Syringoma of the vulva. A case report.

Syringoma of the vulva, especially as the multiple form, is a rare disorder. A review of the diagnoses in 4,500 patients from the Vulvar Clinic, Hospital de Clínicas José de San Martín, First Chair of Gynecology, Buenos Aires University, revealed only three cases, two of which were asymptomatic. The third patient, with multiple lesions and severe discomfort, is presented. With cryotherapy the lesions healed, and the patient was asymptomatic even during warm weather.

Tratamiento multidisciplinario del cáncer de la mama localmente avanzado no inflamatorio: resultados preliminares / Multimodal treatment for locally advanced non inflamatory breast cancer: preliminary results

Desde 1985 hemos tratado 99 pacientes con cáncer de mama estadio III (operables e inoperables) con una misma estrategía, combinando QT primaria, radioterapia, cirugía y QT de consolidación. Hubo 75 estadios IIIB y 24 estadios IIIA. En 11 casos se pudo realizar cirugía conservadora. Tuvimos 6 respuestas patológicas completas. Cuarenta y ocho pacientes han cumplido 2 años de tratadas y se consideraron evaluables. La mediana de SV fue d3e 60-66 meses. El porcentaje de SV en este grupo es 45,8 por ciento. Se analiza la incidencia de los distintos factores pronóstico en la SV. No se observó recidiva local en los casos en que se conservó la mama. Tuvimos muy baja toxicidad y se concluye con la necesidad de buscar tratamientos sistémicos más agresivos que podrían incidir en un futuro incremento de SV

Tratamiento multidisciplinario del cáncer de la mama localmente avanzado no inflamatorio: resultados preliminares / Multimodal treatment for locally advanced non inflamatory breast cancer: preliminary results

Desde 1985 hemos tratado 99 pacientes con cáncer de mama estadio III (operables e inoperables) con una misma estrategía, combinando QT primaria, radioterapia, cirugía y QT de consolidación. Hubo 75 estadios IIIB y 24 estadios IIIA. En 11 casos se pudo realizar cirugía conservadora. Tuvimos 6 respuestas patológicas completas. Cuarenta y ocho pacientes han cumplido 2 años de tratadas y se consideraron evaluables. La mediana de SV fue d3e 60-66 meses. El porcentaje de SV en este grupo es 45,8 por ciento. Se analiza la incidencia de los distintos factores pronóstico en la SV. No se observó recidiva local en los casos en que se conservó la mama. Tuvimos muy baja toxicidad y se concluye con la necesidad de buscar tratamientos sistémicos más agresivos que podrían incidir en un futuro incremento de SV

Lymph node metastases in carcinoma of the cervix uteri: response to neoadjuvant chemotherapy and its impact on survival.

One hundred and sixty-nine patients with squamous cancer of the cervix uteri treated with three courses of neoadjuvant chemotherapy with the modified VBP scheme are presented. All were subjected to a Wertheim-Meigs operation with paraaortic lymph-adenectomy. The incidence of lymph node metastases is analyzed according to clinical stage, tumor volume, residual tumor in the surgical specimen, and clinical response to neoadjuvant chemotherapy. A significant decrease in the incidence of lymph node involvement was observed in good responders. Survival rates, after 2 years of follow-up, improved in those cases with small residual tumor, negative parametria, and negative nodes.

Results of a phase II trial with neoadjuvant chemotherapy in carcinoma of the cervix uteri.

Results of a Phase II trial with neoadjuvant chemotherapy in carcinoma of the cervix uteri (VBP modified scheme) show that 85.7% of patients given this therapy were NED in Stage IIb versus 54% of a nonrandomized control group given conventional therapy. In Stage IIIb the averages are 66.6% vs. 31% in the control group. Analysis of the ecographic data has shown that if a critical prechemotherapy volume (120 cm3) is exceeded, the prognosis is unfavorable, especially in cases treated with radiotherapy as second-line treatment.

Association of human papillomavirus infection and vulvar intraepithelial neoplasia: a morphological and immunohistochemical study of 30 cases.

Thirty cases of vulvar intraepithelial neoplasia (VIN) were analyzed in order to determine the frequency of association with human papillomavirus (HPV) infection, and the relationship between this association and patient's age, extent of vulvar lesions, and coexistence with cervicovaginal neoplasia. The presence of condyloma or moderate to marked koilocytosis, now considered as morphological evidence of HPV infection, was observed in 66.6% of our cases. A search for HPV antigens, using the peroxidase-antiperoxidase (PAP) method, was performed in 13 selected cases, and positive staining was detected in 3 of them. The presence of HPV infection correlates with a mean age of 48.8 years, 50% of multicentricity of VIN and coexistence with cervical neoplasia in 30% of the cases, as opposed to a mean age of 55.5 years, 10% of multicentricity of VIN and absence of cervical neoplasia in patients without HPV infection. The demonstration of multiple foci of early stromal invasion in a 43-year-old woman, with multicentric VIN lesions associated with HPV infection, indicates that, even in the presence of such clinicopathological features, the risk of developing stromal invasion should be considered. Considerations are made in relation with the presence of HPV antigen in morphological normal epithelium adjacent to the lesion. Therapeutic implications were also investigated.

