Carcinoma escamoso de vulva / Vulvar squamous carcinoma

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)

History of Abuse in Women With Vulvar Pruritus, Vulvodynia, and Asymptomatic Controls.

OBJECTIVE: Chronic vulvar pruritus and vulvodynia are common vulvar diseases. The aim of this study was to compare gynecologic and sexual and physical abuse histories from patients with these diagnoses and from healthy controls. MATERIALS AND METHODS: Questionnaires were self-completed by patients diagnosed with vulvar itch-scratch (n = 93), patients diagnosed with vulvodynia (n = 232), and patients presenting for annual gynecologic examinations (n = 104) at the University of Michigan Hospitals, Ann Arbor, MI. RESULTS: Patients who came for annual examinations were less likely to report past gynecologic infections (p < .05) and indicated higher interest in and more frequent sexual activity than the other 2 groups (p = .003). Vulvodynia patients had the highest scores on the McGill Pain Questionnaire (p < .001). Subjects with either vulvar disorder were more likely to self-report a history of gynecologic infections than annual examination controls. Rates of sexual (p = .78) and physical abuse (p = .12) were similar for all 3 groups. CONCLUSIONS: Patients with vulvar pruritus and vulvodynia report similar rates of sexual and physical abuse.

Management of lichen sclerosus with triamcinolone ointment: effectiveness in reduction of patient symptom scores.

OBJECTIVE: To determine whether topical triamcinolone ointment effectively reduces patient's symptoms for the management of lichen sclerosus (LS). MATERIALS AND METHODS: A retrospective chart review of LS patients seen during 2004 to 2008 in the Saint Louis University Vulvar Clinic was conducted. Inclusion criteria were biopsy-confirmed LS and age 18 years and older. Data were collected at the initial visit and at 6 to 10 weeks, 3 months, and 6 months of follow-up. Effectiveness was assessed using symptom scores on a Likert scale. Data were analyzed using either paired t tests or nonparametric Wilcoxon signed rank tests using a p value less than.05 to denote statistical significance. RESULTS: Of 41 women, 34 met inclusion criteria. Vulvar pruritus was the most frequently reported vulvar symptom, occurring in 32 (94.1%) of 34 women. Dyspareunia, vulvar burning, and vulvar pain were reported in 17 (54.8%) of 31, 22 (64.7%) of 34, and in 13 (38.2%) of 34 women, respectively. Statistically significant reductions in mean symptom scores between the initial and the 6- to 10-week follow-up visits were found for dyspareunia, vulvar burning, vulvar pruritus, and pain (p values < .05 to < .001) and at 3-month follow-up visits for dyspareunia, vulvar burning, and vulvar pruritus (p < .05). Complete symptom relief was reported for 8 (47.1%) of 17 women with dyspareunia, 19 (86.4%) of 22 women with vulvar burning, 23 (71.9%) of 32 women with vulvar pruritus, and 12 (92.3%) of 13 women with vulvar pain. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Topical triamcinolone ointment is an effective treatment for the management of LS based on the significant reduction of patient symptom scores. Inherent risks with long-term use of high-potency corticosteroids should prompt all practitioners to consider triamcinolone ointment as a safer long-term treatment for patients with LS.

Vaginal douching practice and related symptoms in a rural area of Turkey.

PURPOSE: To investigate vaginal douching habits and associated factors among women living in rural Turkey. METHODS: This study was performed in the gynecology department of a government hospital in a rural area of Turkey, from February to March 2010. The study included 393 women admitted to the gynecology clinic. The age, marital status, education, socioeconomic status, reason for vaginal douching, douching frequency, symptoms, and previous treatments were investigated. All of the subjects were asked about the use of, frequency, and reason for vaginal douching. Significant risk factors in the vaginal douching group and odds coefficients were found using binary logistic regression. RESULTS: The major symptoms of the subjects were itching and vaginal discharge. Of the 393 women, 317 (80.66%) performed vaginal douching and all of them had recurrent or treatment-resistant mixed agent vulvovaginitis. The majority of the women douched for ritual cleansing or washing before prayer (n = 278; 91.6%). The majority of the cases (n = 354; 90.1%) were of lower socioeconomic and educational status. The odds ratios and 95% confidence interval (CI) of the risk variables vaginal douching frequency, cervical motion tenderness, dyspareunia, and vaginal itching were 9.39 (2.07-42.48), 7.31 (2.08-25.64), 6.52 (2.26-18.78), and 1.46 (1.22-1.74), respectively. CONCLUSIONS: In our region, vaginal douching is a common practice among women, especially those of lower socioeconomic and educational status. Clinicians should inform patients about the risks of vaginal douching to minimize the risks associated with this behavior.

