National Cancer Institute®
Last Modified: March 1, 2002
UI - 11820332
AU - Akashi K; Nagasaka T; Nakashim N; Harada T; Okamoto T; Mizutani S;
TI - Ishiko H Squamous cell carcinoma of the vulva and adjacent lesions treated at Nagoya University Hospital from 1965 to 1997.
SO - Nagoya J Med Sci 2001 Nov;64(3-4):109-21
AD - Department of Laboratory Medicine, and Obstetrics & Gynecology of Nagoya University School of Medicine, Japan.
Japan has a lower incidence of vulvar squamous cell carcinoma (VSCC) than Western nations. To pin-point the reasons for this, we reviewed biopsy samples from all cases treated at Nagoya University Hospital over the past 33 years in order to investigate the background lesions for VSCC. Two of 36 VSCC patients had adjacent or coexisting lichen sclerosus (LS), 5 had squamous cell hyperplasia (SCH), and 16 had vulvar intraepithelial neoplasia (VIN). There were 8 cases in which these lesions were thought to be the origin of the VSCC, 1 in which keratinizing squamous cell carcinoma (KSC) was seen in LS, 1 in which verrucous SCH was the origin, and 6 in which 4 basaloid carcinoma and 2 warty carcinoma developed from basaloid VIN and warty VIN, respectively. Although 8 other cases of keratinizing or non-keratinizing squamous cell carcinomas (NSC) coexisted with VIN NOS (not otherwise specified), differentiated VIN or basaloid VIN, we could not be histologically certain of the origin. Among 22 VSCC patients tested for HPV DNA, only an 84-year-old woman presenting a histological feature of KSC tested positive by in situ hybridization (ISH). It was considered that LS and SCH had little and VIN considerable capacity to cause the malignancy of VSCC. We surmise that in Japan the majority of squamous cell carcinoma is unrelated to HPV. One reason for the low incidence of VSCC is largely due to race; the homogeneous, monoethnic Japanese population, as well as the few cases of HPV-related VSCC.
UI - 11788182
AU - Louis-Sylvestre C; Haddad B; Paniel BJ
TI - Paget's disease of the vulva: results of different conservative treatments.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Dec 1;99(2):253-5
AD - Department of Obstetrics and Gynecology, Maternite Centre Hospitalier Intercommunal, Intercommunal Hospital of Creteil, 40 Avenue de Verdun, 94010 Cedex, Creteil, France.
OBJECTIVE: To evaluate three conservative treatments for vulvar Paget's disease: wide excision, laser alone, or limited surgery associated with laser. STUDY DESIGN: A retrospective analysis of 52 patients treated with wide excision (31 cases), limited surgery, and peripheral laser [Br J Obstet Gynecol 1995;102:359], or laser alone [Gynecol Oncol 1975;3:46]. RESULTS: Mean time to recurrence was 1+/-0.6 years after laser alone, 1.9+/-1.5 years after the association limited excision and peripheral laser, and 2.7+/-1 years after wide excision alone. At 1 year recurrence rates were 67% after laser alone, 33% after the association laser plus surgery, and 23% after wide excision. CONCLUSION: Conservative management preserves vulvar anatomy and function, but recurrence rates are high.
UI - 11812085
AU - Daling JR; Madeleine MM; Schwartz SM; Shera KA; Carter JJ; McKnight B;
TI - Porter PL; Galloway DA; McDougall JK; Tamimi H A population-based study of squamous cell vaginal cancer: HPV and cofactors.
