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Cancer Epidemiology Aug 2023To study the impact of the COVID-19 pandemic and consequent lockdown on the number of diagnoses of gynaecological malignancies in the Netherlands.
OBJECTIVE
To study the impact of the COVID-19 pandemic and consequent lockdown on the number of diagnoses of gynaecological malignancies in the Netherlands.
METHODS
We performed a retrospective cohort study using data from the Netherlands Cancer Registry (NCR) on women of 18 years and older diagnosed with invasive endometrial, ovarian, cervical or vulvar cancer in the period 2017-2021. Analyses were stratified for age, socioeconomical status (SES) and region.
RESULTS
The incidence rate of gynaecological cancer was 67/100.000 (n = 4832) before (2017-2019) and 68/100.000 (n = 4833) during (2020) the COVID-19 pandemic. Comparing the number of diagnoses of the two periods for the four types of cancer separately showed no significant difference. During the first wave of COVID-19 (March-June 2020), a clear decrease in number of gynaecological cancer diagnoses was visible (20-34 %). Subsequently, large increases in number of diagnoses were visible (11-29 %). No significant differences in incidence were found between different age groups, SES and regions. In 2021 an increase of 5.9 % in number of diagnoses was seen.
CONCLUSION
In the Netherlands, a clear drop in number of diagnoses was visible for all four types of gynaecological cancers during the first wave, with a subsequent increase in number of diagnoses in the second part of 2020 and in 2021. No differences between SES groups were found. This illustrates good organisation of and access to health care in the Netherlands.
Topics: Female; Humans; Genital Neoplasms, Female; Incidence; Netherlands; Retrospective Studies; Pandemics; COVID-19; Communicable Disease Control
PubMed: 37356263
DOI: 10.1016/j.canep.2023.102405 -
Archives of Pathology & Laboratory... Dec 2023Differentiated vulvar intraepithelial neoplasia (dVIN) is a human papillomavirus-independent lesion with the potential for rapid progression to invasive squamous cell...
CONTEXT.—
Differentiated vulvar intraepithelial neoplasia (dVIN) is a human papillomavirus-independent lesion with the potential for rapid progression to invasive squamous cell carcinoma (SCC). The histopathologic features of dVIN are diverse, have overlapping characteristics with lichen sclerosus (LS) and lichen simplex chronicus (LSC), and may be diagnosed by dermatopathologists or gynecologic pathologists because of the vulva's anatomic location.
OBJECTIVES.—
To identify the salient histopathologic features of dVIN, particularly those that predict progression to SCC, and to evaluate interobserver agreement in diagnosing dVIN within the same subspecialty and across subspecialties.
DESIGN.—
One general surgical pathologist, 2 pathology-trained dermatopathologists, and 1 gynecologic pathologist blinded to the final diagnoses were asked to record 20 histopathologic features and to provide their final interpretations on cases of dVIN (n = 65), LS (n = 126), LSC (n = 112), and LS with LSC (n = 6).
RESULTS.—
Interobserver agreement for the 4 diagnoses and 10 histopathologic features was moderate. Logistic regression analysis indicated that keratin pearls, basal pleomorphism, and basal layer disarray were independent variables for diagnosing dVIN (coefficients 1.95, 1.97, and 0.91, respectively; P < .001) and progression to SCC (coefficients 1.96, 1.20, and 1.08, respectively; P < .001).
CONCLUSIONS.—
There is no single histopathologic feature pathognomonic for dVIN; however, the presence of keratin pearls, basal pleomorphism, and basal layer disarray should raise high suspicion for dVIN and concurrent SCC. Expertise in both dermatologic and gynecologic pathology is beneficial for diagnosing dVIN.
Topics: Female; Humans; Observer Variation; Vulvar Neoplasms; Carcinoma in Situ; Carcinoma, Squamous Cell; Keratins
PubMed: 36821250
DOI: 10.5858/arpa.2022-0088-OA -
Caspian Journal of Internal Medicine 2023Dermatofibrosarcoma protuberans (DFSP) is a soft tissue tumor that originates from deep layers of the dermis and mainly is common in young adults to middle age. This...
BACKGROUND
Dermatofibrosarcoma protuberans (DFSP) is a soft tissue tumor that originates from deep layers of the dermis and mainly is common in young adults to middle age. This tumor is rare in the vulva.
