Does HPV infection have impact on results of photodynamic treatment of vulvar lichen sclerosus?

BACKGROUND: The association between lichen sclerosus (LS) and human papilloma virus (HPV) infections remains unclear. The co-occurrence of both pathologies may impact treatment and prognosis. This study aimed to assess the results of photodynamic therapy (PDT) for vulvar LS and the effect of incidence of HPV infection on the results of treatment and duration of remission. METHODS: A total of 73 patients with LS were included in the study. In each patient, 14 types of HPV were detected. PDT was performed using the PhotoDyn 501, which emits light at 630 nm wavelength and power density of 204 mW/cm². Focal lesions were exposed for 10 min once weekly for a total of 10 weeks. The complete treatment cycle was repeated after 3 months, whenever required. The biopsy was repeated after completion of treatment. RESULTS: The number of treatment cycles for HPV-positive and HPV-negative patients were not statistically different (cases after one or two PDT cycles). An exception was a group of patients with LS requiring three PDT cycles. Analysis of remission period considering HPV results (positive vs. negative) did not reveal a significant statistical difference. Mean remission period among HPV-negative patients was longer in comparison to remission time for those with positive HPV results (14 ±â€¯9 vs. 11 ±â€¯9 months). CONCLUSIONS: PDT may be a promising, effective, and safe method for the treatment of LS regardless of HPV infection.

Successful pregnancy and delivery following selective use of photodynamic therapy in treatment of cervix and vulvar diseases.

BACKGROUND: Photodynamic therapy has been gaining popularity, particularly among young women. Therefore it is crucial to evaluate PDT for safety and its impact on fertility and delivery of healthy newborns. OBJECTIVE: The study analyzed the PDT treatment of 10 young women, who suffered from diseases of the vulva and cervix. The aim of the analysis was evaluating what impact PDT treatment had on their pregnancies and delivery. METHODS: 10 patients (22-32 years of age, 25.5 years of age on average) were treated with PDT in 2007-2014. 2 patients suffered from squamous cell hyperplasia, 2 patients from vulvar lichen sclerosus, 1 - genital warts, 1 - VIN I (current terminology: LSIL/Flat condyloma), 2 - CIN III (HSIL), 2 - CIN I (LSIL). The patients underwent photodynamic therapy (PDT). In the course of PDT the 5% 5- aminolevulinic acid was used in gel form three hours before irradiation. The affected areas were irradiated with a halogen lamp PhotoDyn 501 (590-760 nm) during a 10-min radiation treatment. The treatment was repeated weekly for 10 weeks. RESULTS: The median observation time period between the end of therapy and delivery was 3.92 years (2-7 years). None of the patients suffered from infertility. All patients gave birth to healthy, full-term infants. In case of one pregnancy cervical cerclage was needed. Two patients were treated for hypothyroidism caused by the Hashimoto disease. One patient had gestational diabetes. Two patients had already given birth to 2 children. Five patients gave birth by caesarean section. CONCLUSION: Topical PDT selectively used for treating the diseases of the female reproductive organs was applied in our group of patients and proved to be a safe method. It had no apparent negative impact on female fertility and allowed these women to give birth to healthy children.

New directions in cervical cancer prophylaxis worldwide and in Poland - Case study of the Polish rural female population.

INTRODUCTION: Cervical cancer is one of the most frequent malignant neoplasms in females. Such neoplasms can be almost completely eliminated by means of adequate primary and secondary prophylaxis. The most developed countries focus their attention on the improvement of prophylaxis systems, test quality, and efficacy improvement, as well as on the expansion of the primary prophylaxis. In Poland, the discussions focus on the improvement of the malfunctioning population programme. OBJECTIVE: Drawing on recent research findings, the article presents current Polish and global recommendations with regard to screening tests for cervical cancer. The results of the Population Programme of Prophylaxis and Early Detection of Cervical Cancer are discussed in the context of current trends of healthy behaviour among women inhabiting rural areas. DESCRIPTION OF THE STATE OF KNOWLEDGE: In the future, it will be relevant to increase the number of human papillary virus (HPV) tests as part of the prophylaxis programme, especially among the high risk patient group. In particular, there is a necessity to increase the number of vaccinations among young women, especially before the beginning of their sexual activity, as well as to establish new strategies of secondary prophylaxis in this group. At present, women who had been vaccinated should undergo routine screening. In Poland, the report based on SIMP registry (IT System of Prophylaxis Monitoring), shows that only 27% of the 3.3 million of invited women participated in the cytology tests. The data analysis shows that women living in rural areas more often respond and participate in the tests, compared to women living in the cities (39.3% vs. 16.8%).

Photodynamic therapy in the treatment of vulvar lichen sclerosus.