A possible new trend in the management of the carcinoma of the cervix uteri.

Thirty-three patients with locally advanced carcinoma of the cervix were treated with chemotherapy as first line treatment. Great emphasis was applied to document, in the most objective manner, the tumor size response. The first 8 patients received a conventional scheme composed of vincristine, bleomycin and cis-platinum (VBP) at 21-day intervals. The results were not as satisfactory as expected. In the other 25 patients a more aggressive VBP scheme was used, at 10-day intervals. Surprisingly satisfactory results and tolerance were observed. In many instances verified tumor reduction allowed surgical radical treatment in prechemotherapy inoperable cases.

Estrogen and progesterone receptor assays on the vulvar epithelium.

Seventy-seven samples of healthy and diseased vulvar epithelium (one per patient) were processed using the carbon-coated-dextran biochemical technique. The results were analyzed according to Scatchard or the unique point technique. The samples of normal tissue were obtained from patients who underwent surgical procedures for different gynecologic pathologies. The samples of diseased tissue were obtained with punch biopsy from patients with several vulvar disorders. Ten samples were obtained from the episiotomy wound in pregnant patients during labor. Estrogen receptors were assayed in all cases. Progesterone receptors were assayed simultaneously in 73 of the cases. The minimum concentration considered positive was 2 fmol/mg of protein. A map of the vulvar region was drawn, and samples were obtained from different sites whenever possible.

Deceptive vulvar papillomavirus infection. A possible explanation for certain cases of vulvodynia.

Use of the colposcope for vulvar and vaginal examination in four cases of long-standing vulvodynia led to the identification of lesions with an unusual appearance. In the vulvar vestibule, epithelial projections resembling cactus, camel humps or stony colonial pavement were observed. In the vagina, the lesions looked more like cerebral folds. Biopsies of these lesions showed histopathologic changes diagnostic of human papillomavirus infection, scored according to Reid's criteria. In one case, capsid antigen was detected with the peroxidase technique in the nuclei of the superficial cells. Past history and positive findings in the sexual partners of some of the patients suggested long-standing herpesvirus activity in the lower genital tract. In some cases of recalcitrant vulvodynia, colposcopic examination of the vulva and vagina may lead to a viral explanation for symptoms previously considered psychosomatic in origin.

Epithelial ovarian cancer: do all metastases present similar chemosensitivity?

Three cases of advanced epithelial ovarian carcinoma Stage III-IV which could not be submitted to classical surgical and oncological treatment (BSO-TH) are presented. After a year of chemotherapy a complete remission was observed. Myometrial and myocervical micrometastases were found in a specimen from the hysterectomy, carried out during second-look, that was negative. These micrometastases, when they are present, apparently show a different chemosensitivity, as compared with other metastasis localization. The causes of this phenomenon are analyzed.

Melanoma of the vulva. The experience at Buenos Aires University.

Nine cases of vulvar melanoma were studied: the histologic variants, depth of invasion and prognostic significance of these factors and of node involvement were analyzed. The histologic types were in situ melanoma (one case), superficial spreading melanoma (two cases) and nodular melanoma (six cases). The mean age of the patients was 64.9 years. Eight patients were treated with radical surgery and one with chemotherapy only. We found a good prognosis for in situ melanoma with free margins; a tendency for superficial spreading melanoma to recur, though it has a good prognosis when it does not exceed Clark level II; and an ominous prognosis for nodular melanoma, probably because of its late diagnosis.

Recurrent vulvar malignancies in an 11-year prospectively followed vulvar distrophy: a gynecologist's permanent concern.

This case reports on a vulvar lichen sclerosus, followed during 11 years, with poor response to many different local and general treatments. After 6 years of control the patient developed a mild atypia. Two years later, an invasive carcinoma was diagnosed and radically treated. Six months later, a local recurrence was excised. During the last year of control new biopsies of the neovulva showed, at different times, carcinoma in situ and severe atypia.

Lichen sclerosus of the vulva recurrent after myocutaneous graft. A case report.

A woman with stage I squamous carcinoma of the vulva associated with diffuse lichen sclerosus was treated with radical vulvectomy plus inguinofemoral and pelvic lymphadenectomy. This procedure was followed by vulvar reconstruction using bilateral gracilis myocutaneous grafts. Two years later the previously normal grafted skin had developed lichen sclerosus. This occurrence is unique and completely unexpected in view of the graft technique, which preserves the original blood supply and deep dermal tissues.