[The five more frequent inflammatory vulvar lesions]. / Les cinq lésions inflammatoires les plus fréquentes en anatomie pathologique vulvaire.

Lichen sclerosus, lichen planus, psoriasis and plasma cell vulvitis are the most common diagnosis amongst inflammatory vulval diseases, the most frequently suspected by the clinicians and the most frequently diagnosed by the pathologist. We expose their clinical and pathological aspects and detail the most recurrent diagnosis difficulties.

Desquamative Inflammatory Vaginitis and Plasma Cell Vulvitis Represent a Spectrum of Hemorrhagic Vestibulovaginitis.

OBJECTIVE: The aim of the study was to identify whether desquamative inflammatory vaginitis (DIV) and plasma cell vulvitis (PCV) are distinct clinicopathologic entities. MATERIALS AND METHODS: The pathology database identified biopsies described as "vaginitis" or "vulvitis" occurring in nonkeratinized epithelium or mucocutaneous junction. Exclusions were age less than 18 years, unavailable slides or records, concurrent neoplasia, or histopathology consistent with other entities. Clinical data included demographics, symptoms, examination, microbiology, treatment, and response. Histopathologic review documented site, epithelial thickness and characteristics, infiltrate, and vascular abnormalities. Cases were analyzed according to histopathologic impression of DIV or PCV based on previous pathologic descriptions. RESULTS: There were 36 specimens classified as DIV and 18 as PCV from 51 women with mean age of 51 years; 3 (6%) had concurrent biopsies with both. Pain was more common in PCV, but rates of discharge, itch, and bleeding were comparable. Rates of petechiae or erythema were similar and vaginal examination was abnormal in 72% of PCV cases. All DIV and 33% of PCV occurred in squamous mucosa; the remaining PCV cases were from mucocutaneous junction. Mean epithelial thickness, rete ridge appearance, exocytosis, and spongiosis were similar in DIV and PCV. Epithelial erosion, wide-diameter lesions, plasma cells, and stromal hemosiderin occurred in both but were more common in PCV. Lymphocyte-obscured basal layer, narrow-diameter lesions, hemorrhage, and vascular congestion were seen in both, but more common and marked in DIV. CONCLUSIONS: Desquamative inflammatory vaginitis and PCV have overlapping symptoms, signs, and histopathologic features. They may represent a single condition of hemorrhagic vestibulovaginitis with varying manifestations according to location and severity.

Management of Urologic Conditions in Small Ruminants.

Small ruminants frequently experience urologic conditions, such as obstructive urolithiasis, posthitis, vulvitis, and urinary tract infections. Urologic conditions are more common in male small ruminants, especially castrated males, primarily due to their anatomy. Traditionally, urologic conditions warranted culling from the herd without significant efforts in treatment. However, more goats and sheep are now being kept as pets. Small ruminant owners have strong emotional attachments to their animals and are more likely to seek treatment of medical disorders, including urologic conditions. Surgical or medical treatments are available. Conditions also may be avoided through hydration, diet, hygiene, and other means.

Vulvar Silicone Granuloma.

We report a case of vulvar silicone granulomas following injection of liquid silicone into the labia. The patient is a 51-yr-old female who presented with vulvar pain and enlarged, indurated labia majora. In the past, she had undergone bilateral labial cosmetic augmentation with a silicone-based filler injected directly into the labia and into the gluteal regions. This had been performed in a nonmedical setting. At surgery, oblong firm soft tissue masses were removed from both labia. Microscopically, the lesions demonstrated replacement of the subcutaneous adipose tissue by fibrous tissue containing innumerable round empty spaces of different sizes, either within or surrounded by macrophages and occasional foreign-body giant histiocytes. The clear vacuoles corresponded to silicone fluid which had been dissolved during tissue processing. There are only rare case reports of vulvar silicone granuloma in the literature, and these were due to migration of silicone to the vulva from distant sites. Our report details a case of vulvar silicone granuloma secondary to direct injection of liquid silicone material into the labia.

Vulvar diseases: Conditions in adults and children.

The most problematic vulvovaginal conditions are familiar to dermatologists but may exhibit distinct clinical features or medication management because of the anatomic location. The second article in this continuing medical education series focuses on management pearls for treating vulvar diseases. We highlight key conditions, such as lichen sclerosus, erosive lichen planus, and vulvodynia. In addition, we review conditions that dermatologists may be less familiar with, such as plasma cell vulvitis, desquamative inflammatory vaginitis, vulvar aphthae, and low estrogen states. Nearly 1 in 6 women experience undiagnosed and untreated vulvovaginal discomfort at some point in their lives. Physicians who treat vulvar disorders will improve the quality of life of countless women.

Nivolumab in chemotherapy-resistant cervical cancer: report of a vulvitis as a novel immune-related adverse event and molecular analysis of a persistent complete response.

