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International Journal of Gynecological... Jan 2024Vaginal carcinoma is a rare malignancy accounting for 1-2% of all gynecological cancers. Surgery has a limited role, while definitive radiotherapy-chemotherapy followed...
OBJECTIVE
Vaginal carcinoma is a rare malignancy accounting for 1-2% of all gynecological cancers. Surgery has a limited role, while definitive radiotherapy-chemotherapy followed by interventional radiotherapy is considered a valid alternative. The aim of the TRIDENT (TRImodal DEfinitive invasive vagiNal carcinoma Treatment) pilot study was to report the results of a modern standardized trimodal protocol treatment consisting of image guided definitive radiotherapy-chemotherapy followed by image guided interventional radiotherapy in terms of safety and efficacy.
METHODS
Between January 2019 and December 2021, we analyzed 21 consecutive patients with primary vaginal cancer who had received radiotherapy-chemotherapy followed by interventional radiotherapy. The primary study endpoint was local control, and secondary endpoints were metastasis free survival, overall survival, and rate and severity of acute and late toxicities.
RESULTS
14 patients had FIGO (International Federation of Gynecology and Obstetrics) stage II, five patients had stage III, and two had stage IVB disease. Median total external beam radiotherapy dose for the tumor was 45 Gy. Median total dose on positive nodes was 60 Gy. Median total dose for interventional radiotherapy was 28 Gy over four high dose rate fractions to achieve between 85 and 95 Gy equivalent dose, in 2 Gy fractions (EQD2)α/β10, to the high risk clinical target volume, and 60 Gy EQD2α/β10 to the intermediate risk clinical target volume. All patients received weekly platinum based chemotherapy. Median follow-up was 20 months (range 10-56 months). Two year actuarial local control, metastasis free survival, and overall survival rate were 79.4%, 90.5%, and 79.4%, respectively. In terms of acute toxicity, there were no grade 4 events and only one acute grade (G) 3 toxicity (skin). Only vaginal stenosis (G3) was documented 12 months after therapy due to late toxicity.
CONCLUSIONS
In this study, definitive radiotherapy-chemotherapy followed by interventional radiotherapy was a safe and effective treatment modality for primary vaginal cancer.
PubMed: 38290784
DOI: 10.1136/ijgc-2023-004956 -
International Journal of Gynecological... Jan 2024Adenoid cystic carcinoma (ACC) is a rare neoplasm most frequently observed in the salivary glands, that can occur in other organs, including the vulva and vagina....
Adenoid cystic carcinoma (ACC) is a rare neoplasm most frequently observed in the salivary glands, that can occur in other organs, including the vulva and vagina. Oncogenic mechanisms involving MYB, NFIB, and MYB-NFIB rearrangements have been described, but evidence in the vulva and vagina remains scarce. Our aim is to report the clinicopathologic features, immunohistochemical, and molecular findings in a series of vulvar and vaginal ACCs. Five cases were included. Medical records and slides were reviewed. Formalin-fixed paraffin-embedded material was available in 4 cases, where additional immunohistochemical and molecular studies were carried out. Fluorescence in situ hybridization using MYB, MYBL1, and NFIB bacterial artificial chromosome-clones break-apart and MYB::NFIB BAC-clones fusion probes was performed. The patients' mean age at diagnosis was 52 years. Tumor size ranged from 0.5 to 5 cm. Microscopic examination revealed tubular, cribriform, and solid patterns. Perineural invasion was seen in 4 cases. Patients were treated with surgery, some with adjuvant radiation therapy. During follow-up (mean: 11 yr), 4 patients developed local recurrences. Recently, one of these patients developed pulmonary disease. Cam 5.2, CK5/6, CD117, and DOG-1 were positive in all 4 cases and S100 and calponin were positive in 3 cases. MYB rearrangement was present in 3 cases, including one with concurrent MYB amplification. There were no MYBL1 or NFIB rearrangements and no MYB::NFIB fusions. Our findings corroborate that the histologic, immunohistochemical, and oncogenic background is similar between ACCs of the lower female genital tract and ACCs elsewhere, although the canonical MYB::NFIB fusion seems to be a less common finding in this location.
