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Journal of Cancer Research and... 2021While delivering radiotherapy it is utmost important to minimize target motion to decrease margins in postoperative gynaecological patients. Hence certain bladder and...
AIM
While delivering radiotherapy it is utmost important to minimize target motion to decrease margins in postoperative gynaecological patients. Hence certain bladder and rectum filling protocols are followed by each institute. During cone beam computed tomography (CBCT) verification, we observed that this motion was more affected by rectal filling. To verify, we retrospectively analysed the vaginal movement and its relation with bladder and rectum filling.
MATERIALS AND METHODS
We evaluated CBCTs of 15 patients of carcinoma endometrium. Bladder and rectum both were contoured offline on each scan. To assess the motion of vagina, two reference points were selected. Posterior movement of bladder and anterior movement of rectum were noted on these points on each scan.
RESULTS
Total 150 scans (135 KV-CBCT scans and 15 planning computed tomography) of 15 patients were studied. Stepwise regression analysis reported that bladder wall changes has a nonsignificant relationship with bladder volume among all the individuals. The significant rectal wall changes both at Point X and Y were observed in six patients and only at Point X in three patients. Rest of the patients showed no significant relationship in their CBCT scans. Thus 60% patients showed significant relation between rectal volume and rectal wall changes.
CONCLUSION
Hence we suggest to advice our patients more regarding volume of rectum to decrease vaginal motion. Bladder volume is needed to decrease the dose to small intestine. However prospective data with large number of patients in the study is required to confirm these findings.
Topics: Cone-Beam Computed Tomography; Endometrial Neoplasms; Female; Humans; Motion; Postoperative Period; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Image-Guided; Rectum; Retrospective Studies; Urinary Bladder; Vagina
PubMed: 33723148
DOI: 10.4103/jcrt.JCRT_1113_19 -
BMC Cancer Mar 2022This research aimed to provide an overview of the impact of adjuvant vaginal brachytherapy (VBT) and external beam pelvic radiotherapy (EBRT) with or without VBT on...
BACKGROUND
This research aimed to provide an overview of the impact of adjuvant vaginal brachytherapy (VBT) and external beam pelvic radiotherapy (EBRT) with or without VBT on survival in stage I to II EC patients in China from a long-term multi-institutional analysis.
METHODS
We retrospectively analyzed stage I to II EC patients from 13 institutions treated between 2003 and 2015. All patients underwent surgical staging and received adjuvant RT. Patients were divided into groups of low-risk (LR), intermediate-risk (IR), high-intermediate-risk (HIR) and high-risk (HR). Survival statistics, failure pattern, and toxicity of different radiation modalities in different risk groups were analyzed.
RESULTS
A total of 1048 patients were included. HR disease represented 27.6%, HIR 17.7%, IR 27.7% and LR 27.1%, respectively. Endometrioid adenocarcinoma (EAC) and non-endometrioid carcinoma (NEC) accounted for 92.8 and 7.2%. A total of 474 patients received VBT alone and 574 patients received EBRT with or without VBT. As for EAC patients, the 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rate was: 94.6, 90.4, 93.0 and 91.6%, respectively. For LR patients, EBRT (with or without VBT) seemed to be a risk factor. With the higher risk category, the survival benefit of EBRT gradually became remarkable. EBRT (with or without VBT) significantly increased DFS, LRFS and DMFS compared to VBT alone in the HR group (p < 0.05). Distant metastasis was the main failure pattern for all risk groups. As for NEC patients, the 5-year OS, DFS, LRFS and DMFS rate was: 93.4, 87.2, 91.7 and 89.3%, respectively. As for toxicity, EBRT (with or without VBT) significantly increased the incidence of grade 1-2 gastrointestinal, urinary, and hematological toxicity.
CONCLUSIONS
For stage I to II EC patients, EAC accounted for the majority and had better prognosis than NEC. For EAC patients, VBT alone resulted in comparable survival to EBRT in the LR, IR and HIR groups, while EBRT significantly increased survival in the HR group. EBRT had higher rate of toxicity than VBT.