BACKGROUND: Treatment options for advanced cervical cancer are limited and patients experiencing recurrence after first-line cisplatin-based chemotherapy and bevacizumab have a poor prognosis. A recent phase II study in advanced cervical cancer has demonstrated a disease control rate of 68.4% with the immune checkpoint inhibitor nivolumab. By blocking immune checkpoints, immunotherapy puts the immune system into a state of hyper-activation that can cause immune-related adverse events. We present the clinical, pathological and molecular data of a patient with metastatic cervical cancer and progressive disease after second-line therapy. We report on the therapeutic response under third-line immunotherapy with nivolumab, the immune-related adverse events (IRAE), and their successful management. CASE PRESENTATION: We report the case of a 62-year-old woman who was diagnosed with advanced squamous cell carcinoma of the cervix with paraaortic lymph node metastases. After an initial combined radio-chemotherapy with cisplatin, she developed local and nodal (supraclavicular) recurrence. Second-line chemotherapy with 6 cycles of carboplatin, paclitaxel, and bevacizumab resulted in a partial response for 6 months. Checkpoint inhibition with nivolumab was started due to progression, leading to persistent complete remission. Immunotherapy was well tolerated for 8 months until the patient presented with an immune-related isolated vulvitis, which was successfully managed with topical corticosteroids. CONCLUSIONS: The persistent complete response after third-line treatment for relapsed chemotherapy-resistant cervical cancer presented in this case highlights the potential of immunotherapy for patients with advanced cervical cancer impressively. To our knowledge, this is the first report of an isolated immune-related vulvitis under nivolumab. This adverse event might be underdiagnosed and mistreated, however, it is of importance due to its impact on quality of life, sexual wellbeing and compliance of patients. Successful IRAE management may enable prolonged immune checkpoint inhibitor therapy. In the future, routine molecular tumour profiling is likely to aid in the stratification of cervical cancer patients for immunotherapy. Here, we provide the methylome data of a case with complete response.

Candida vaginitis among symptomatic pregnant women attending antenatal clinics in Mwanza, Tanzania.

OBJECTIVE: This study was done to determine the patterns of Candida spp. causing vaginitis and associated factors among pregnant women attending antennal clinic in Mwanza, Tanzania. RESULTS: A total of 197 (65.6%) out of 300 non-repetitive swabs had positive growth of Candida spp. Candida albicans 125 (63.4%) was the most predominant isolated specie followed by C. tropicalis 35 (17.8%) and C. glabrata 33 (16.8%). Laboratory confirmed candida vaginitis was independently predicted by douching practices (OR 3.2, 95% CI 1.3-7.5 P = 0.007), history of antibiotics use (OR 1.8, 95% CI 1.02-3.0, P = 0.04) and low social economic status (OR 2.04, 95% CI 1.1-3.7 P = 0.02). About two-third of pregnant women with clinical features of vaginitis attending antenatal clinic in Mwanza, Tanzania were confirmed to have Candida vaginitis mainly caused by Candida albicans.

Vulvitis migratoria causada por gnatostomiasis importada / Migratory vulvitis caused by imported gnathostomiasis

Resumen La gnatostomiasis es una parasitosis emergente en países no endémicos. Este nematodo zoonótico requiere de agua dulce para su ciclo de vida, donde sus larvas se enquistan principalmente en peces. La migración subcutánea de las larvas produce habitualmente una paniculitis eosinofílica de rápido avance. Se describe un caso clínico de un paciente con una lesión migratoria, sin mejoría clínica con terapia antibacteriana. La búsqueda de factores de riesgo, sumado a la evolución y a los hallazgos de laboratorio hizo sospechar el diagnóstico. La gnatostomiasis debe ser sospechado en pacientes con lesiones de piel migratorias, que han consumido pescado crudo durante viajes a países endémicos en Sudamérica o Asia.

Gnathostomiasis is an emerging disease in non-endemic countries. This zoonotic nematode requires aquatic freshwater environments to complete its life cycle where larvae get encrusted in fishes. Typically, the infection manifests as migratory subcutaneous lesion caused by the larvae trak, which produces an eosinophilic panniculitis. Here we describe a patient who presented a migratory lesion with no response to antimicrobial therapy, a careful travel and food history together with specific laboratory tests led to the correct diagnosis. Gnathostomiasis should be suspected in patients with migratory skin lesions who have consumed raw freshwater fish during travel to endemic countries in South America or Asia.

Zoon vulvitis - a rare form of chronic inflammation of the vulva.

OBJECTIVE: Description of finding out rare disease Zoon vullvitis. Desing: Case report and differential diagnosis. SETTING: Department of Obstetric and Gynecology, University Hospital Ostrava. CASE REPORT: Zoon vulvitis or plasma cell vulvitis (PCV) belongs to extremely rare and often misdiagnosed inflammatory disease of the vulva. Lesions may look like shiny, sharply bordered , erythematosus patches or macular lesions. Less than 50 cases have been reported. This article is devoted to clinical findings, differential diagnosis and treatment of PCV. We present one clinical case with typical clinical and histopathological manifestations. Risk of dysplasia exists and long-term follow-up is desirable.

Allergic Contact Dermatitis of the Vulva.