CASE PRESENTATION
A 53-year-old multiparous menopause female had complained of asymptomatic swelling of the right labia major. Dermatofibrosarcoma protuberans was reported in primary tumor resection. Six months later, rapid growing mass recurred in the vulva. The patient underwent radical Vulvectomy and resection of the margin of about 2-3 cm along with bilateral Inguinofemoral lymphadenectomy. The margins of the mass were negative in the frozen section. Microscopic examination revealed that hypercellular neoplasm in dermis comprising monomorphic spindle cells with high mitotic activity, some hyperchromatic nuclei arranged in palisading fashion. Microscopic and IHC study confirmed the conversion of dermatofibrosarcoma protuberans to fibrosarcoma.
CONCLUSION
This case was presented due to the rarity of dermatofibrosarcoma protuberance in the vulva and pathologic conversion to fibrosarcoma.
PubMed: 37520865
DOI: 10.22088/cjim.14.3.572 -
Acta Oncologica (Stockholm, Sweden) May 2024Electrochemotherapy (ECT) is a combined treatment method based on electroporation and simultaneous chemotherapy. In cases where radiotherapy has previously been used,...
BACKGROUND
Electrochemotherapy (ECT) is a combined treatment method based on electroporation and simultaneous chemotherapy. In cases where radiotherapy has previously been used, surgery is often the only treatment option for vulvar cancer recurrence with potential resection of clitoris, vagina, urethra or anal sphincter. The unique advantage of ECT is its selectivity for cancer cells while sparing the surrounding healthy tissue. The aim of the study was to compare the ECT treatment of vulvar cancer recurrence for non-palliative purposes with surgical treatment.
MATERIALS AND METHODS
Eleven patients with single vulvar cancer recurrence were treated with ECT and followed up for 12 months. As a control group, 15 patients with single vulvar cancer recurrence were treated with wide local excision. The following data were collected, analyzed and compared: Age, body mass index, comorbidities, histological type, location and size of vulvar cancer recurrence, treatment history, details of procedures and hospital stay.
RESULTS
The probability curves for local tumor control did not differ between the ECT group and the surgical group (p = 0.694). The mean hospital stay and the mean duration of procedure were statistically significantly shorter in the ECT group (p < 0.001). There were no statistically significant differences between the ECT and surgical groups in terms of mean body mass index, associated diseases, previous treatments, presence of lichen sclerosus, p16 status, gradus, anatomical site of the tumor, and type of anesthesia.
CONCLUSION
In this case-control study, treatment of vulvar cancer recurrence with ECT for non-palliative purposes was comparable to surgical treatment in terms of effectiveness. The results need to be confirmed in larger randomized trials.
Topics: Humans; Female; Vulvar Neoplasms; Electrochemotherapy; Neoplasm Recurrence, Local; Case-Control Studies; Aged; Middle Aged; Aged, 80 and over; Adult; Treatment Outcome; Follow-Up Studies
PubMed: 38770722
DOI: 10.2340/1651-226X.2024.33241 -
European Journal of Obstetrics,... Jul 2024Aggressive angiomyxoma is an uncommon mesenchymal neoplasm characterized by a high recurrence rate, usually observed in the lower genital tract of women during their...
OBJECTIVE
Aggressive angiomyxoma is an uncommon mesenchymal neoplasm characterized by a high recurrence rate, usually observed in the lower genital tract of women during their reproductive age.
STUDY DESIGN
Seventeen cases of aggressive angiomyxoma confirmed by pathology from January 2007 to December 2021 in Beijing Chao-yang Hospital were included. We collected clinical data and summarized the clinical and immunohistochemical features.
RESULTS
All seventeen included patients were females, aged between 23 and 57 years (mean, 37.7 years; median, 42 years). Fourteen patients were newly diagnosed and three were recurrent. The tumors were located in vulva (58.8 %), vagina (23.5 %), buttock (11.8 %), and cervix (5.9 %). The tumors size were 2 to 15 cm in greatest dimension (mean 8 ± 4.4 cm, median 6 cm). Follow-up data was available for nine patients, which ranged from 25 to 124 months (mean, 82 months; median, 80 months). At the end of follow-up, no other recurrence or metastasis was reported. Immunohistochemical analysis showed immunoreactive for estrogen (10/11) and progesterone (8/11) receptor, desmin (6/8), smooth muscle actin (4/10), and vimentin (4/4), S-100 (1/8) and CD34 (1/7). The Ki67 level was less than 5 % in five cases.
