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World Journal of Surgical Oncology Sep 2014Radical surgery of primary vaginal carcinoma typically involves partial or complete resection of the vagina, and young patients in particular can experience sexual... (Comparative Study)
Comparative Study
BACKGROUND
Radical surgery of primary vaginal carcinoma typically involves partial or complete resection of the vagina, and young patients in particular can experience sexual dysfunction after surgery. Vaginoplasty is mandatory for this population, multiple vaginal reconstructive techniques have been reported. Here we attempted to determine whether the peritoneum is a feasible alternative to the sigmoid colon in vaginoplasty performed during radical surgery.
METHODS
Between February 2005 and July 2009, 12 patients underwent radical surgery for Federation of International Gynecology and Obstetrics Stage I primary vaginal carcinoma in the upper one-third of the vagina. To retain a sex life, the patients received vaginoplasty either with the peritoneum (peritoneal group, 5 patients) or with the sigmoid colon (sigmoid group, 7 patients) during radical surgery. Surgeries were performed at the Anhui Provincial Hospital in China. The data between the two groups was retrospectively analyzed.
RESULTS
The operating time was shorter for the peritoneal group than for the sigmoid group (P<0.05). There were no significant differences in blood loss as well as in the length or width of the neo-vaginas between the two groups during surgery (P>0.05). No metastasis or operation-related complications were observed in any of the patients. Six months after surgery, the neo-vaginas of both groups were smooth, soft, and moist. The neo-vaginas in the sigmoid group were similar in size during and 6 months after surgery. The neo-vaginas in the peritoneal group were shorter (although no less wide) 6 months after surgery (P<0.05); length and width (that admitted two fingers) remained stable thereafter. All patients experienced a satisfactory sex life after surgery. Colposcopy revealed a good vaginal surface covered with squamous epithelium in the neo-vaginas of the peritoneal group, and intestinalization in the neo-vaginas of the sigmoid group. At the 36-month follow-up, all patients were clinically free of disease.
CONCLUSIONS
Laparoscopic vaginoplasty using the peritoneum compared with using the sigmoid colon is simpler and more feasible for management of Stage I primary vaginal carcinoma. Its benefits include shorter operating time, no bowel disturbance, and production of a hygienic vaginal environment, as well as a potential sex life and oncologic outcome comparable to that of sigmoid colon vaginoplasty.
Topics: Adult; Carcinoma, Squamous Cell; Colon, Sigmoid; Female; Follow-Up Studies; Humans; Laparoscopy; Middle Aged; Operative Time; Peritoneum; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome; Vagina; Vaginal Neoplasms
PubMed: 25266567
DOI: 10.1186/1477-7819-12-302 -
Current Opinion in Obstetrics &... Aug 1991Increasing agreement is being reached among the International Society for the Study of Vulvar Disease, the International Society of Gynecological Pathologists, the World... (Review)
Review
Increasing agreement is being reached among the International Society for the Study of Vulvar Disease, the International Society of Gynecological Pathologists, the World Health Organization, and the International Federation of Gynecology and Obstetrics concerning the terminology used to describe the abnormalities of and surgical procedures for vulvar disease. This paper focuses on Paget's disease of the vulva, which is beset with recurrence and a higher incidence of invasive disease than previously recognized, although diagnostic methods have improved. Agreements on the definition for and measurement of superficially invasive squamous cell carcinoma of the vulva have also been reached. The prognostic features of tumors likely to be associated with nodal metastases are being delineated with a view to the use of conservative surgery. The risks in underestimating a tumor's capacity to metastasize are emphasized.
Topics: Carcinoma, Squamous Cell; Female; Humans; Lymph Node Excision; Paget Disease, Extramammary; Vagina; Vulva; Vulvar Neoplasms
PubMed: 1652302
DOI: No ID Found -
The Journal of Obstetrics and... Jun 2015Vaginal carcinoma is a rare gynecological malignancy that is usually treated by radiation therapy and/or surgery combined with chemotherapy. Here, we report a case of...
