-
Frontiers in Medicine 2023Esophageal lichen planus (ELP) is an inflammatory disorder that affects the skin, cutaneous appendages and mucous membranes. The esophageal involvement is rare. We...
Esophageal lichen planus (ELP) is an inflammatory disorder that affects the skin, cutaneous appendages and mucous membranes. The esophageal involvement is rare. We present the case of a 70-year-old woman with years of dysphagia and a history of erosive lichen planus involving the vulva, vagina, gingiva, and skin, who was eventually diagnosed with esophageal lichen planus. The patient's condition was refractory and progressed to the development of intraepithelial squamous neoplasia. We reviewed the literature on this condition.
PubMed: 38173935
DOI: 10.3389/fmed.2023.1233566 -
International Journal of Surgery Case... Sep 2023Renal cell carcinoma (RCC) is a relatively uncommon malignancy, comprising only 3 % of adult cancers, but it is responsible for 85 % of primary renal tumors. When RCC...
INTRODUCTION AND IMPORTANCE
Renal cell carcinoma (RCC) is a relatively uncommon malignancy, comprising only 3 % of adult cancers, but it is responsible for 85 % of primary renal tumors. When RCC metastasizes, the most common sites are the lungs, liver, bones, and brain. Although it is rare, RCC can also metastasize to the vagina. About 18-33 % of RCC cases are diagnosed with metastasis at the time of initial diagnosis.
CASE PRESENTATION
A 48-year-old woman presented with postcoital bleeding and dyspareunia. At the physical examination, a polypoid mass was discovered on the right lateral wall of the upper third of her vagina and CT scan showed a right renal. Biopsies revealed clear cell renal carcinoma with metastasis to the vagina. The patient was diagnosed with stage IV (T3cN2 M1) renal cancer and underwent systemic therapy with Everolimus. However, subsequent imaging showed tumor progression, and the patient opted to halt treatment and was subsequently lost to follow-up.
CLINICAL DISCUSSION
In the past decade, there have been fewer than ten reported cases of RCC metastasizing to the vagina. Diagnosing vaginal clear cell carcinoma is challenging due to overlapping morphology with clear cell renal cell carcinoma, requiring immunohistochemistry. Treatment of vaginal cancers is challenging due to their rarity, and there is a lack of consensus on the optimal approach due to limited prospective studies.
CONCLUSIONS
Although the occurrence of RCC metastasis to the vagina is very uncommon, it is important to consider the possibility of metastatic RCC in cases of vaginal bleeding or lesions.
PubMed: 37579631
DOI: 10.1016/j.ijscr.2023.108657 -
Medicine Nov 2023Removal of a large uterus poses a challenge in minimally invasive surgery for patients with early-stage endometrial cancer. This manuscript presents 3 cases performed...
RATIONALE
Removal of a large uterus poses a challenge in minimally invasive surgery for patients with early-stage endometrial cancer. This manuscript presents 3 cases performed the improved surgical procedure with minimal trauma.
PATIENT CONCERNS
Three patients with obesity (Body Mass Index: 31.93, 30.06, and 51.82 kg/m2) and large uterus (7.3 × 8.0 × 7.6 cm, 8.5 × 8.9 × 8.5 cm, and 8.3 × 10.1 × 6.9 cm) visited our hospital because of vaginal bleeding, and received dilation and curettage. Pathological examination revealed endometrial carcinoma.
DIAGNOSES
Endometrial carcinoma, obesity.
INTERVENTION
Laparoscopy and transverse-abdominal extra-fascial hysterectomy were performed. First, we performed bilateral adnexectomy, pelvic lymph node dissection, and para-aortic lymph node sampling, and exposed and separated the para-uterine tissue and bladder before cutting off the uterus from the vagina through laparoscopy. Second, we made a 10 cm suprapubic transverse incision in the lower abdomen, clamped the vagina using right-angle forceps to follow the principle of tumor-free technique, placed the uterus in a surgical bag for retrieval the uterus immediately from the incision.
OUTCOME
All 3 patients underwent intestinal recovery for 24 hours post operation; 50 mL blood was lost during the operation with a well-healing wound and no complication. Till date, there has been no recurrence or metastasis in any of them.
LESSONS
Improving the surgical procedure could enhance safety and ease of operation even in cases of obesity and a large uterus.