PubMed: 38289149
DOI: 10.1097/PGP.0000000000001016 -
Gan To Kagaku Ryoho. Cancer &... Jan 2024A 30s female complaining of anal pain and melena was referred to our hospital. The support by adolescent-and-young- adult(AYA)team was initiated after the first...
A 30s female complaining of anal pain and melena was referred to our hospital. The support by adolescent-and-young- adult(AYA)team was initiated after the first encounter. Colonoscopic examination revealed an ulcerated tumor on the anterior wall of anal canal with its anal margin on anal verge and the tumor was diagnosed as an adenocarcinoma. Contrast- enhanced CT and MRI revealed adjacency of tumor and vagina, enlarged lymph nodes and multiple pulmonary nodules. 18F-fluorodeoxyglucose(FDG)-positron emission tomography(PET)additionally revealed tracer accumulation in left sciatica, which led us to the diagnosis of advanced anal cancer. We planned and safely performed concomitant partial vaginal resection in robot-assisted laparoscopic abdominoperineal resection for the palliative purpose after discussion on physical and psychosocial issues including stoma and fertility with the patient, her family and AYA members. The pathological diagnosis was pT4b(vagina)N1aM1b, pStage ⅣB, and the local margin was pathologically negative. The postoperative course was smooth and she was discharged on postoperative day 16. Fifty one days after operation, she started systemic chemotherapy after decision on not to take ovarian samples and continues systemic chemotherapy as of writing. Support by AYA team was effective to facilitate the patient's decision-making and the communication between the patient and the medical team.
Topics: Female; Humans; Adolescent; Adult; Anal Canal; Adenocarcinoma; Anus Neoplasms; Pelvis; Fluorodeoxyglucose F18
PubMed: 38247095
DOI: No ID Found -
Journal of Contemporary Brachytherapy Dec 2023To compare dose volume parameters of target and organs at risk in vaginal vault brachytherapy using ovoids or cylinder in post-operative endometrial carcinoma.
PURPOSE
To compare dose volume parameters of target and organs at risk in vaginal vault brachytherapy using ovoids or cylinder in post-operative endometrial carcinoma.
MATERIAL AND METHODS
The study was done among 25 histologically proven post-operative endometrial carcinoma patients requiring vaginal brachytherapy. All patients underwent both cylinder and ovoids application alternatively on weekly basis. Ovoids size ranged from 2 to 3 cm diameter. Diameters of cylinder ranged between 2.5 and 3.5 cm. Bladder, rectum, urethra, and clinical target volume (CTV) were contoured on CT simulation images. Prescribed dose was 6-7 Gy in 2-3 fractions at 0.5 cm from the surface of applicator.
RESULTS
The mean values of D, D, V, V, V, and V of CTV were comparable between cylinder and ovoids plans. The mean dose of CTV was significantly higher with cylinder than with ovoids, and D was significantly higher with ovoids (mean = 15.63 Gy vs. 14.64 Gy, = 0.016, and D = 37.82% vs. 42.86%, = 0.042, for cylinder vs. ovoids). In the dosimetry of the vault, D, D, V, V, V, and mean of the vault did not show any significant difference between cylinder and ovoids. The V was significantly higher with cylinder plans than ovoids, and D of the vault was significantly higher with ovoids plans (V = 14.81% vs. 6.86%, = 0.02, and D = 37.77% vs. 44.80%, = 0.029, for cylinder vs. ovoids). D, D, D, and mean for the bladder, rectum, and urethra were comparable between the cylinder and ovoid plans.
CONCLUSIONS
The present study showed that the dose to organs at risk, most of the dosimetric parameters of CTV, and vault were comparable between the cylinder and ovoid plans. Both applicators provide good reproducibility. The choice of applicator will ultimately depend on the institutional policies and oncologist decision. However, in patients with dog-ear configuration of the vagina, ovoids may be preferred as per ABS guidelines.