Vaginal carcinoma is a rare gynecological malignancy that is usually treated by radiation therapy and/or surgery combined with chemotherapy. Here, we report a case of invasive vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving neoadjuvant chemotherapy and conservative surgery. A 36-year-old non-parous woman had a solid tumor in the vagina. Positron emission tomography/computed tomography showed a tumor in the vagina with high FDG uptake (SUV = 17.33) but no metastatic lesions. The patient was diagnosed with vaginal squamous cell carcinoma, FIGO stage I, T1N0M0. Because she wished to retain her fertility, neoadjuvant chemotherapy consisting of irinotecan hydrochloride and nedaplatin was initiated. After four courses of chemotherapy, partial vaginectomy was carried out and the pathological diagnosis of the residual lesion was VAIN 3. Following two further courses of the same chemotherapy, she obtained complete response, and has shown no evidence of disease for 14 months.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Carcinoma, Squamous Cell; Female; Humans; Irinotecan; Neoadjuvant Therapy; Neoplasm Staging; Organ Sparing Treatments; Organoplatinum Compounds; Remission Induction; Uterine Hemorrhage; Vagina; Vaginal Neoplasms
PubMed: 25512111
DOI: 10.1111/jog.12638 -
Gynecologic Oncology Mar 2001Development of carcinoma in situ in a neovagina is rare.
BACKGROUND
Development of carcinoma in situ in a neovagina is rare.
CASE
A case of carcinoma in situ of a neovagina complicated by recurrence after ablative therapy is discussed. Recurrence occurred within 4 months of initial therapy, and a total vaginectomy was performed after the patient declined other therapeutic options.
CONCLUSION
Recurrent carcinoma in situ of a neovagina can be successfully treated by surgical excision.
Topics: Carcinoma in Situ; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Skin Transplantation; Vagina; Vaginal Neoplasms
PubMed: 11263940
DOI: 10.1006/gyno.2000.6078 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Mar 1999To investigate the reconstructional method of posterior wall of vagina after the resection of rectum carcinoma.
OBJECTIVE
To investigate the reconstructional method of posterior wall of vagina after the resection of rectum carcinoma.
METHODS
From August 1991 to March 1996, 10 patients with rectum carcinoma were adopted in this study, among them, there were 4 cases belong to B stage of Dukas, and 6 cases belong to C stage of Dukes. In operation, rectum carcinoma and posterior wall of vagina were resected, and concurrent reconstruction was finished by using pedicled muscular flap of uterus.
RESULTS
The effect of operation were satisfactory except one case who was failed because of insufficient blood supply of the flap. Followed-up for 3-6 months, the posterior wall of vagina healed in 7 cases, the width of vagina was 2-3 fingers and the depth was 5-6 cm.
CONCLUSION
Reconstruction of the posterior wall of vagina with pedicled muscular flap of uterus was available in clinic. For its simplicity and feasibility, it's suitable for the resection of rectum carcinoma in which the posterior wall of vagina was infiltrated.
Topics: Adult; Carcinoma, Ductal, Breast; Female; Follow-Up Studies; Humans; Middle Aged; Plastic Surgery Procedures; Rectal Neoplasms; Surgical Flaps; Uterus; Vagina
PubMed: 12080775
DOI: No ID Found -
International Journal of Gynecological... Apr 2005We report a case of ectopic sebaceous glands in the upper third of the posterior wall of the vagina of a 49-year-old woman. This is, to our knowledge, the first fully...
We report a case of ectopic sebaceous glands in the upper third of the posterior wall of the vagina of a 49-year-old woman. This is, to our knowledge, the first fully documented case report of their occurrence in the vagina. The review of the literature and possible embryologic origin are discussed.
Topics: Carcinoma, Squamous Cell; Choristoma; Female; Humans; Middle Aged; Sebaceous Glands; Vagina; Vaginal Neoplasms
PubMed: 15782076
DOI: 10.1097/01.pgp.0000155031.14510.e6 -
European Journal of Obstetrics,... Apr 1981Cell-free extracts were prepared from tissue specimens of intraepithelial carcinoma of the cervix uteri of human patients and subsequently injected into newborn and...