SO - Gynecol Oncol 2002 Feb;84(2):263-70
AD - Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, Washington 98109-1024, USA. email@example.com
BACKGROUND: Little is known about the etiology of in situ or invasive squamous cell cancer of the vagina. It is thought that some vaginal cancers may have the same etiology as cervical cancer. It is also not known whether in situ and invasive vaginal cancer share the same etiologic factors. We conducted a study to evaluate risk factors for in situ and invasive vaginal cancer and their potential relationship to prior exposure to human papillomaviruses (HPV). METHODS: A population-based case-control study included 156 women with squamous dialing in western Washington state. Cases and controls were interviewed in person and provided blood samples; archival tumor tissue was retrieved for cases. Blood samples were tested for antibodies to HPV, and tumor tissue was tested for HPV DNA. RESULTS: Women with vaginal cancer were more likely to have five or more lifetime sexual partners (OR = 3.1, 95% CI 1.9 to 4.9), to have an early age at first intercourse (<17 years OR = 2.0, 95% CI 1.2 to 3.5), and to be current smokers at diagnosis (OR = 2.1, 95% CI 1.4 to 3.1) than control women. Approximately 30% of all cases had been treated for a prior anogenital tumor, most often of the cervix. Prior hysterectomy was a risk factor only among women who had no history of prior anogenital cancer (OR = 3.9 95% CI 2.5 to 6.1). Antibodies to HPV16 L1 were strongly related to risk of vaginal cancer (OR = 4.3, 95% CI 3.0 to 6.2). We detected HPV DNA in tumor blocks from over 80% of the patients with in situ and 60% of the patients with invasive cancers. CONCLUSIONS: In situ and invasive vaginal neoplasia have many of the same risk factors as cervical cancer, including a strong relationship to HPV infection. Women who have been treated for a prior anogenital cancer, particularly of the cervix, have a high relative risk, although low absolute risk, of being diagnosed with vaginal cancer. (c)2002 Elsevier Science
UI - 11812092
AU - Tabata T; Takeshima N; Nishida H; Hirai Y; Hasumi K
TI - Treatment failure in vaginal cancer.
SO - Gynecol Oncol 2002 Feb;84(2):309-14
AD - Department of Gynecology, Cancer Institute Hospital, 1-37-1 Kami-Ikebukuro, Toshima-ku, Tokyo 170-8455, Japan. firstname.lastname@example.org
OBJECTIVE: The aim of this study was to analyze the pattern of treatment failure in patients with vaginal cancer. METHODS: Fifty-one patients with primary vaginal cancer (registered between 1957 and 1995) were reviewed. Primary treatment consisted of surgery in 12 patients and radiation in 39 patients. In these patients, the prognosis and treatment failure were analyzed in relation to clinicopathological factors. RESULTS: The 5-year survival rate was 100% in stage 0 (N = 5), 82% in stage I (N = 11), 70% in stage II (N = 23), 0% in stage III (N = 5), 14% in stage IV (N = 7), and 61% overall (N = 51). Although early disease had a relatively favorable prognosis, two of five patients with stage 0 disease developed local recurrence. There was no site-related difference in survival, but survival was better when the tumor occupied less than one-third of the vaginal wall compared with more than one-third. All relapses in stage 0-II patients were local recurrences, whereas treatment failure in stage III-IV patients was due to either persistent local disease or new distant metastasis. CONCLUSION: The present findings suggest that more intensive local therapy may achieve a better prognosis for patients with early disease. Conversely, suppression of distant metastasis along with aggressive local control is needed for advanced disease. Conventional radiotherapy alone is of little value for advanced disease. B)2002 Elsevier Science.
UI - 11856713
AU - Shimada K; Ohashi I; Shibuya H; Tanabe F; Akashi T
TI - MR imaging of an atypical vaginal leiomyoma.
SO - AJR Am J Roentgenol 2002 Mar;178(3):752-4
AD - Department of Radiology, Toride Kyodo General Hospital, 2-1-1 Hongo, Toride-shi, 302-0022 Ibaraki, Japan.
UI - 11849805
AU - Monk BJ; Tewari KS; Puthawala AA; Syed AM; Haugen JA; Burger RA
TI - Treatment of recurrent gynecologic malignancies with iodine-125 permanent interstitial irradiation.
SO - Int J Radiat Oncol Biol Phys 2002 Mar 1;52(3):806-15
AD - Division of Gynecologic Oncology, The Chao Family N.C.I.-Designated Comprehensive Cancer Center, University of California, Irvine-Medical Center, Orange, CA 92868, USA.
PURPOSE: To analyze the outcome of permanent 125I interstitial radiotherapy for unresectable retroperitoneal recurrences of gynecologic malignancies. METHODS AND MATERIALS: A retrospective review of 20 patients treated between 1979 and 1993 was performed to evaluate survival and morbidity associated with the interstitial 125I technique. RESULTS: Nineteen tumors were located on the lateral pelvic wall and one in the para-aortic region. Eight patients, not previously irradiated, received external beam radiotherapy (EBRT) along with 125I interstitial implants placed at the time of celiotomy. Nineteen (95%) are dead of disease at 1-69 months of follow-up. The median survival was 7.7 months for patients treated with 125I alone and 25.4 months for those treated with both 125I and EBRT. One patient is alive without evidence of disease 69 months after 125I implantation. Fistulas, bowel obstructions, and fatal complications occurred only among patients previously irradiated. CONCLUSIONS: When used in a previously irradiated field, 125I interstitial radiotherapy has major morbidity and is unlikely to be associated with cure or long-term survival. In radiotherapy-naive patients with unresectable isolated recurrent gynecologic malignancies, 125I implants and EBRT are feasible and occasionally may contribute to long-term disease-free survival.