BACKGROUND: Vulvar lichen sclerosus is a chronic and incurable disease that causes various unpleasant symptoms and serious consequences. OBJECTIVE: The purpose of the study was to assess the effectiveness of photodynamic therapy in the treatment of vulvar lichen sclerosus. METHODS: Participants in the study included 102 female patients aged 19-85 suffer from vulvar lichen sclerosus. The patients underwent photodynamic therapy (PDT). In the course of PDT the 5% 5- aminolevulinic acid was used in gel form. The affected areas were irradiated with a halogenic lamp PhotoDyn 501 (590-760nm) during a 10-min radiation treatment. The treatment was repeated weekly for 10 weeks. RESULT: PDT has brought about a good therapeutic effect (complete or partial clinical remission), with 87.25% improvement rate in patients suffering from lichen sclerosus. The greatest vulvoscopic response was observed in the reduction of subepithelial ecchymoses and teleangiectasia (78.95%), and the reduction of erosions and fissures (70.97%). A partial remission of lichenification with hyperkeratosis was observed in 51.61% of cases. The least response was observed in the atrophic lesions reduction (improvement in 37.36% of cases). CONCLUSION: Our patients suffering from vulvar lichen sclerosus demonstrated positive responses to photodynamic therapy and the treatment was well tolerated. Photodynamic therapy used to treat lichen sclerosus yields excellent cosmetic results.

Comparison of efficiency of photodynamic diagnostics with topical use of the 3% and 15% aminolevulinic acid in the detection of vulvar lesions.

UNLABELLED: The essence of the photodynamic diagnostic method is interaction between light and chemical compounds that form in reaction to light. In order to obtain fluorescence, tissue has to be exposed to energy in the form of light with the wavelength corresponding to the bandwidth of the photosensitizer absorption. The photodynamic method allows for the detection of even small lesions. This method facilitates the process of detecting vulvar cancer, especially in its early stages when it can develop on the foundation of overgrown epithelium. At that point the vulvoscopic image is difficult to interpret, in particular when multifocal growth occurs. OBJECTIVES: The objective of the study was evaluating the efficiency of the photodynamic method PDD (photodynamic diagnosis) in the detection of vulvar lesions when two concentrations of the photosensitizer were used (3%- and 15%-aminolevulinic acid), as well as evaluating the efficiency of this method when compared to the efficiency of vulvoscopy, against the result of histological examination. METHODS: Two concentrations of the 5-ALA cream (aminolevulinic acid) - 3% and 15% - were used in the PDD testing. The study group was divided into two subgroups A and B. In subgroup A the 15% eucerine-based cream was used. In subgroup B the 3% ALA gel with and addition of 2% DSMO was used. The photosensitizer was applied to the vulva 4-6h before the examination. In order to obtain fluorescence, energy in the form of light whose wavelength was approximately 405 nm, and whose source was a SLED diode, was transmitted to vulvar tissue. The positive result of the exam was obtaining tissue fluorescence. All patients underwent vulvoscopy and a histological examination of tissue samples was performed in all cases. The efficiency of the photodynamic testing in subgroups A and B was compared with the efficiency of vulvoscopy, against the result of histological examination. Sensitivity, specificity, as well as positive and negative predictive values of the PDD examination and vulvoscopy in both subgroups, were evaluated. RESULTS: When the 15% ALA was used in detecting vulvar lesions, the photodynamic diagnostics was characterized by sensitivity of 100%, specificity of 92%, positive predictive value of 80%, negative predictive value of 100%, and correlation with the histopathological examination of 93.9%. When the 3% ALA was used, we observed: sensitivity of 100%, specificity of 91.4%, positive predictive value of 78.5%, negative predictive value of 100%, and correlation with the histopathological examination of 93.4%. Differences in the two subgroups were not statistically significant. CONCLUSIONS: High correlation was observed between the accuracy of the photodynamic method of examining vulvar lesions and the accuracy of the histological examination, especially in cases of precancerous lesions and vulvar cancer. The photodynamic examination, when the 3%-ALA/2%DSMO is used, is characterized by a greater sensitivity, comparable specificity, as well as, comparable positive and negative prognostic values, in comparison to the vulvoscopic examination. The photodynamic method, when used with other diagnostic methods, facilitates performing the needle aspiration biopsy and allows for a greater precision of histological diagnoses. The pathological fluorescence obtained during the PDD examination gives information about the spread and multifocality of vulvar lesions, which can facilitate making presurgical decisions concerning the extensiveness of surgery. The photodynamic method, when the 3% ALA/2% DSMO is applied topically, is of comparable efficiency as the 15% ALA, in the detection of vulvar lesions. High safety of the photodynamic method was shown, both in terms of the topical application of the aminolevulinic acid and the subsequent use of light.

[Abrikosov's tumor of the vulva--a case report]. / Guz abrikosova (guz z komórek ziarnistych) wargi sromowej--opis przypadku.

A rare case of Abrikosov's tumor of the vulva has been reported. A 49 year old postmenopausal woman was admitted to hospital with a slow growing tumor of the left greater pudendal lip. The patient underwent tumorectomy. Histologically GCM--granular cell myoblastoma known as the Abrikosov's tumor was diagnosed. As the tumor was of no potential malignancy the patient did not require any additional treatment. We present our experience and the review of current literature.