Urgencias en ginecología oncológica / Emergencies in oncological gynaecology

En este trabajo se describen los signos de sospechade neoplasia por los que la paciente acude al Serviciode Urgencias, centrándonos en el sangrado genital,la masa pélvica y el prurito vulvar. Los pacientestambién pueden acudir por procesos resultantes decomplicaciones de la enfermedad, como en el caso dela obstrucción ureteral, la carcinomatosis, la ascitis,procesos tromboembólicos, hemorragias, estreñimiento,náuseas y vómitos, obstrucción intestinal y dolor.Por último, se describen complicaciones secundarias altratamiento como el linfocele abdominal e inguinal y laenteritis y proctitis postradioterápica(AU)

This article describes the signs for suspecting neoplasiathat lead the patient to come to the Accident andEmergency Service, concentrating on genital bleeding,pelvic mass and vulvar pruritus. Patients can also comedue to processes resulting from complications of thedisease, such as urethral obstruction, carcinomatosis,ascites, thromboembolic processes, haemorrhages,constipation, nausea and vomiting, intestinal obstructionand pain. Finally, we describe complications thatare secondary to the treatment, such as abdominal andinguinal lymphocele and post-radiotherapy enteritisand proctitis(AU)

Semiología y exploración ginecológica en la infancia y adolescencia / No disponible

No disponible

[Enterobiasis among schoolchildren in a rural population from Estado Falcón, Venezuela, and its relation with socioeconomic level]. / Enterobiasis en escolares de una población rural del Estado Falcón, Venezuela y su relación con el nivel socio-económico.

Between may and july 2001, a survey was conducted in order to investigate the prevalence and symptoms of Enterobius vermicularis infection and its relationship with the socio-economic status and household crowding of 154 schoolchildren aged 6-12 years from a rural village in Falcon State, Venezuela. The Graham technique (perianal swabs with an adhesive cellulose tape) was used to perform the parasitological diagnosis. The overall prevalence was high (57.79%). There was no difference in the prevalence between sexes (X2 = 0.005; d.f. = 1) or ages (X2 = 3.63; d.f. = 6) (p > 0.05), suggesting similar risk conditions for all individuals. Anal pruritus was the most common clinical finding (53.9%). Other less frequent manifestations were the following: perianal lesions (34.8%) and vulvovaginitis (32.6%). Graffar analysis revealed that the majority of schoolchildren belong to the poorer socioeconomic strata: IV (55.9%) and V (29.87%), with overcrowded living conditions. The correlation between E. vermicularis infection and crowding rates was found to be statistically significant (r = 0.98; p < 0.001). In the light on these results, it can be concluded that poverty, overcrowding, anal pruritus, scarcity of water, inadequate personal and community hygiene play a relevant role on the transmission dynamics and endemic maintenance of enterobiasis among schoolchildren from Sabaneta.

Vulvar disease.

Unique embryologic and immunologic aspects of the vulva contribute to the diagnostic and therapeutic challenges of managing vulvar problems. Individual variations in care of the genital region, defined by personal and societal "norms," may at times exacerbate vulvar problems. Three dimensions are considered in the evaluation of a vulvar problem: 1) lesion type, 2) lesion location, and 3) associated systemic and laboratory findings. This review of vulvar disease highlights a number of common and problematic vulvar conditions. Treatment options for vulvar conditions are covered with an expanded discussion of newer immune response modifiers.

The commonest causes of symptomatic vulvar disease: a dermatologist's perspective.

A prospective study of 141 consecutive adult patients with chronic vulvar symptoms referred to a dermatologist was carried out to determine the commonest conditions seen. Eighty-nine per cent of patients underwent vulvar biopsy. The commonest cause of chronic vulvar symptoms in this group of patients was dermatitis, seen in 54% of patients. The other commonly seen conditions were lichen sclerosus (13%), chronic vulvovaginal candidiasis (10%), dysaesthetic vulvodynia (9%) and psoriasis (5%). Although 38% of patients had previously been diagnosed as suffering from human papillomavirus (HPV) vulvitis, histopathological evidence of HPV was seen in only 5%. All cases showing HPV also demonstrated spongiotic dermatitis on biopsy. In this study group, a majority (overall 72%) of patients with a chronic vulvar complaint had a corticosteroid responsive dermatosis rather than a gynaecological condition. The patients with HPV on biopsy also responded to topical corticosteroids, and it was concluded that their symptoms may have been due to dermatitis unrelated to the presence of HPV. In such patients, the assumption that 'subclinical HPV' is a cause of symptoms and the practice of focusing medical and particularly surgical treatment on eradication of the virus may be inappropriate. A review of the commonest vulvar conditions seen by the author is presented.

