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CytoJournal 2022Carcinoma of cervix is classified as per the WHO classification into primary tumors which are predominantly epithelial tumors, mesenchymal tumors and tumor like lesions,... (Review)
Review
Carcinoma of cervix is classified as per the WHO classification into primary tumors which are predominantly epithelial tumors, mesenchymal tumors and tumor like lesions, mixed epithelial stromal tumors, melanocytic, germ cell, and lymphoid tumors. Secondary tumors are uncommon. Squamous cell carcinoma (SCC) in various morphological forms needs to be separated from other epithelial tumors for treatment modality selection. Majority of SCC are human papilloma virus (HPV) positive. The histological pattern, HPV type, and grading do not affect prognosis. Mixed mesenchymal and epithelial tumors are of Mullerian origin. Among sarcomas, Botryoid rhabdomyosarcoma needs to be looked for, as a small biopsy may miss it. Carcinoma cervix is not the only cancer caused by HPV. High-risk HPV is implicated in causation of various other cancers such as anal cancers, oropharyngeal cancers, vulval cancers, vaginal cancers, and penile cancers. Low-risk HPV viruses similarly cause infections of perianal and genital region in males and females. The terminology for these lesions has evolved before understanding of pathogenesis of low- and high-risk HPV. The lower anogenital squamous terminology (LAST), an acronym for LAST, incorporates the low- and high-grade squamous intraepithelial lesion (HSIL) terminology. In invasive cancers, a superficially invasive SCC is a well-defined entity. LAST outlines areas where p16 use is recommended. No benefit of addition of other biomarkers like p63 or ki67 is found in problem-solving in differentiation of HSIL from mimics or low-grade squamous intraepithelial lesion. Routine use of biomarkers is not advocated.
PubMed: 35928526
DOI: 10.25259/CMAS_03_14_2021 -
Obstetrical & Gynecological Survey Oct 2021Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder affecting skin of intertriginous areas that is often encountered and treated by nondermatologic... (Review)
Review
IMPORTANCE
Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder affecting skin of intertriginous areas that is often encountered and treated by nondermatologic specialists.
OBJECTIVE
The purpose of this literature review is to provide a comprehensive, clinical source of information on HS as it relates to incidence of disease, pathophysiology, diagnosis, and overall management of this condition.
EVIDENCE ACQUISITION
Sources were obtained through a comprehensive literature search using PubMed and PMC. Various terms were used to query the database, including "hidradenitis suppurativa," "pathogenesis," "prevalence," "management," "surgery," "perineal," and "vulva."
RESULTS
Underreported prevalence and unknown pathogenesis have subsequently led to variable approaches in clinical management, often employing a combination of medical and surgical management.
CONCLUSIONS
Early diagnosis and treatment of HS may lead to better disease control and minimize patients' associated morbidity related to disease.
RELEVANCE
Knowledge of vulvoperineal hidradenitis is necessary for gynecologists and primary care physicians to ensure early diagnosis, management, and referral for optimal patient outcomes.
Topics: Chronic Disease; Female; Hidradenitis Suppurativa; Humans; Perineum; Prevalence
PubMed: 34724076
DOI: 10.1097/OGX.0000000000000944 -
Archives of Medical Sciences.... 2023Gynecological cancer is among the leading causes of cancer-related mortality worldwide, with malignancies of the ovary, uterus, fallopian tube, cervix, vagina, and vulva...
Gynecological cancer is among the leading causes of cancer-related mortality worldwide, with malignancies of the ovary, uterus, fallopian tube, cervix, vagina, and vulva making up 10-18% of all cancers diagnosed in women globally. Gynecological cancer and atherosclerosis are two of the most frequent medical entities that afflict women worldwide; thus the possible correlations between them ought to be explored. Vulvar, cervical, vaginal, endometrial, and ovarian cancers have been found to have common points with atherosclerosis regarding their pathogenesis and predisposing factors. Obesity and metabolic syndrome, HPV infection, vitamin D deficiency, and increased telomere length constitute common ground between these two afflictions, which this article aims to analyze.
PubMed: 38283923
DOI: 10.5114/amsad/176655 -
International Urogynecology Journal Feb 2023A 31-year-old patient with a history of fetal sacrococcygeal teratoma requiring tumor resection and pelvic reconstruction in infancy presented with a 3-year history of...
INTRODUCTION AND HYPOTHESIS
A 31-year-old patient with a history of fetal sacrococcygeal teratoma requiring tumor resection and pelvic reconstruction in infancy presented with a 3-year history of recurrent vulvar abscesses and voiding dysfunction. Magnetic resonance imaging demonstrated a fluid collection posterior to the pubic bone and inferior to the bladder. The objective was to demonstrate the key steps in the resection and repair of an anterior urethral diverticulum via robot-assisted laparoscopic approach.
METHODS
Cystoscopy followed by robot-assisted laparoscopic retropubic dissection was used for resection of an anterior urethral diverticulum followed by urethral reconstruction.