Topics: Adult; Aged; Aged, 80 and over; Brachytherapy; Carcinoma, Endometrioid; China; Endometrial Neoplasms; Female; Humans; Middle Aged; Neoplasm Staging; Pelvis; Radiotherapy, Adjuvant; Retrospective Studies; Survival Rate; Treatment Outcome; Vagina
PubMed: 35287626
DOI: 10.1186/s12885-022-09343-4 -
California Medicine Nov 1968The vaginal smear reveals a spectrum of borderline lesions of the uterine cervix. This spectrum is the source of new clinical problems involving both the recognition and... (Review)
Review
The vaginal smear reveals a spectrum of borderline lesions of the uterine cervix. This spectrum is the source of new clinical problems involving both the recognition and treatment of these various entities. A review of the literature of the past decade indicates that vaginal smears should be obtained regularly every year or two in all women beginning at the onset of sexual activity, but the initial smear may be falsely negative in 10 to 30 percent of cases. When patients have abnormal smears, the precise diagnosis can be established more accurately by cold-knife conization than by multiple punch biopsy. While hysterectomy has been considered "definitive treatment," late recurrence in the vagina occurs in 1.24 percent of patients so treated. A compilation of 1,100 patients with carcinoma in situ of the cervix treated by conization and follow-up smear reveals that in over 90 percent the disease was controlled by the cone alone, and the remainder by repeat cone or hysterectomy. Precise definition is required in treatment decisions concerning micro-invasive lesions, but these may be well treated by non-radical measures. In almost 500 patients so treated, no death occurred from therapy or tumor metastasis.When carcinoma in situ is found during pregnancy, a coexisting invasive carcinoma must be excluded by appropriate conization or punch biopsy and definitive therapy completed after vaginal delivery.
Topics: Carcinoma; Female; Humans; Hysterectomy; Pregnancy; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 4881982
DOI: No ID Found -
Journal of Cancer 2019: Lower genital tract carcinomas that coexist with genitourinary malformations are rare. The aim of this study was to investigate the clinicopathologic characteristics...
: Lower genital tract carcinomas that coexist with genitourinary malformations are rare. The aim of this study was to investigate the clinicopathologic characteristics and outcomes of patients with this rare joint condition. The aim of this study was to investigate the clinicopathologic characteristics and outcomes of these patients to analyze the associations among clinicopathologic features in this rare entity. : The medical records of patients with carcinoma of lower genital tract combined with genital tract malformations who were treated at Peking Union Medical College Hospital (Beijing, China) between January 1995 and December 2017 were retrospectively reviewed and a comprehensive literature review was performed. The correlations between variables were determined using Fisher's exact test. : Thirty-six patients were identified, among whom 22 had cervical carcinoma, 10 had vaginal carcinoma, and two had carcinomas of both the cervix and vagina. The most common genital tract anomaly was uterus didelphys (n=17), and 63.9% of patients had with urinary tract malformations. Twenty-five (69.4%) had pathologically confirmed adenocarcinoma, 10 (27.8%) had squamous cell carcinoma (SCC), and 1 had adenosquamous carcinoma. Patients with urinary tract malformations developed adenocarcinoma more frequently than those without malformations (95.7% vs. 30.8% <0.001). Compared with patients with SCC, patients with adenocarcinoma presented at a younger age (36.1 vs. 47.0 years, =0.011), had more advanced stages disease (57.7% vs. 10.0% were in stage II-IV, =0.022), and tended to have poorer five-year overall survival rates (75.6% vs. 100.0%, =0.279). : Patients with simultaneous malformations of the genital and urinary tracts had a high probability of developing adenocarcinoma. It is recommended that rigorous gynecologic exams with Pap smears and imaging analyses be performed periodically in women with genital malformations, as they may be at a risk of genital malignancies.