Prevalence of vaginal infections with bacterial vaginosis, Trichomonas vaginalis and Candida albicans among pregnant women at the Port Moresby General Hospital Antenatal Clinic.

A clinico-sociodemographic and microbiological survey was carried out at the Port Moresby General Hospital Antenatal Clinic to determine the prevalences of bacterial vaginosis, Trichomonas vaginalis and Candida albicans vaginal infections in pregnancy and to examine if the infections had any association with some suspected sociodemographic risk factors. The study was carried out between December 1990 and January 1991. Of 206 consecutive subjects surveyed, 79 (38%) had symptomatic infection. However, on speculum examination, abnormal discharge was seen in 188 (91%). 118 (57%) had microbiologically confirmed infection. The prevalences of the individual infections were T. vaginalis 19%, C. albicans 23% and bacterial vaginosis 23%. Combined infection, i.e. two infections occurring together in the same subject, was uncommon. None of the infections had an association with any of the sociodemographic characteristics studied. Of the 118 positive subjects, 52 (44%) complained of vaginal discharge and 55 (47%) complained of pruritus.

PIP: The prevalences of vaginal infections with Trichomonas vaginalis, bacterial vaginosis, and Candida albicans were investigated in 206 consecutive pregnant women presenting to Port Moresby (Papua New Guinea) General Hospital in 1990-91 for their first antenatal visit. Bacteriologic investigation identified Candida in 48 women (23%), T. vaginalis in 39 (19%), and bacterial vaginosis in 48 (23%). Overall, 118 women (57%) were bacteriologically positive for at least one infection. 79 (38%) of the infected women complained of a vaginal discharge and 78 (38%) reported vulvar irritation; however, vaginoscopy revealed abnormal discharge in 188 (91%) of women with an infection. Infection was not associated with gestational age or any of the sociodemographic variables examined (age, parity, ethnic group, residence, husband's education). The fact that the majority of pregnant women in this series had a vaginal infection is alarming in light of the hypothesized association of such infections with intra-amniotic infection, endometritis, premature rupture of the membranes, preterm labor or birth, and low birth weight. A randomized, controlled prospective study is needed to assess the extent to which, if any, these infections are related to the high perinatal morbidity and mortality from low birth weight at Port Moresby General Hospital.

Pruritus in diabetes mellitus: investigation of prevalence and correlation with diabetes control.

Three hundred diabetic and 100 nondiabetic hospital outpatients (both groups of comparable age and sex distribution) were assessed for the presence of generalized and localized pruritus. Pruritus vulvae was significantly more common in diabetic women (18.4%) than in controls (5.6%) and was significantly associated with poor diabetes control (mean glycosylated hemoglobin level less than 12%). Other forms of localized pruritus were equally common in diabetic and nondiabetic patients, regardless of glycosylated hemoglobin levels. Generalized pruritus was present in 14 diabetic patients, but in 5 cases the symptom was ascribed to intercurrent illness or drug administration. Thus, generalized pruritus without apparent cause was present in only 8 diabetic patients (2.7%) and was not significantly more common than in nondiabetic patients. It is doubtful if diabetes mellitus per se should be regarded as a cause of generalized or localized pruritus, other than pruritus vulvae.

Vaginal candidiasis and the role of the digestive tract as a source of infection.

Of 300 female patients seen in a Venereal Diseases clinic, 84 (28-0 per cent) were found to be harbouring Candida albicans or C. parapsilosis in the genital tract and 33 per cent of these patients had clinical signs of vulvovaginitis. Of the 84 patients, 71-4 per cent harboured yeasts in the ano-rectal tract; of the remaining 216 patients, 25-9 per cent harboured yeasts in the ano-rectal tract. There was no evidence to suggest that the incidence of yeasts in the mouth, ano-rectal or genital tracts changed with age or use of oral contraception.