CONCLUSIONS
AAM is a hormone-sensitive, distinct rare mesenchymal neoplasm with high incidence of local recurrence. Surgery is the preferred treatment, with complete resection being an essential prerequisite for minimizing the risk of recurrence.
Topics: Humans; Female; Adult; Myxoma; Middle Aged; Retrospective Studies; Perineum; Young Adult; Pelvic Neoplasms; Genital Neoplasms, Female; Vulvar Neoplasms; Neoplasm Recurrence, Local; Vaginal Neoplasms; Buttocks
PubMed: 38762952
DOI: 10.1016/j.ejogrb.2024.05.012 -
Factors influencing the supportive care needs of female patients with genital cancer in South Korea.Medicine Dec 2023Genital cancers are particularly important compared to other cancers because of the psychological impact they have on the individual. This study investigated the...
Genital cancers are particularly important compared to other cancers because of the psychological impact they have on the individual. This study investigated the complexity in illness and quality of life among female genital cancer patients and determined the effects of these factors on supportive care needs to provide evidential data for the development of nursing intervention strategies to reduce supportive care needs in female genital cancer patients. This cross-sectional study collected data from July 22 to August 17, 2021. The study subjects were 103 female outpatients and inpatients aged 19 years or older who were treated for cervical cancer, endometrial cancer, ovarian cancer, or other female genital cancers such as vulvar cancer and vaginal cancer in a university hospital in Korea. The data were analyzed with t-tests and Scheffé's test using SPSS 26.0. The factors affecting supportive care needs were examined using hierarchical regression. The average age of the subjects was 56.41 (±9.91) years. Cervical cancer was the most common diagnosis at 42.7%, followed by ovarian cancer at 34.0%, and endometrial cancer at 21.4%. The factors affecting supportive care needs included a middle school education or below (β = 0.21, P = .028), unemployment (β = 0.23, P = .018), complexity in illness (β = 0.32, P < .001), and quality of life (β = -0.68, P < .001). Developing a strategy for managing the complexity in illness and quality of life caused by various variables including disease stage and type of treatment is necessary to reduce the supportive care needs of female genital cancer patients. Improving their quality of life through effective communication with healthcare providers is essential.
Topics: Humans; Female; Middle Aged; Aged; Quality of Life; Cross-Sectional Studies; Genital Neoplasms, Female; Hospitals, University; Uterine Cervical Neoplasms; Ovarian Neoplasms; Genitalia; Surveys and Questionnaires; Health Services Needs and Demand
PubMed: 38134056
DOI: 10.1097/MD.0000000000036650 -
Acta Obstetricia Et Gynecologica... Feb 2024Our objective was to investigate the trajectories of anxiety, depression, emotional and social functioning in women with newly diagnosed vulvar cancer from the time of...
INTRODUCTION
Our objective was to investigate the trajectories of anxiety, depression, emotional and social functioning in women with newly diagnosed vulvar cancer from the time of diagnosis to 12 months after treatment. A further aim was to identify risk factors for high levels of anxiety.
MATERIAL AND METHODS
PROVE (PROspective Vulvar Cancer Evaluation) is a nationwide longitudinal cohort study investigating quality of life in women with newly diagnosed vulvar cancer by the following validated patient-reported outcome measures at diagnosis, and 3 and 12 months after treatment: The Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Vulvar module VU34. Mean scores, changes over time and associations were analyzed by generalized estimated equations and log-linear regression models, adjusted for possible confounders.
RESULTS
Between 2019 and 2021, 105 (69%) women completed the questionnaires at all three time points. At diagnosis, 42% of the women reported elevated anxiety levels, decreasing significantly to 30% during the first 12 months. Insomnia, persisting vulvar symptoms and high information needs were significantly associated with a high level of anxiety (relative risk [RR] 2.1, 95% CI 1.2-3.7 for insomnia; RR 2.8, 95% CI 1.7-4.6 for vulvar symptoms, RR 2.7, 95% CI 1.5-4.9 for information needs). We found a trend towards a higher level of anxiety in younger women (<65 years: RR 1.5, 95% CI 1.0-2.5). Participants reported a low and stable prevalence of depression (14%) and high social functioning throughout the study period.