PubMed: 31281483
DOI: 10.7150/jca.30486 -
Frontiers in Oncology 2021Vulvar cancer is the fourth most common gynecologic cancer, and prognosis is poor in advanced vulvar cancer patients. Treatment for advanced vulvar cancer has not been...
BACKGROUND
Vulvar cancer is the fourth most common gynecologic cancer, and prognosis is poor in advanced vulvar cancer patients. Treatment for advanced vulvar cancer has not been satisfactory. In this report, we firstly report a FIGO IVB vulva verrucous carcinoma patient who obtained good prognosis after systemic treatment.
CASE PRESENTATION
A patient was admitted to hospital due to her vulvar lesion persistent for past 14 years. The vulvar mass has widely invaded urethra, part of anus, the lower third of the vagina, bilateral superior and inferior branches of pubis, and bilateral internal and external muscles of obturator. Multiple metastatic lymph nodes were also found in the pelvic cavity. The histopathological studies confirmed vulvar verrucous carcinoma with a PD-L1 overexpression. After six courses of neoadjuvant chemotherapy and pembrolizumab, the patient underwent radical vulvectomy and achieved optimal cytoreduction. Postoperative pathology found no residual tumor. The patient then received one course of postoperative chemotherapy and pembrolizumab, underwent radiation therapy, and was disease free after 6 months follow-up.
CONCLUSION
Our individualized treatment strategy is successful. Pembrolizumab is safe and effective in the treatment of advanced vulvar verrucous carcinoma with PD-L1 overexpression.
PubMed: 34123775
DOI: 10.3389/fonc.2021.598594 -
Revista Colombiana de Obstetricia Y... Dec 2019To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment... (Review)
Review
OBJECTIVE
To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment and prognosis of vaginal neoplasms or HPV infection in transgender women or with MRKH syndrome.
MATERIALS AND METHODS
A 56-year-old woman consulted to the Hospital Universitario of Sevilla (Spain). During the clinical examination, a exophytic tumor at the bottom of the vagina was found and the biopsy reported squamous carcinoma and positive nucleic acid amplification test for human papilloma (HPV) type 16. A literature search of case reports, case series and observational studies published from 2000 to October 2019 in English and Spanish was performed in Medline via PubMed, with the follow- ing terms: "congenital abnormalities"; "Mullerian aplasia"; "neovagina"; "Vaginal neoplasms"; "Squamous carcinoma"; "HPV infection" was performed.
RESULTS
14 studies were finally included; seven corresponded to squamous cell carcinoma, three to adenocarcinoma and four reported HPV infection only. All of the squamous cell carcinomas were at advanced stages due to local or lymphatic compro- mise and received radiotherapy with concomitant chemotherapy or radical surgery. The prognosis was bad in three of the cases. Patients with adenocarcinoma also presented with advanced lesions due to local extensión and received surgical treatment and two cases received concomitant chemotherapy. Only one patient was followed-up for five years or more. HPV infection is common in women who underwent neovagina reconstruction.
CONCLUSIONS
Patients with neovagina are susceptible to develope squamous carcinomas or adenocarcinomas depending if skin or intestinal tissue grafts are used. According to local compromise at the time of diagnosis, radical or combined treatments are required. Which screening strategies for HPV, squamous cell carcinomas and adenocarcinoma is to be investigated.
Topics: 46, XX Disorders of Sex Development; Adenocarcinoma; Biopsy; Carcinoma, Squamous Cell; Congenital Abnormalities; Female; Humans; Middle Aged; Mullerian Ducts; Nucleic Acid Amplification Techniques; Papillomavirus Infections; Surgically-Created Structures; Vagina; Vaginal Neoplasms
PubMed: 32142241
DOI: 10.18597/rcog.3328 -
Cancer Cytopathology Aug 2019Mesonephric adenocarcinomas are rare neoplasms which most commonly arise in the lateral cervix and vagina. Tumors with similar morphologic, immunophenotypic, and...