PubMed: 38230405
DOI: 10.5114/jcb.2023.134171 -
Asian Journal of Surgery Apr 2024
Topics: Female; Humans; Neoadjuvant Therapy; Vagina; Vaginal Neoplasms; Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Neoplasm Staging
PubMed: 38220528
DOI: 10.1016/j.asjsur.2024.01.030 -
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 -
Case Reports in Oncology 2024Malignant mixed müllerian tumor (MMMT) is a rare neoplasm, consisting of carcinomatous (epithelial) and sarcomatous (mesenchymal) components that most commonly arise in...
Malignant mixed müllerian tumor (MMMT) is a rare neoplasm, consisting of carcinomatous (epithelial) and sarcomatous (mesenchymal) components that most commonly arise in the endometrium and more infrequently in the ovaries, fallopian tube, cervix, and vagina. Primary peritoneal carcinosarcoma (PPCS) is an extremely rare extragenital presentation of MMMT. Although the occurrence of breast cancer and epithelial ovarian carcinoma in association with pathogenic variants is firmly established, the etiologic role of these genes in the development of other tumor types is less well known. Here, we present a rare case of PPCS in a 42-year-old Brazilian woman with a pathogenic variant, c.2808_2811del (NM_000059.3). The patient developed metastatic breast cancer at the age of 37 and underwent a risk-reducing bilateral salpingo-oophorectomy 2 years later. She was then diagnosed with PPCS 3 years after the risk-reducing surgery. She underwent treatment with surgery, chemotherapy, and targeted therapy but passed away almost 5 years after the second primary tumor diagnosis. To our knowledge, this is the first case of peritoneal carcinosarcoma described in a pathogenic variant carrier, and its report leads to a better understanding of the disease's molecular features and possible therapeutic approaches.
PubMed: 38179550
DOI: 10.1159/000534179 -
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 -
Cureus Nov 2023Primary fallopian tube carcinomas (PFTCs) are quite rare with the incidence ranging from 0.3% to 1.1% amongst all the gynaecological malignancies. Here, we present a...
Primary fallopian tube carcinomas (PFTCs) are quite rare with the incidence ranging from 0.3% to 1.1% amongst all the gynaecological malignancies. Here, we present a rare case of a 44-year-old female (parity-2, live-2 and abortion-2), with one previous classical caesarean section and one vaginal birth after caesarean section (VBAC), bilateral tubal ligation done referred to our gynaecology OPD with complaints of pain in the abdomen since the past six days. The patient also had complaint of spotting per vagina for the past two months. Her ultrasonography and contrast-enhanced CT abdomen and pelvis were suggestive of broad ligament fibroid, which turned out to be a PFTC. Primary fallopian tube malignancies are so rare that this entity may be missed in routine clinical practice and surprisingly noticed during operative procedure or on histopathology reports. Thus, one must be aware of this rare clinical entity and keep it in mind while taking patients on the operating table.
PubMed: 38130542
DOI: 10.7759/cureus.49142 -
Journal of Clinical Ultrasound : JCU 2024Malignant triton tumor (MTT) is a highly aggressive malignant neoplasm, classified as a variant of malignant peripheral nerve sheath tumor with rhabdomyoblastic... (Review)
Review
Malignant triton tumor (MTT) is a highly aggressive malignant neoplasm, classified as a variant of malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation. There are few reports that MTT occurred in urogenital system. In the present study, we report the first MTT occurring in the uterus. A 57-year-old woman came to the emergency department due to persistent vaginal bleeding for 2 months. The gynecological palpation found that a club-shaped excrescence existed in the vagina about 7 cm × 3 cm × 3 cm. The mass located in the lower segment of the uterus and the cervix was confirmed by gynecological vaginal ultrasound and magnetic resonance imaging, which was preliminarily diagnosed as cervical carcinoma. After neoplasm punch biopsy, the pathological diagnosis was malignant triton tumor. The patient finally lost follow-up. This is the first report about MTT in the uterus and suggests that pathological biopsy combined with imaging examination is necessary for the diagnosis of rarely MTT.
Topics: Female; Humans; Middle Aged; Neurofibrosarcoma; Nerve Sheath Neoplasms; Neurilemmoma; Skin Neoplasms; Uterus
PubMed: 38126255
DOI: 10.1002/jcu.23630