Topics: Female; Humans; Uterus; Laparoscopy; Hysterectomy; Endometrial Neoplasms; Lymph Node Excision; Obesity
PubMed: 37960798
DOI: 10.1097/MD.0000000000035981 -
Anticancer Research Oct 2023Vaginal intraepithelial neoplasia (VaIN) is a rare human papillomavirus (HPV)- related premalignant condition. VaIN lesions are diagnosed histologically through...
BACKGROUND/AIM
Vaginal intraepithelial neoplasia (VaIN) is a rare human papillomavirus (HPV)- related premalignant condition. VaIN lesions are diagnosed histologically through colposcopy-guided biopsies of suspicious areas, conduced by gynecologists with expertise in lower genital tract diseases. The present study aimed to evaluate the accuracy of colposcopy in the diagnosis of VaIN of any grade.
PATIENTS AND METHODS
We conducted a retrospective analysis on a cohort of 149 women diagnosed with low grade (LG)-VaIN (VaIN1) and high grade (HG)-VaIN (VaIN2-3) between 2010 and 2022 at the "Regional Referral Center for Prevention, Diagnosis and Treatment of HPV-related Genital Disorders", Ospedale Maggiore Policlinico, Milan, Italy. All women had been referred to our center for an abnormal Pap smear or as part of routine follow-up of other HPV-related diseases and had undergone a vaginal biopsy under colposcopic guidance.
RESULTS
The distribution of the histological grades of VaIN lesions was the following: 62 women (41.6%) were diagnosed with VaIN1, 51 (34.2%) with VaIN2, and 36 (24.2%) with VaIN3. Grade II (major) abnormal colposcopic patterns were recorded in 71 cases (47.7%) and were more commonly observed in women with VaIN3 (80.6%). However, we found a poor and not statistically significant association between colposcopic and histological grade of VaIN. The sensitivity, specificity, positive predictive value, and negative predictive value of colposcopy for histologically confirmed VaIN were 56.3%, 64.5%, 69% and 51.2%, respectively. The overall diagnostic accuracy of colposcopy was 59.7%.
CONCLUSION
Colposcopy-guided biopsy plays an important role in the diagnosis of VaIN and in the distinction between low and high-grade lesions. Our data show that major colposcopic abnormalities moderately correlate with HG-VaIN and that grade I colposcopic findings do not exclude HG-VaIN, especially VaIN2. Targeted biopsies of suspicious vaginal areas must be performed in all women with an abnormal Pap smear.
Topics: Pregnancy; Female; Humans; Retrospective Studies; Papillomavirus Infections; Vagina; Vaginal Neoplasms; Colposcopy; Uterine Cervical Dysplasia; Carcinoma in Situ; Human Papillomavirus Viruses; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 37772563
DOI: 10.21873/anticanres.16658 -
International Journal of Surgical... Oct 2023Primary enteric type adenocarcinomas of the vagina are extremely rare. We present a 63-year-old woman who had a polypoid mass localized to the distal vagina. The lesion...
Primary enteric type adenocarcinomas of the vagina are extremely rare. We present a 63-year-old woman who had a polypoid mass localized to the distal vagina. The lesion was composed of a columnar glandular cell proliferation with focal cribriforming, reminiscent of tubular adenoma. Immunohistochemical stains were notable for expression of enteric markers (CDX2 and KRT20), as well as negativity for Mullerian markers (PAX8, ER, and PR), diffuse expression for p16, and positivity for high-risk HPV mRNA expression. Ultimately, a diagnosis of vaginal primary HPV-associated enteric type adenocarcinoma was rendered for this unusual lesion. To our knowledge, no prior cases of HPV-associated enteric type adenocarcinomas of the vagina have been described before.
Topics: Female; Humans; Middle Aged; Biomarkers, Tumor; Papillomavirus Infections; Vagina; Vaginal Neoplasms; Adenocarcinoma; Carcinoma in Situ; Uterine Cervical Neoplasms
PubMed: 36694422
DOI: 10.1177/10668969221150529 -
Turk Patoloji Dergisi Mar 2024Approximately 95% of cervical squamous cell carcinomas are associated with high-risk HPV, with a small number of HPV-independent tumors. However, low-risk HPV types have...
A Low-Risk HPV-Associated Well-Differentiated Squamous Cell Carcinoma of the Cervix with Low-Grade Squamous Intraepithelial Lesion Morphology: Clinical and Pathologic Diagnostic Difficulties and Review of the Literature.