RESULTS
Cystoscopy revealed a large anterior cavity at the midpoint of the urethra consistent with an anterior urethral diverticulum. This likely tracked inferiorly toward her vulva during repeated episodes of infection expressing through her recurrent abscesses. Retropubic space exploration revealed dense fibrotic tissue adherent to the underside of the pubic tubercule contiguous with the anterior urethral diverticulum, which was successfully resected.
CONCLUSIONS
Female anterior urethral diverticulum is a rare entity. A robot-assisted laparoscopic approach can be safely utilized to identify and resect an anterior urethral diverticulum. Key points include optimization of port placement, use of a council-tip catheter to facilitate bladder drainage in the setting of distorted pelvic anatomy, and multi-layered tension-free urethral closure with flap placement.
Topics: Humans; Female; Adult; Urethra; Robotics; Abscess; Laparoscopy; Urethral Diseases; Diverticulum
PubMed: 36129481
DOI: 10.1007/s00192-022-05355-7 -
Journal of Clinical Virology : the... Jul 2023Human papillomavirus associated anogenital cancers are a significant global burden. The detection of biomarkers (circulating tumour DNA; ctDNA or circulating HPV DNA;... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Human papillomavirus associated anogenital cancers are a significant global burden. The detection of biomarkers (circulating tumour DNA; ctDNA or circulating HPV DNA; cHPV DNA) in blood referred to as "liquid biopsy" may support the early diagnosis and monitoring of affected individuals.
METHODS
A systematic review, including meta-analysis of studies available in the literature on the utilization of ctDNA and cHPV DNA as diagnostic, predictive, and monitoring biomarker tests of HPV associated anogenital cancers was performed following the criteria of PRISMA.
RESULTS
A total of 31 studies were eligible for systematic review; 20 used cHPV DNA in cervical cancers; 7 used ctDNA in cervical cancer; 5 used cHPV DNA in anal cancer; no eligible studies on vulva, vaginal or penile cancer were available. The meta-analysis identified low sensitivity (0.36) and high specificity (0.96) of cHPV DNA as diagnostic for cervical cancer. Comparatively, there was high sensitivity (0.95) and specificity (1.0) of cHPV DNA for the diagnosis of anal cancer. cHPV DNA and/or ctDNA in cervical cancer were prognostic markers associated with poor clinical outcomes. Additionally, in anal cancer the post treatment detection of cHPV DNA was informative in the prediction of treatment response or progression-free survival.
CONCLUSION
ctDNA and cHPV DNA are promising diagnostic and prognostic biomarkers for the detection of anogenital disease. Evolution and refinement of molecular tools is likely to improve performance further. Additionally the comparative absence of studies in the vulval, vaginal and penile context warrants further exploration and research.
Topics: Female; Humans; Uterine Cervical Neoplasms; Papillomavirus Infections; Human Papillomavirus Viruses; Anus Neoplasms; DNA
PubMed: 37163963
DOI: 10.1016/j.jcv.2023.105469 -
Medicina (Kaunas, Lithuania) Jun 2022Human Papillomavirus is the main cause of cervical cancer, including squamous cell carcinoma of the oropharynx, anus, rectum, penis, vagina, and vulva. In recent years,... (Review)
Review
Human Papillomavirus is the main cause of cervical cancer, including squamous cell carcinoma of the oropharynx, anus, rectum, penis, vagina, and vulva. In recent years, considerable effort has been made to control HPV-induced diseases using either prophylactic or therapeutic approaches. A critical review of the literature about the therapeutic Human Papillomavirus vaccine was performed to analyze its efficacy in the treatment of female lower genital tract lesions and its possible perspective application in clinical practice. The most important medical databases were consulted, and all papers published from 2000 until 2021 were considered. We retrieved a group of seven papers, reporting the role of anti HPV therapeutic vaccines against the L2 protein in the order of their efficacy and safety in female lower genital tract disease. In addition, the immune response due to vaccine administration was evaluated. The development of therapeutic vaccines represents an interesting challenge for the treatment of HPV infection of the lower genital tract. Literature data underline that the L2 protein may be an interesting and promising target in the development of therapeutic HPV vaccines, but the possible strengths and the unclear longevity of L2 immune responses are factors to be considered before clinical use.
Topics: Female; Humans; Male; Papillomaviridae; Papillomavirus Infections; Papillomavirus Vaccines; Uterine Cervical Neoplasms; Vaccination
PubMed: 35888579
DOI: 10.3390/medicina58070860 -
Expert Review of Vaccines Nov 2019: Safety and efficacy of prophylactic HPV vaccines against HPV infection and associated cervical cancers and precursors is well documented in the literature; however,...
