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Cureus May 2023Although vulvar lesions are mostly malignant, polyps represent one of the most frequent benign tumors of the vulva, typically measuring less than 5 cm in size. Larger...
Although vulvar lesions are mostly malignant, polyps represent one of the most frequent benign tumors of the vulva, typically measuring less than 5 cm in size. Larger lesions are uncommon and are likely the result of mesenchymal cell growth in the hormonally responsive subepithelial stromal layer of the lower genital tract. Typically, vulvar polyps are asymptomatic in their initial stages, and patients often delay seeking medical attention due to sociocultural factors. In this report, we present a case of a giant vulvar polyp and examine the underlying etiology and symptoms of this condition, highlighting the life stages of women that are most frequently affected. Additionally, we emphasize the rare but potential occurrence of malignant forms.
PubMed: 37378209
DOI: 10.7759/cureus.39152 -
Gynecologic Oncology Reports May 2021•Primary vulvar Langerhans cell histiocytosis is rare with less than 40 reported cases.•Diagnosis of vulvar LCH requires prompt metastatic workup to rule out...
•Primary vulvar Langerhans cell histiocytosis is rare with less than 40 reported cases.•Diagnosis of vulvar LCH requires prompt metastatic workup to rule out multisystem involvement.•Treatment protocols for isolated vulvar LCH vary widely and there is not an established standard of care.•Continue surveillance is warranted even after prolonged periods of remission.
PubMed: 34036139
DOI: 10.1016/j.gore.2021.100785 -
Scientific Reports Jun 2022Purulent vulvar discharges, primarily caused by genito-urinary tract infections, are an important source of economic loss for swine producers due to sow culling and...
Purulent vulvar discharges, primarily caused by genito-urinary tract infections, are an important source of economic loss for swine producers due to sow culling and mortality. However, the agents that compose the vaginal microbiota of sows and their changes during infections are not well understood. The first goal of this study was to characterize and compare the vaginal bacterial content of healthy (HE, n = 40) and purulent vulvar discharge sows (VD, n = 270) by a culture-dependent method and MALDI-TOF MS identification. Secondly, we performed 16S rRNA targeted metagenomic approach (n = 72) to compare the vaginal microbiota between these groups. We found a wide variety of bacteria, with Proteobacteria, Firmicutes, and Bacteroidota being the most abundant phyla in both groups, as well as Escherichia-Shigella, Streptococcus, and Bacteroides at the genus level. Most agents identified in the sequencing method also grew in the culture-dependent method, showing the viability of these bacteria. Alpha diversity did not differ between HE and VD sows, regarding sample richness and diversity, but a beta-diversity index showed a different microbiota composition between these groups in two tested herds. ANCOM analysis revealed that Bacteroides pyogenes were more abundant in VD females and can be a marker for this group. Other agents also require attention, such as the Streptococcus dysgalactiae and Staphylococcus hyicus found in remarkably greater relative abundance in VD sows. Network analysis revealed important positive correlations between some potentially pathogenic genera, such as between Escherichia-Shigella, Trueperella, Streptococcus, Corynebacterium, and Prevotella, which did not occur in healthy sows. We conclude that the alteration of the vaginal microbiota between healthy and purulent vulvar discharge sows, although not extreme, could be due to the increase in the relative abundance of specific agents and to associations between potentially pathogenic bacteria.
Topics: Animals; Bacteria; Female; Humans; Microbiota; RNA, Ribosomal, 16S; Swine; Vagina; Vulva
PubMed: 35650232
DOI: 10.1038/s41598-022-13090-8 -
Journal of Nematology 2021Male and female copulatory organs figure prominently in nematode taxonomy, but the associated musculature remains insufficiently explored. The aim of this study was...
Male and female copulatory organs figure prominently in nematode taxonomy, but the associated musculature remains insufficiently explored. The aim of this study was therefore to further our knowledge of the musculature of the vulva and male copulatory organs in nematodes by using phalloidin staining and confocal microscopy to examine two nematode species, and sp. The musculature of the round vulva in sp. comprises three pairs of radial vulval dilators and another pair of dilators of the anterior inner vulval plate. This arrangement is similar to that of the Rhabditida, but in the anterior pair appears to have been transformed into the vulval plate muscles. The musculature of the slit-like vulva in includes dilators of the vulval lips and external vulval flap, constrictors of the vulval slit and posterior transverse muscle bands. The opposing pairs of vulval dilators show quadrilateral symmetry as observed in the Rhabditida, but the constrictors running along the rim of the vulva have no counterparts in other species. The musculature of the male copulatory organ in sp. comprises two pairs of spicule protractors and retractors and three pairs of gubernacular muscles. In , as in the other Aphelenchoididae, the gubernaculum is absent and there is one pair of spicule protractors and two pairs of muscles inserted on the saddle (angular bend) of the spicules. The arrangement of the spicule saddle muscles resembles those of the gubernaculum, which may indicate that in this family the gubernaculum has become fused to the spicules. The literature review of muscles of nematode copulatory organs are given in a table for 15 muscle groups; it can be used for phylogenetic reconstruction and classification of the order Rhabditida.