Approximately 95% of cervical squamous cell carcinomas are associated with high-risk HPV, with a small number of HPV-independent tumors. However, low-risk HPV types have also been detected in rare cervical squamous cell carcinomas. Low-grade squamous intraepithelial lesion-related changes are a rare morphologic finding in cervical squamous cell carcinoma. We present the case of a 30-yr-old woman who presented with pelvic pain and foul-smelling vaginal discharge showing an exophytic lesion protruding from the cervix. Repeated superficial biopsies showed a low-grade squamous intraepithelial lesion (LSIL) characterized by binucleation and koilocytosis. Chromogenic in-situ hybridization revealed the presence of HPV6/11. The absence of high-risk HPV was confirmed by PCR. After following the patient for nine months without intervention, type III hysterectomy and bilateral pelvic paraaortic lymphadenectomy were performed. Microscopic examination showed well-differentiated squamous cell carcinoma with solid epithelial islands and extensive eosinophilic cytoplasm without pleomorphism. HPV 6 and 11 were also detected with chromogenic in-situ hybridization. Neoplasm invaded the full-thickness of the cervical wall and infiltrated the vagina, parametrium, the proximal ureter and bladder. The patient who received chemoradiotherapy is disease-free at 36 months follow-up. Low-risk HPV-related well-differentiated invasive squamous lesions exist, and such lesions could be a diagnostic pitfall for gynecologists and pathologists; in these cases, radiologic-pathologic correlation and radiologic guided biopsy are mandatory.
PubMed: 38530111
DOI: 10.5146/tjpath.2024.13189 -
Medicina (Kaunas, Lithuania) Mar 2024: Neoplasms of the vagina are rare and account for 1-2% of all tumors of the female reproductive system. Primary neoplasms of the vagina are most often carcinomas...
: Neoplasms of the vagina are rare and account for 1-2% of all tumors of the female reproductive system. Primary neoplasms of the vagina are most often carcinomas originating from squamous or glandular epithelium. Of the primary glandular tumors, clear cell, endometrioid, and serous adenocarcinomas are the most common types, while mucinous and mesonephric types are very rare. Mucinous adenocarcinoma is histologically subclassified into endocervical and intestinal types. We add to the existing literature another case of an extremely rare gynecological neoplasm-primary vaginal mucinous adenocarcinoma (PVMAC) intestinal type associated with vaginal villous adenoma with high-grade dysplasia. We discuss the clinical, radiological and morphological features of this rare entity. : We report a case of a 59-year-old woman with PVMAC intestinal type associated with vaginal villous adenoma with high-grade dysplasia. The patient was evaluated with a gynecological exam, and biopsy, curettage and tumor excision were performed. The positron emission tomography-computed tomography (PET/CT) scan, at the level of the pelvis, supported the primary location of the disease. Histological and immunohistochemical methods were applied. : The gynecological examination of the vagina revealed an exophytic polypoid mass with a diameter of 3 cm, located on the posterior wall, in the area of introitus vaginae. The PET/CT scan revealed a hypermetabolic malignant formation involving the vagina and anal canal, without evidence of pelvic and inguinal lymphadenopathy, and also, it excluded disease at sites other than the vagina. The histological and immunohistochemical investigations, as well as the clinical and radiological data, lent support to the diagnosis "primary vaginal mucinous adenocarcinoma intestinal type". : PVMAC intestinal type is a rare gynecological pathology, which presents a serious challenge for oncogynecologists, radiologists and pathologists.
Topics: Humans; Female; Middle Aged; Adenocarcinoma, Mucinous; Vaginal Neoplasms; Positron Emission Tomography Computed Tomography; Vagina
PubMed: 38674171
DOI: 10.3390/medicina60040525 -
Annals of Clinical and Laboratory... Nov 2023Uterine carcinosarcomas (UCS) are aggressive tumors characterized by their biphasic nature, consisting of high-grade epithelial and mesenchymal elements. One component... (Review)
Review
Uterine carcinosarcomas (UCS) are aggressive tumors characterized by their biphasic nature, consisting of high-grade epithelial and mesenchymal elements. One component may predominate over the other. We present the case of a 59-year-old female who initially received a diagnosis of endometrial serous carcinoma and presented one year later with a malignant neoplasm in the lung featuring osteosarcomatous differentiation. Notably, the bone scan did not reveal any evidence of a primary bone tumor. However, additional sampling from the endometrium demonstrated a UCS with an osteosarcomatous component.Upon reviewing existing literature, it has been observed that metastases in carcinosarcoma cases generally arise from the carcinomatous component. Conversely, the sarcomatous component typically spreads locally to areas such as the vagina, cervix, or fallopian tubes. The presented case stands out as a unique instance of an undiagnosed UCS manifesting as metastatic osteosarcoma in the lung. This case underscores the complexity and diverse presentations of UCS and emphasizes the importance of comprehensive evaluation in understanding its clinical manifestations.