Cell-free extracts were prepared from tissue specimens of intraepithelial carcinoma of the cervix uteri of human patients and subsequently injected into newborn and juvenile mice of NMRI strain via several routes. Cytological controls of vaginal epithelium were carried out in periods of 8--12 wk. Groups of mice were killed at varying intervals for histological examination. After a latency of 4-8 mth dysplastic changes of the vaginal epithelium were found in 67.6% (48 out of 71) of the mice and were graded as hyperplasia, mild and severe dysplasia and carcinoma in situ. Antibody against herpes virus hominis was not detected in the sera of these mice. Only 1 out of 120 control mice had mild dysplasia 16 mth after inoculation of an extract from noninfected human embryo kidney cells. In 9 out of 10 human cases of histologically confirmed cervical carcinoma in situ, injection of extracts into mice was followed by the appearance of dysplastic epithelium in the murine vagina. In the one case in which no positive response was obtained, the observation time had been less than 6 mth.
Topics: Animals; Carcinoma in Situ; Epithelium; Female; Humans; Mice; Neoplasm Transplantation; Transplantation, Heterologous; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vagina
PubMed: 7194826
DOI: 10.1016/0028-2243(81)90037-x -
Diagnostic Cytopathology Feb 2012Most vaginal neoplasms represent metastasis from the cervix, endometrium, colon and ovary and distinction from a primary lesion does not pose a diagnostic problem....
Most vaginal neoplasms represent metastasis from the cervix, endometrium, colon and ovary and distinction from a primary lesion does not pose a diagnostic problem. Recently, it has been recognized that women with urothelial carcinoma (UC) who have undergone radical cystectomy with orthotopic neobladder reconstruction are at risk for recurrence in the lower gynecologic tract. Our objective is to describe the cytologic features of cases with confirmed UC in the vagina in this clinical setting. Four vaginal specimens from patients with prior radical cystectomy and orthotopic neobladder reconstruction with histologically confirmed UC were evaluated. The vaginal specimens consisted of Thinprep® and Papanicolaou-stained slides. Cytomorphologic parameters including cellular arrangement, cell size and shape, cytoplasm, and nuclear features were evaluated and compared with a corresponding surgical biopsy. All four cases were highly cellular with abundant neoplastic cells arranged singly and in loose three-dimensional clusters with overlapping nuclei. The neoplastic cells were large and polygonal with well-defined cell borders, high nuclear to cytoplasmic ratio, and granular basophilic cytoplasm. The chromatin was coarse with small nucleoli. Scattered keratinized single cells with atypical hyperchromatic nuclei were observed in each case. In summary, UC involving the vagina can share many morphologic features with primary squamous cell carcinomas at this site, including focal keratinization. Abundant three dimensional clusters of neoplastic cells and a previous history of orthotopic neobladder reconstruction are helpful cytomorphologic and clinical features supporting a diagnosis of UC involving the vagina and may prevent unnecessary work-up for a new primary lesion.
Topics: Aged; Aged, 80 and over; Carcinoma, Transitional Cell; Cystectomy; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Papanicolaou Test; Plastic Surgery Procedures; Urinary Bladder; Urinary Bladder Neoplasms; Vagina; Vaginal Neoplasms; Vaginal Smears
PubMed: 22246935
DOI: 10.1002/dc.21600 -
Cancer Feb 1976Twenty-one cases of clear cell adenocarcinoma of the cervix and vagina have been reviewed. Fifteen cases occurred in females under 25 years of age and four in women over...