: Safety and efficacy of prophylactic HPV vaccines against HPV infection and associated cervical cancers and precursors is well documented in the literature; however, their efficacy against vulval and vaginal endpoints has not been previously assessed.: Published results of trials involving licensed HPV vaccines were included. Main efficacy outcomes were histologically confirmed high-grade vulval and vaginal precancer distinguishing those associated with vaccine HPV types and any vulval and vaginal precancerous lesions. Exposure groups included women aged 15-26 or 24-45 years being initially negative for high-risk HPV (hrHPV), negative for the HPV vaccine types, and women unselected by HPV status.: Our results show that the HPV vaccines are equally highly efficacious against vulval/vaginal disease as previously noted for cervical disease. The vaccines demonstrated excellent protection against high-grade vulval and vaginal lesions caused by vaccine-related HPV types among young women who were not initially infected with hrHPV types or types included in the vaccines (vaccine efficacies more than 90%). No protection against high-grade vulval and vaginal lesions associated with HPV16/18 was observed for mid-adult women. Trials were not powered to address protection against invasive cancers.
Topics: Adolescent; Adult; Female; Humans; Middle Aged; Papillomavirus Infections; Papillomavirus Vaccines; Precancerous Conditions; Treatment Outcome; Vaginal Neoplasms; Vulvar Neoplasms; Young Adult
PubMed: 31718338
DOI: 10.1080/14760584.2019.1692658 -
Biomedicines Dec 2021Women's intimate health depends on several factors, such as age, diet, coexisting metabolic disorders, hormonal equilibrium, sexual activity, drug intake, contraception,... (Review)
Review
Women's intimate health depends on several factors, such as age, diet, coexisting metabolic disorders, hormonal equilibrium, sexual activity, drug intake, contraception, surgery, and personal hygiene. These factors may affect the homeostasis of the internal environment of the genital tract: the vulva, vagina and cervix. This equilibrium is dependent on strict and complex mutual interactions between epithelial cells, immunocompetent cells and microorganisms residing in this environment. The microbiota of the genital tract in healthy women is dominated by several species of symbiotic bacteria of the genus. The bacteria inhibit the growth of pathogenic microorganisms and inflammatory processes by virtue of direct and multidirectional antimicrobial action and, indirectly, by the modulation of immune system activity. For the homeostasis of the genital tract ecosystem, antimicrobial and anti-inflammatory peptides, as well as proteins secreted by mucus cells into the cervicovaginal fluid, have a fundamental significance. Of these, a multifunctional protein known as lactoferrin (LF) is one of the most important since it bridges innate and acquired immunity. Among its numerous properties, particular attention should be paid to prebiotic activity, i.e., exerting a beneficial action on symbiotic microbiota of the gastrointestinal and genital tract. Such activity of LF is associated with the inhibition of bacterial and fungal infections in the genital tract and their consequences, such as endometritis, pelvic inflammation, urinary tract infections, miscarriage, premature delivery, and infection of the fetus and newborns. The aim of this article is to review the results of laboratory as well as clinical trials, confirming the prebiotic action of LF on the microbiota of the lower genital tract.
PubMed: 34944756
DOI: 10.3390/biomedicines9121940 -
NEJM Evidence Feb 2024Human papillomaviruses (HPVs), of which there are over 200 types, typically infect cells of the skin and mucosa. Most infections are cleared by the immune system without...
Human papillomaviruses (HPVs), of which there are over 200 types, typically infect cells of the skin and mucosa. Most infections are cleared by the immune system without any intervention; however, in a small percentage of infected individuals, the virus persists, resulting in a variety of disorders. More specifically, 13 HPV types have been characterized as oncogenic because of their central role in the development of premalignant and malignant lesions of the oropharynx (mouth and throat), lower gastrointestinal tract (anus), and genital organs (uterine cervix, vagina, vulva, and penis). Worldwide, HPV infections contribute to approximately 5% of all cancers, with an estimated 625,000 women and 69,000 men affected annually by HPV-related cancers.
Topics: Male; Humans; Female; Papillomavirus Infections; Human Papillomavirus Viruses; Precancerous Conditions; Pelvis; Vaccination
PubMed: 38320496
DOI: 10.1056/EVIDe2300336 -
Pathogens (Basel, Switzerland) Nov 2020In contrast to the diverse studies on human papillomaviruses (HPVs), information on animal PVs associated with anogenital lesions is limited. In the animal kingdom,... (Review)
Review
In contrast to the diverse studies on human papillomaviruses (HPVs), information on animal PVs associated with anogenital lesions is limited. In the animal kingdom, papillomas occur more commonly in cattle than in any other animals, and diverse types of papillomaviruses (BPVs) exist, including the very recently discovered BPV type 29 (BPV29). From this perspective, we will review previous studies describing PV types associated with anogenitals in animals, with a focus on BPVs. To date, two classical BPV types, classified into (BPV1 and BPV2) and (BPV22), and two novel (BPV28 and BPV29) have been identified from anogenital lesions and tissues of the domestic cow. Due to the limited reports describing anogenital-associated PVs in animals, the relationships between their phylogenetic and pathogenetic properties are still undiscovered. Animal studies are valuable not only for the veterinary field but also for human medicine, as animal diseases have been shown to mimic human diseases. Studies of anogenital-associated PVs in animals have a positive impact on various research fields.
PubMed: 33260814
DOI: 10.3390/pathogens9120993