BACKGROUND
Mesonephric adenocarcinomas are rare neoplasms which most commonly arise in the lateral cervix and vagina. Tumors with similar morphologic, immunophenotypic, and molecular characteristics recently have been described in the uterine corpus and ovary. Herein, the authors sought to characterize the cytomorphologic features of adenocarcinomas exhibiting mesonephric-like differentiation arising in the upper gynecologic tract.
METHODS
Institutional databases were queried retrospectively for tumors of the upper gynecologic tract described as a "tumor of Wolffian origin" or "with mesonephric features" between 2007 and 2017. All available cytologic material was reviewed. Cytomorphologic characteristics were evaluated by 3 pathologists.
RESULTS
The current study cohort consisted of 8 cases taken from 7 patients. Primary sites included the ovary (3 cases); endometrium (4 cases); and pelvis, not otherwise specified (1 case). All cases demonstrated tight 3-dimensional clusters of overlapping cells. Additional architectural features included tubular (5 of 8 cases; 63%) and papillary (3 of 8 cases; 38%) formations. Cells were small with scant (7 of 8 cases; 88%) to moderate (1 of 8 cases; 12%) cytoplasm. Three of the 8 cases (38%) demonstrated extracellular hyaline globules. Nuclei were uniform in size (6 of 8 cases; 75%) or showed mild anisonucleosis (2 of 8 cases; 25%). Nuclear grooves and indentations were observed in all cases. Mitoses (5 of 8 cases; 63%) and apoptotic bodies (4 of 8 cases; 50%), when present, were rare. No necrosis was noted.
CONCLUSIONS
Adenocarcinomas exhibiting mesonephric-like differentiation show a monotonous population of small cells with scant to moderate cytoplasm and abundant nuclear grooves arranged in tight, overlapping, 3-dimensional clusters. Occasionally, papillary or tubular architecture, as well as extracellular hyaline globules, may be seen. These features should prompt further testing (eg, immunohistochemistry) to confirm the diagnosis and to exclude potential mimics.
Topics: Adenocarcinoma; Adult; Aged; Endometrial Neoplasms; Endometrium; Female; Humans; Mesonephroma; Middle Aged; Ovarian Neoplasms; Ovary; Retrospective Studies
PubMed: 31318491
DOI: 10.1002/cncy.22160 -
JSLS : Journal of the Society of... 2016Hybrid-natural orifice surgery combines the advantages of traditional transabdominal laparoscopic surgery, while limiting surgical trauma to the abdominal wall. Among...
BACKGROUND AND OBJECTIVES
Hybrid-natural orifice surgery combines the advantages of traditional transabdominal laparoscopic surgery, while limiting surgical trauma to the abdominal wall. Among various routes of intra-abdominal access, the transvaginal method is most appealing because of its utility and proven safety. We describe a series of 4 colonic resections performed with this approach, combined with minilaparoscopy and needlescopic approaches, and discuss the technical aspects, efficacy, and applicability of this technique.
METHODS
Three patients were selected to undergo hybrid transvaginal natural-orifice right hemicolectomy. A fourth patient, who underwent a segmental resection of a splenic flexure carcinoma, was included. Transvaginal port access was obtained via posterior colpotomy, and was used for dissection, vascular ligation, bowel division, and anastomosis. We used a combination of standard laparoscopic, minilaparoscopic, and needlescopic instruments transabdominally, focusing on reduced size and number of access points.
RESULTS
Duration of laparoscopy, oncologic outcomes and rate of operative morbidity were comparable to the published literature. Early return of gastrointestinal function and low analgesic requirements was observed in all patients. No morbidity related to transvaginal access was observed and the procedure was performed without difficulty in all cases.
CONCLUSION
Colonic resection performed by hybrid natural-orifice technique offers several advantages over purely transabdominal laparoscopic procedures. Transvaginal access is easy to perform and offers excellent safety, efficacy, and versatility, especially for right hemicolectomy. Techniques to reduce abdominal wall surgical trauma, such as minilaparoscopy and needlescopic graspers, can be combined effectively in colonic resections, and may act synergistically to reduce postoperative pain and improve outcomes.