Allergic contact dermatitis is an important diagnostic consideration in the evaluation of patients presenting with vulvar complaints. The high prevalence of contact sensitization in the vulvar region is likely multifactorial. We review the extant literature regarding key predisposing factors in the pathogenesis of vulvar allergic contact dermatitis, as well as the most commonly implicated allergens as identified by a number of retrospective studies and case series. On the basis of our findings, we provide diagnostic and therapeutic recommendations for practicing clinicians.

Disorders of vulva and vagina in children and adolescent.

Disorders of vulva and vagina are the most common problem in childhood in gynecological practice. As child is not the little adult, as young girl is not little woman. Childhood is characterized by changing hormone levels, which influenced hormone-dependent tissues. Etiology and diagnostics of this most common diseases are very often different of the same problem in adult woman. The most common diseases in childhood is synechia vulvae, inflammation of vulva and vagina called vulvovaginitis and skin disorders. It is very important to know everything about diagnostics and treatment to help young girls. Key words: vulvovaginitis, lichen sclerosus, synechia vulvae, child rest period, sexual development period, yeast infection.

«Perineal groove», ese gran desconocido / Perineal groove, the great unknown

El perineal groove, o surco perineal, es una malformación benigna y poco frecuente que tiende a la resolución espontánea. De forma general, se caracteriza por un surco húmedo en la línea media perineal que se extiende desde la horquilla vulvar hasta el ano. El surco perineal se presenta más frecuentemente en niñas, aunque también se ha descrito en varones. Se ignora su incidencia real, debido en parte al desconocimiento del mismo por parte de los profesionales. Presentamos el caso de una recién nacida de 2 días de vida en la que se detecta una lesión lineal en el periné. Es importante su reconocimiento dado que entraña un amplio diagnóstico diferencial de lesiones, incluidas algunas con importantes connotaciones legales por la zona en la que se presenta (AU)

The perineal groove, or perineal sulcus, is an uncommon and benign anomaly which tends to resolve spontaneously. In general, it has been described as a wet sulcus in the midline perineum which extends from the fourchette to the anus. Although the perineal groove appears more frequently in girls, it has been described in males too. The incidence of perineal groove is ignored, it is due to the lack of knowledge of it by health professionals. We report one case of a 2-days-old baby girl. There was found a lineal lesion in the perineum during her clinical examination. Its recognition is important since it involves a wide differential diagnosis of injures, including some of them with important legal implications because of the area in which it is presented (AU)

Vulvitis de Zoon: caso clínico / Zoon vulvitis: clinical case

Se presenta un caso de una paciente de 84 años con vulvitis de Zoon. Se trata de una dermatosis vulvar de etiología incierta, muy poco frecuente, que ocasiona sintomatología inespecífica de prurito y escozor vulvar de larga evolución, acompañados de una o varias lesiones focales circunscritas y eritematosas de difícil diagnóstico clínico. Se insiste en la necesidad de realización de biopsia vulvar para obtención de un diagnóstico histológico de certeza. Se comentan las opciones terapéuticas actuales descritas en la literatura aunque no existe un tratamiento de elección.

An 84 year old female patient with Zoons vulvitis case is reported. It is a rare vulvar dermatosis of unknown etiology, with unspecific symptoms such as pruritus and vulvar stinging, both developed over a long period of time, accompanied with focal erythematous injuries. As a clinical diagnosis remains difficult, it is essential that a biopsy is obtained for accurate histological diagnosis. Despite different therapeutic options available, there is no consensus on a standardized treatment.

Inflammatory Vulvar Dermatoses.

Inflammatory vulvar dermatoses affect many women, but are likely underdiagnosed due to embarrassment and reluctance to visit a health care provider. Although itch and pain are common presenting symptoms, the physical examination can help distinguish between different disease entities. Because many women's health providers have minimal training in the categorization and management of dermatologic disease, definitive diagnosis and management can be difficult. Herein, strategies for diagnosing vulvar lichen sclerosus, lichen planus, contact dermatitis, lichen simplex chronicus, and psoriasis are discussed along with basic management of these diseases, which commonly involves decreasing inflammation through behavioral change, gentle skin care, topical corticosteroids, and systemic therapies.

[Burning Vulva: Significance of Surgery in Inflammatory and Precancerous Vulvar Pathologies]. / Vulväres Brennen: Stellenwert der Chirurgie bei entzündlichen und präkanzerösen Vulvapathologien.

Vuval pathologies manifested by allodynia and burning sensations can be due to infection, inflammatory dermatoses or other causes. Infective as well as certain inflammatory diseases, e.g. drug eruptions, allergic eczemas, irritative dermatitis/vulvitis, Behcet's Syndrome and pemphigus/pemphigoid usually respond well to conservative treatment. The category of inflammatory diseases also contains pathologies that in certain circumstances do require a surgical intervention, e.g. Lichen ruber planus/Lichen sclerosus, Condyloma, scars, premalignant lesions (VIN, genital M. Paget) and cancer. Vulodynia also can cause some stinging to the vulvar skin. The surgical aspects relating to the treatment of the benign and premalignant pathologies indicated above are mentioned in this mini-review.