PubMed: 34993492
DOI: 10.21307/jofnem-2021-107 -
Maturitas Aug 2024Genitourinary syndrome of menopause is a comprehensive term that groups genital, urinary and sexual signs and symptoms mainly due sex hormone deficiency and aging, with... (Review)
Review
Genitourinary syndrome of menopause is a comprehensive term that groups genital, urinary and sexual signs and symptoms mainly due sex hormone deficiency and aging, with a crucial impact on quality of life of midlife women. While this broad definition captures the common underlying physiopathology and the frequent overlap of symptomatology, improving knowledge about different components of genitourinary syndrome of menopause may be relevant for individualized treatment, with possible implications for efficacy, compliance and satisfaction. This narrative review focuses on the vulvar component of genitourinary syndrome of menopause, highlighting anatomical and functional peculiarities of the vulva that are responsible for some of the self-reported symptoms, as well as specific signs at physical examination. Increasing evidence points towards a pivotal role of vulvar vestibular health in the occurrence of sexual pain, one of the most common and distressing symptoms of genitourinary syndrome of menopause, which should be evaluated with validated scales taking a biopsychosocial perspective. This is an essential step in the recognition of different phenotypes of genitourinary syndrome of menopause and in the assessment of the most effective diagnostic and therapeutic algorithm. Menopausal vulvar health deserves more research into tailored non-hormonal and hormonal treatment options.
Topics: Humans; Female; Menopause; Vulva; Syndrome; Female Urogenital Diseases; Sexual Dysfunction, Physiological; Quality of Life; Vulvar Diseases
PubMed: 38704313
DOI: 10.1016/j.maturitas.2024.108006 -
PNAS Nexus Nov 2022Male mating in is a complex behavior with a strong mechanosensory component. has several characterized mechanotransducer proteins, but few have been shown to...
Male mating in is a complex behavior with a strong mechanosensory component. has several characterized mechanotransducer proteins, but few have been shown to contribute to mating. Here, we investigated the roles of , a piezo channel, and , a mechanotransducing TRPN channel, in male mating behavior. We show that is expressed in several male-specific neurons with known roles in mating. We show that, among other neurons, is expressed in the Post-Cloacal sensilla neuron type A (PCA) sensory neuron, which monitors relative sliding between the male and the hermaphrodite and inhibits neurons involved in vulva detection. Mutations in both genes compromise many steps of mating, including initial response to the hermaphrodite, scanning, turning, and vulva detection. We performed pan-neuronal imaging during mating between freely moving mutant males and hermaphrodites. Both and mutants showed spurious activation of the sensory neurons involved in vulva detection. In mutants, this spurious activation might be caused by PCA failure to inhibit vulva-detecting neurons during scanning. Indeed, we show that without functional , PCA fails to detect the relative sliding between the male and hermaphrodite. Cell-specific expression restores PCA's mechanosensory function. Our results demonstrate new roles for both and mechanotransducers in mating behavior.
PubMed: 36712331
DOI: 10.1093/pnasnexus/pgac213 -
Indian Journal of Sexually Transmitted... 2023Vulvar vestibular papillomatosis (VP) is considered a normal anatomical variant of the vulva. We present a 19-year-old girl with a history of "small itchy growths" on...
Vulvar vestibular papillomatosis (VP) is considered a normal anatomical variant of the vulva. We present a 19-year-old girl with a history of "small itchy growths" on the vulva for 2 months without any associated discharge. These lesions were causing significant anxiety to the patient. Cutaneous examination revealed multiple, uniformly arranged, skin-colored, monomorphic micropapillae on the inner aspect of the labia minora. Biopsy showed mucosal hyperplasia with papillomatosis and loosely arranged subdermal tissue, no koilocytes were spotted. The diagnosis of vulvar VP was made. We want to highlight this clinical entity as most dermatologists are not familiar with this benign condition and easily confuse it with genital warts. This inexperience may result in unnecessary investigations causing psychological discomfort to the patient. We herein present such a case which brings out the diagnostic dilemma.
PubMed: 37457529
DOI: 10.4103/ijstd.ijstd_26_22 -
Gynecologic Oncology Jan 2022The impact of adjuvant radiotherapy (RT) to the vulva with regard to prognosis and local recurrence in patients with vulvar squamous cell cancer (VSCC) is poorly...