Twenty-one cases of clear cell adenocarcinoma of the cervix and vagina have been reviewed. Fifteen cases occurred in females under 25 years of age and four in women over 45 years. In seven cases, a positive history of maternal ingestion of diethylstilbestrol (DES) was obtained. One mother gave a history of medication with conjugated estrogens and ethisterone. Of the 13 patients with a negative history, three were born during the time period when DES was commonly used to prevent abortion. Fifteen carcinomas were cervical in origin; seven of these also involved the vagina. In six cases the carcinoma was entirely vaginal. Vaginal involvement of the carcinomas was more common in the estrogen-related group. Two non-estrogen-related cases had coexisting congenital malformations with double uterus and vagina and unilateral renal agenesis. The histopathologic appearance was similar in both groups. In most cases, a mixture of papillary, microcystic, tubular, and solid features was seen. Vaginal adenosis was found in nine cases, six of which were estrogen-related. Surgical therapy was employed in most cases and was generally superior to radiation therapy. Five patients had lymphatic involvement. All died from carcinoma. The survival rate among sixteen patients followed for 2 years or more was 62.5%. The probable müllerian origin of clear cell adenocarcinoma is discussed. It is suggested that DES, by virtue of being an estrogen, interferes with the normal process of differentiation and degeneration of müllerian epithelium in the fetal vagina. The persistence of müllerian cells altered at the subcellular level could form the basis for development of carcinoma in later life. However, a similar sequence of events must also be accepted to occur "spontaneously" since clear cell adenocarcinoma can develop in women without a history of maternal estrogens.
Topics: Adenocarcinoma; Adolescent; Adult; Diethylstilbestrol; Female; Humans; Kidney; Maternal-Fetal Exchange; Middle Aged; Pregnancy; Prognosis; Uterus; Vagina; Vaginal Diseases; Vaginal Neoplasms
PubMed: 1253110
DOI: 10.1002/1097-0142(197602)37:2<858::aid-cncr2820370235>3.0.co;2-8 -
European Journal of Cancer (Oxford,... Jan 2017Standard treatment of advanced cervicovaginal cancer [international federation of gynecology and obstetrics (FIGO) stages II(B), III(A, B), IVA] is (chemo-)radiation... (Clinical Trial)
Clinical Trial Observational Study
BACKGROUND
Standard treatment of advanced cervicovaginal cancer [international federation of gynecology and obstetrics (FIGO) stages II(B), III(A, B), IVA] is (chemo-)radiation excluding the possibility of systematic histopathological assessment of locoregional tumour spread. Laterally extended endopelvic resection (LEER) and therapeutic lymph node dissection (tLND) are novel surgical treatment options for advanced cervicovaginal cancer.
METHODS
The therapeutic efficacy of LEER for locally advanced primary and recurrent cervicovaginal cancer was reassessed by an update of the prospective observational trial at the University of Leipzig. LEER specimens were histopathologically analysed for patterns of locoregional tumour spread with particular consideration of morphogenetic cancer fields. Histopathological features associated with malignant ureteral obstruction were evaluated. Clinical (FIGO), pathological (pT) and ontogenetic (oT) tumour staging were compared.
RESULTS
Eighty-eight patients with locally advanced primary and recurrent cervicovaginal cancer were treated with LEER and tLND. LEER removed all but one tumour with microscopically clear margins (R0). After median follow-up of 40 months (7-191) five-year overall survival rate was 50% (95% confidence interval [CI]: 40-62) for the whole cohort and 46% (95% CI: 34-62) for 51 patients without a curative option from current treatment. The tissue domains of cervicovaginal cancer spread mirrored the derivatives of the morphogenetic fields instrumental for the formation of the lower genital ducts. Periureteral fibrosis accompanying mesometrial invasion, tumour infiltration of the mesureter and infiltration of the ureter itself were identified as histopathological correlates of ureteral obstruction associated with an increasingly worse prognosis. Ontogenetic tumour staging based on morphogenetic cancer fields predicted outcome better than pT and FIGO staging.
INTERPRETATION
LEER and tLND expand the curative treatment options for advanced cervicovaginal cancer. Histopathological assessment of advanced disease supports the concept of tumour spread within morphogenetic cancer fields, provides insights into the pathomechanism of ureteral obstruction and allows precise tumour staging.
Topics: Adult; Aged; Analysis of Variance; Carcinoma; Female; Humans; Intestines; Lymph Node Excision; Middle Aged; Neoplasm Staging; Perineum; Postoperative Complications; Prospective Studies; Plastic Surgery Procedures; Retrospective Studies; Survival Analysis; Ureter; Uterine Cervical Neoplasms; Vagina
PubMed: 27914244
DOI: 10.1016/j.ejca.2016.10.016