CONCLUSIONS
Women with newly diagnosed vulvar cancer report a high level of anxiety at diagnosis. Despite a significant improvement, anxiety remains widely prevalent during the first year of follow-up. Targeting insomnia, vulvar symptoms and unmet needs may decrease anxiety during surveillance.
Topics: Humans; Female; Depression; Quality of Life; Longitudinal Studies; Vulvar Neoplasms; Prospective Studies; Sleep Initiation and Maintenance Disorders; Anxiety
PubMed: 37891709
DOI: 10.1111/aogs.14710 -
Journal of Obstetrics and Gynaecology :... Dec 2023
Topics: Humans; Female; Tubular Sweat Gland Adenomas; Perineum; Neoplasms; Sweat Gland Neoplasms; Vulvar Neoplasms
PubMed: 36912189
DOI: 10.1080/01443615.2023.2186781 -
In Vivo (Athens, Greece) 2023The aim of this study was to evaluate patient preferences regarding cervical dysplasia clinics. Specifically, preferences in terms of diagnostic and therapeutic pathways...
BACKGROUND/AIM
The aim of this study was to evaluate patient preferences regarding cervical dysplasia clinics. Specifically, preferences in terms of diagnostic and therapeutic pathways as well as logistical and structural aspects were addressed to recognize unmet needs and improve existing structures of cervical dysplasia care.
PATIENTS AND METHODS
This questionnaire-based study was conducted between June and December 2022 at an academic medical center in Southwestern Germany. A total of 226 patients who had an appointment at the certified dysplasia clinic were included.
RESULTS
The vast majority of patients (74.8%) preferred counseling at the certified dysplasia clinic in the case of an abnormal finding of the cervix or labia. A prompt appointment (within a maximum of 4 weeks), a timely notification about test results (within a maximum of 2 weeks), a travel time <60 minutes and seeing the same doctor during follow-up appointments were recognized as important aspects. While about half of the patients (53.5%) were indifferent to the sex of the gynecologist, almost all of the remaining patients stated they would prefer to be seen by a female doctor (44.3% female doctor vs. 2.2% male doctor).
CONCLUSION
Most women expect very timely appointments and result notifications. Moreover, they favor short travel times and continuity of care. The identified patient preferences should be considered to increase patient satisfaction and quality of care when developing and optimizing management at specialized dysplasia clinics.
Topics: Humans; Male; Female; Patient Preference; Cervix Uteri; Patient Satisfaction; Uterine Cervical Dysplasia; Vulvar Neoplasms; Hyperplasia
PubMed: 37652527
DOI: 10.21873/invivo.13326 -
World Journal of Clinical Cases Apr 2024Rectocutaneous fistulae are common. The infection originates within the anal glands and subsequently extends into adjacent regions, ultimately resulting in fistula...
BACKGROUND
Rectocutaneous fistulae are common. The infection originates within the anal glands and subsequently extends into adjacent regions, ultimately resulting in fistula development. Cellular angiofibroma (CAF), also known as an angiomyofibroblastoma-like tumor, is a rare benign soft tissue neoplasm predominantly observed in the scrotum, perineum, and inguinal area in males and in the vulva in females. We describe the first documented case CAF that developed within a rectocutaneous fistula and manifested as a perineal mass.
CASE SUMMARY
In the outpatient setting, a 52-year-old male patient presented with a 2-year history of a growing perineal mass, accompanied by throbbing pain and minor scrotal abrasion. Physical examination revealed a soft, well-defined, non-tender mass at the left buttock that extended towards the perineum, without a visible opening. The initial assessment identified a soft tissue tumor, and the laboratory data were within normal ranges. Abdominal and pelvic computed tomography (CT) revealed swelling of the abscess cavity that was linked to a rectal cutaneous fistula, with a track-like lesion measuring 6 cm × 0.7 cm in the left perineal region and attached to the left rectum. Rectoscope examination found no significant inner orifices. A left medial gluteal incision revealed a thick-walled mass, which was excised along with the extending tract, and curettage was performed. Histopathological examination confirmed CAF diagnosis. The patient achieved total resolution during follow-up assessments and did not require additional hospitalization.
CONCLUSION
CT imaging supports perineal lesion diagnosis and management. Perineal angiofibromas, even with a cutaneous fistula, can be excised transperineally.
PubMed: 38660078
DOI: 10.12998/wjcc.v12.i10.1778