UI - 11793263
AU - Zbar AP; Nishikawa H; BeerGabel M
TI - Vertical rectus abdominis myocutaneous transposition flap for total pelvic exenteration in recurrent vulvar carcinoma invading the anus.
SO - Tech Coloproctol 2001 Apr;5(1):66
AD - Kaplan Medical Center, Rehovot, 76100 Israel. email@example.com
UI - 11728665
AU - Abu-Musa A; Khalil A; Ghaziri G; Seoud M; Abbas J
TI - Synchronous vulvar and breast cancer.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Dec 10;100(1):92-3
AD - Department of Obstetrics and Gynecology, American University of Beirut Medical Center, P.O. Box 113-6044-6A, Beirut, Lebanon. firstname.lastname@example.org
Synchronous vulvar and breast cancer is rare. A 44-year-old women presented with a lesion in the right labia majora and right upper quadrant breast lump. After work-up, she underwent radical wide local vulvar excision and modified radical mastectomy with axillary lymph node dissection. The pathology of the vulva revealed moderately-differentiated squamous cell carcinoma and that of the breast infiltrating ductal carcinoma. Only two such cases have been previously reported: one was an elderly patient and the second a young patient with HIV infection. Our patient is a young and healthy woman making her presentation a unique and rare case.
UI - 11857367
AU - Raitanen M; Rantanen V; Kulmala J; Pulkkinen J; Klemi P; Grenman S;
TI - Grenman R Paclitaxel combined with fractionated radiation in vitro: a study with vulvar squamous cell carcinoma cell lines.
SO - Int J Cancer 2002 Feb 20;97(6):853-7
AD - Department of Obstetrics and Gynecology, University of Turku, Turku, Finland.
Concurrent paclitaxel and radiation has given promising results in the treatment of a variety of solid tumors. We wanted to test the efficacy of this combination for vulvar carcinoma, which currently has a poor outcome in advanced stages. The radiation sensitivity, sublethal damage repair (SLDR) capacity and effect of paclitaxel during fractionated radiation were assessed in our study on 7 vulvar inherently radioresistant squamous cell carcinoma (SCC) cell lines. The 96-well plate clonogenic assay was used. Survival data were fitted to the linear quadratic model. The area under the curve (AUC), equivalent to mean inactivation dose (D), was obtained with numerical integration. AUC ratios between single-dose radiation and fractionated radiation with or without paclitaxel were used to determine the SLDR of the cell lines and the effect of paclitaxel on it. Seven currently tested vulvar SCC cell lines were found to have a limited capacity of repairing sublethal damage (SLD). Only 3 of them presented SLDR of significance. The effect of concurrent radiation and paclitaxel was clearly additive when the radiation dose was fractionated in most of the cell lines. In addition, 2 of the cell lines having SLDR exhibited a trend toward losing the repair capacity when paclitaxel was present during the irradiation. In addition, the survival curve of the UM-SCV-1A cell line gave the impression of a true paclitaxel effect on SLDR. Paclitaxel used concurrently with fractionated radiation showed effectiveness on vulvar carcinoma. The effect was at least additive and could even be expected to abrogate the SLDR during split-dose radiation. Copyright 2001 Wiley-Liss, Inc.
UI - 11855875
AU - Hyde SE; Ansink AC; Burger MP; Schilthuis MS; van der Velden J
TI - The impact of performance status on survival in patients of 80 years and older with vulvar cancer.