BACKGROUND
The impact of adjuvant radiotherapy (RT) to the vulva with regard to prognosis and local recurrence in patients with vulvar squamous cell cancer (VSCC) is poorly described.
PATIENTS AND METHODS
In the AGO-CaRE-1 study 1618 patients with primary VSCC FIGO stage ≥ IB, treated between 1998-2008, were documented. In this retrospective subanalysis, 360 patients were included based on the following criteria: nodal involvement (pN+), known RT treatment and known radiation fields.
RESULTS
The majority had pT1b/pT2 tumors (n=299; 83.1%). In 76.7%, R0 resection was achieved. 57/360 (15.8%) N+ patients were treated with adjuvant RT to the groins/pelvis and 146/360 (40.5%) received adjuvant RT to the vulva and groins/pelvis. 157/360 (43.6%) patients did not receive any adjuvant RT. HPV status was available in 162/360 patients (45.0%), 75/162 tumors were HPV+(46.3%), 87/162 (53.7%) HPV-. During a median follow-up of 17.2 months, recurrence at the vulva only occurred in 25.5% of patients without adjuvant RT, in 22.8% of patients with adjuvant RT to groins/pelvis and in 15.8% of patients with adjuvant RT to the vulva and groins/pelvis respectively. The risk reducing effect of local RT was independent of the resection margin status. 50% disease free survival time (50% DFST) indicated a stronger impact of adjuvant RT to the vulva in HPV+ compared to HPV- patients (50% DFST 20.7 months vs. 17.8 months).
CONCLUSION
Adjuvant RT to the vulva was associated with a lower risk for local recurrence in N+ VSCC independent of the resection margin status. This observation was more pronounced in patients with HPV+ tumors in comparison to HPV- tumors.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Disease-Free Survival; Female; Germany; Humans; Middle Aged; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant; Vulvar Neoplasms; Young Adult
PubMed: 34794839
DOI: 10.1016/j.ygyno.2021.11.004 -
Journal of the American Academy of... May 2023
Topics: Female; Humans; Vulva; Vulvar Lichen Sclerosus; Laser Therapy; Vulvar Neoplasms; Carcinoma in Situ; Precancerous Conditions; Lichen Sclerosus et Atrophicus
PubMed: 36639033
DOI: 10.1016/j.jaad.2023.01.003 -
Vulvar cancer subclassification by HPV and p53 status results in three clinically distinct subtypes.Gynecologic Oncology Dec 2020There is great need for better risk stratification in vulvar squamous cell carcinoma (VSCC). Our aim was to define the prognostic significance of stratifying VSCC based...
OBJECTIVE
There is great need for better risk stratification in vulvar squamous cell carcinoma (VSCC). Our aim was to define the prognostic significance of stratifying VSCC based on p16 and p53 immunohistochemistry (IHC) as surrogate markers for HPV and TP53 mutations.
METHODS
A large retrospective cohort of surgically treated women with primary VSCC was used. VSCC were classified into three subtypes: HPV-positive (HPVpos), HPV-negative/p53 mutant (HPVneg/p53mut), and HPV-negative/p53 wildtype (HPVneg/p53wt). Overall survival (OS), relative survival (RS), and recurrence-free period (RFP) were depicted using the Kaplan-Meier method and survival curves for relative survival; associations were studied using univariable and multivariable Cox proportional hazard models.
RESULTS
Of the 413 VSCCs, 75 (18%) were HPVpos, 63 (15%) HPVneg/p53wt, and 275 (66%) HPVneg/p53mut VSCC. Patients with HPVneg/p53mut VSCC had worse OS and RS (HR 3.43, 95%CI 1.80-6.53, and relative excess risk (RER) of 4.02; 95%CI 1.48-10.90, respectively, and worse RFP (HR 3.76, 95%CI 2.02-7.00). HPVpos VSCC patients showed most favorable outcomes. In univariate analysis, the molecular subtype of VSCC was a prognostic marker for OS, RS and RFP (p = 0.003, p = 0.009, p < 0.001, respectively) and remained prognostic for RFP even after adjusting for known risk factors (p = 0.0002).
CONCLUSIONS
Stratification of VSCC by p16- and p53-IHC has potential to be used routinely in diagnostic pathology. It results in the identification of three clinically distinct subtypes and may be used to guide treatment and follow-up, and in stratifying patients in future clinical trials.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Clinical Decision-Making; Female; Humans; Middle Aged; Mutation; Neoplasm Recurrence, Local; Papillomaviridae; Papillomavirus Infections; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Tumor Suppressor Protein p53; Vulva; Vulvar Neoplasms; Vulvectomy; Young Adult
PubMed: 32972785
DOI: 10.1016/j.ygyno.2020.09.024