Topics: Female; Humans; Middle Aged; Osteosarcoma; Endometrial Neoplasms; Carcinosarcoma; Bone Neoplasms; Lung
PubMed: 38182153
DOI: No ID Found -
Cancers Jul 2023The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukaemia but can rarely be the primary site of so-called extranodal... (Review)
Review
The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukaemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina, or adnexa. Only about 0.008% of all cervical tumours are primary malignant lymphomas. The most common clinical presentation of primary cervical lymphomas is a history of prolonged minor abnormal uterine bleeding, while unstoppable bleeding at presentation is rarely reported in the literature. "B" symptoms related to nodal lymphomas are usually absent. Since vaginal bleeding is a nonspecific symptom, the first diagnostic hypothesis is usually of one of the more common female genital conditions such as cervical or endometrial carcinoma or sarcoma, fibroids, adenomyosis, or endometriosis. Cervical cytology is usually negative. Preoperative diagnosis requires deep cervical biopsy. No guidelines regarding optimal treatment exists; radiotherapy, chemotherapy, and surgery are used in different combinations. Conservative treatment with the combination of surgery and chemotherapy or surgery and radiotherapy has been reported in a few cases with apparent success. With this review, we aim to understand what the best therapeutic approaches for this rare pathology in young and elderly women are. Moreover, we find favorable pregnancy outcome in patients treated with a fertility sparing approach.
PubMed: 37509340
DOI: 10.3390/cancers15143679 -
Fertility and Sterility Sep 2023To describe a feasible fertility preservation strategy in a woman with vaginal carcinoma.
OBJECTIVE
To describe a feasible fertility preservation strategy in a woman with vaginal carcinoma.
DESIGN
Video case report demonstrating the diagnostic work-up and laparoscopic oocyte retrieval performed under regional anesthesia.
SETTING
University tertiary care hospital.
PATIENT(S)
A 35-year-old nulliparous woman presented with vaginal bleeding and foul-smelling vaginal discharge. After a comprehensive diagnostic work-up, a final diagnosis of squamous cell carcinoma of the vagina stage II (Federation International Obstetrics and Gynecology classification) was made. As per the patient's desire, before undergoing chemoradiotherapy, the patient underwent oocyte cryopreservation. Transvaginal retrieval of oocytes was not feasible because of stenosis of the vaginal introitus and the potential risk of intracavitary tumor cell spillage. Transabdominal ultrasound-guided oocyte retrieval was not possible because of the body's habitus.
INTERVENTION(S)
The patient underwent ovarian stimulation for in vitro fertilization. To minimize estrogen levels, letrozole was used during controlled ovarian stimulation. Laparoscopic oocyte retrieval was performed under spinal anesthesia.
MAIN OUTCOME MEASURE(S)
Successful laparoscopic egg retrieval and cryopreservation in a woman with squamous cell carcinoma of the vagina.
RESULT(S)
A total follicular count of nine was estimated before the oocyte retrieval. Eight oocytes were retrieved at laparoscopy, and eight mature oocytes were successfully cryopreserved. No complications were encountered, and the patient was discharged on the same day of surgery.
CONCLUSION(S)
To our knowledge, this is the first published case of fertility preservation using the laparoscopic approach in a patient with vaginal cancer. Letrozole is a valuable strategy to reduce high estrogen in patients with gynecological cancer undergoing controlled ovarian stimulation. Laparoscopy oocyte retrieval, performed under regional anesthesia, can be performed in an ambulatory setting and should be considered an effective fertility preservation strategy in patients with large vaginal tumors.
Topics: Adult; Female; Humans; Carcinoma, Squamous Cell; Cryopreservation; Estrogens; Fertility Preservation; Laparoscopy; Letrozole; Oocyte Retrieval; Oocytes; Ovulation Induction; Vagina
PubMed: 37302780
DOI: 10.1016/j.fertnstert.2023.06.007