SO - Gynecol Oncol 2002 Mar;84(3):388-93
AD - Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
OBJECTIVE: There are no data available on the impact of performance status on outcome in patients with vulvar cancer. It was the objective of this study to determine the impact of performance status on survival in a group of elderly patients. METHODS: A retrospective review of records of patients with vulvar cancer aged 80 years or greater and treated in a gynecological referral center was performed. Multiple clinical and pathological variables together with performance status were assessed and the impact on overall survival was determined both by univariate and multivariate analysis. RESULTS: Of 75 patients aged 80 years or older, 57 (76%) had standard treatment. The patients who had standard treatment were characterized by an earlier clinical stage and a better performance status compared with patients who had nonstandard treatment. When preoperatively available parameters of all patients were assessed in relation to survival in the total group, Eastern Cooperative Oncology Group (ECOG) performance status was the only independent prognostic indicator for survival. When all clinical and histopathological variables were assessed in the subgroup who had standard treatment, both ECOG performance status and extracapsular lymph node involvement were independent prognostic variables for overall survival. Age was not a significant prognostic variable. CONCLUSIONS: ECOG performance status is the only available pretreatment variable with independent prognostic value for survival in this group of elderly patients with vulvar cancer. These data show the importance of individualizing the treatment of patients with vulvar cancer. Performance status takes a more important place than age in the management process of these patients.
UI - 11855880
AU - Yingna S; Yang X; Xiuyu Y; Hongzhao S
TI - Clinical characteristics and treatment of gestational trophoblastic tumor with vaginal metastasis.
SO - Gynecol Oncol 2002 Mar;84(3):416-9
AD - Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China.
OBJECTIVE: The aim of this study was to evaluate clinical manifestations, management options, and prognosis for women presenting with gestational trophoblastic tumors with vaginal metastasis. METHOD: Fifty-one patients with vaginal metastases were analyzed retrospectively documented by physical examination and tissue biopsy. RESULTS: The incidence of vaginal metastasis in choriocarcinoma and invasive mole was 8.6 and 4.1%, respectively. The metastatic tumors were mostly located in the anterior wall of the lower part of vagina. Eighteen patients presented with hemorrhage and rupture. All patients were treated with 5-Fu combined chemotherapy. Vaginal packing was employed to stop bleeding in 16 patients. Three of them received selective angiographic embolization. Vaginal tumors disappeared after chemotherapy. Forty-four patients with complete remission were followed up periodically without evidence of recurrence. CONCLUSIONS: Large or multiple vaginal metastases place the patients at high risk for significant hemorrhage. 5-Fu combined chemotherapy is still a reliable method for treating vaginal metastases. Angiographic embolization is emerging as a successful procedure to control the severe hemorrhage of vaginal tumors.
UI - 11855886
AU - Sliutz G; Reinthaller A; Lantzsch T; Mende T; Sinzinger H; Kainz C;
TI - Koelbl H Lymphatic mapping of sentinel nodes in early vulvar cancer.
SO - Gynecol Oncol 2002 Mar;84(3):449-52
AD - Department of Gynecology, University of Vienna, Vienna, A-1090, Austria. email@example.com
OBJECTIVE: The aim of the study was to determine the diagnostic accuracy and feasibility of sentinel lymph node (SLN) detection using a gamma local wide excision or vulvectomy including groin dissection, were eligible for the study. Two to 3 h before the planned procedure we injected technetium(99) m-labeled microcolloid intradermally at four locations around the tumor. Dynamic and static images were recorded using a gamma camera. SLN locations were marked on the overlying skin. In the operating theater SLNs were identified at the beginning of the procedure using a handheld gamma-detection probe. After resection of suspected SLNs a standard unilateral or bilateral groin dissection was performed, subsequently followed by local wide excision or, if indicated, radical vulvectomy. Sentinel node detection using technetium(99) m-labeled microcolloid was compared with final histopathological and immunohistochemical results. RESULTS: Scintigraphy showed focal uptake in all 26 patients. Intraoperatively we detected all sentinel nodes by handheld gamma probe. In 20 patients, one sentinel node was identified unilaterally, while in 6 patients two or more nodes were identified bilaterally. Histologically positive SLNs were found in 9 patients. In our preliminary series we did not find any false-negative SLN. CONCLUSION: Identification of sentinel nodes in vulvar cancer is feasible with preoperatively administered technetium(99)m-labeled microcolloid. We confirm the results of previous studies and improve the evidence that the SLN procedure could be implemented in future therapy concepts.
UI - 11852367
AU - Boman F; Farre I; Vinatier D; Querleu D
TI - [A vaginal tumor]
SO - Ann Pathol 2001 Oct;21(5):447-8
AD - Anatomie et Cytologie Pathologiques, Hopital Calmette, CHRU, 59037 Lille Cedex, France. firstname.lastname@example.org
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