Topics: Adult; Aged; Aged, 80 and over; Colectomy; Colorectal Neoplasms; Female; Humans; Laparoscopy; Middle Aged; Natural Orifice Endoscopic Surgery; Treatment Outcome; Vagina
PubMed: 27904307
DOI: 10.4293/JSLS.2016.00062 -
Journal of Clinical Pathology Dec 2001This report describes a lymphoepithelioma-like carcinoma of the vagina. Although such tumours are well described in the cervix this is only the second report of such a... (Review)
Review
This report describes a lymphoepithelioma-like carcinoma of the vagina. Although such tumours are well described in the cervix this is only the second report of such a neoplasm at this site. Histology showed a well circumscribed lesion composed of syncytial sheets of epithelioid tumour cells with an intense inflammatory infiltrate, largely consisting of T lymphoid cells. In situ hybridisation and immunohistochemistry for Epstein-Barr virus were negative. A review of the literature reveals that such neoplasms appear to be extremely rare within the female genital tract outside of the cervix.
Topics: Aged; Aged, 80 and over; B-Lymphocytes; Biomarkers, Tumor; Carcinoma, Squamous Cell; Female; Humans; Immunohistochemistry; T-Lymphocytes; Vaginal Neoplasms
PubMed: 11729219
DOI: 10.1136/jcp.54.12.964 -
Dynamics and Determinants of HPV Infection: The Michigan HPV and Oropharyngeal Cancer (M-HOC) Study.BMJ Open Oct 2018Human papillomavirus (HPV) is the primary cause of cervical and other anogenital cancers and is also associated with head and neck cancers. Incidence of HPV-related...
INTRODUCTION
Human papillomavirus (HPV) is the primary cause of cervical and other anogenital cancers and is also associated with head and neck cancers. Incidence of HPV-related oropharyngeal squamous cell cancers (OPSCCs) is increasing, and HPV-related OPSCCs have surpassed cervical cancer as the most common HPV-related cancer in the USA. Given the multisite nature of HPV, there is strong interest in collecting data from both genital and oral sites, as well as associated data on social and sexual behaviours. The overarching goal of this study is to evaluate patterns of oral HPV infection incidence, clearance and persistence and their relationship to sexual behaviour history.
METHODS AND ANALYSIS
Participants are recruited from two populations: college students at a large public university and general population from the surrounding area. At the first study visit, participants complete a detailed sexual history, health and behaviour questionnaire. Follow-up visits occur every 3-4 months over 3 years, when participants complete an abbreviated questionnaire. All participants provide a saliva sample at each visit, and eligible participants may provide a cervicovaginal self-swab. Genetic material isolated from specimens is tested for 15 high-risk and 3 low-risk HPV types. Statistical analyses will examine outcome variables including HPV prevalence, incidence, persistence and clearance. Logistic regression models will be used to estimate odds ratios and 95% confidence intervals for associations between the outcomes of interest and demographic/behavioural variables collected in the questionnaires. The longitudinal HPV infection data and detailed sexual history data collected in the questionnaires will allow us to develop individual-based network models of HPV transmission and will be used to parameterise multiscale models of HPV-related OPSC carcinogenesis.
ETHICS AND DISSEMINATION
This study has been approved by the University of Michigan Institutional Review Board. All participants are consented in person by trained study staff. Study results will be disseminated through peer-reviewed publications.
Topics: Carcinoma, Squamous Cell; Female; Health Behavior; Humans; Incidence; Michigan; Oropharyngeal Neoplasms; Papillomavirus Infections; Research Design; Saliva; Sexual Behavior; Specimen Handling; Surveys and Questionnaires; Vagina
PubMed: 30282679
DOI: 10.1136/bmjopen-2018-021618