytoplasmic accumulation of receptor, and a heterogeneiy of staining intensity. CONCLUSION: Dysregulation of the EGFR may be important in the levelopment, of cutaneous epithelial malignancies but that giossly abnormal forms of the receptor do not occur. The quantitative and qualitative changes in EGFR that we have demonstrated may well be of importance in the pathogenesis of these keratinocyte tumors.