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Journal of Obstetrics and Gynaecology :... Dec 2023Inguinal lymph node involvement is the most robust predictor of mortality in vulval cancer and sentinel lymph node (SLN) biopsy is a safe diagnostic modality. We...
Sentinel lymph node biopsy based on anatomical landmarks and locoregional mapping of inguinofemoral sentinel lymph nodes in women with vulval cancer: an operative technique.
Inguinal lymph node involvement is the most robust predictor of mortality in vulval cancer and sentinel lymph node (SLN) biopsy is a safe diagnostic modality. We describe a technique based on anatomical landmarks. Our aims are (1) to describe the territorial mapping of SLNs, (2) to evaluate the associated complication rate vis-à-vis those reported in the literature, and (3) to assess its accuracy in detecting SLNs. Data from women who underwent groin SLN biopsies for vulval cancer at a single cancer centre were prospectively collected. All subjects met the GROINSS-V eligibility criteria. The location of the SLN relative to the saphenous vein was recorded. All women were followed up and early and late complications were recorded. The recurrence rate at the time of the census was calculated. A total of 71 groins in 44 women were included. The SLN was primarily located over Cloquet's node (85.2%). The incidence of early wound cellulitis and dehiscence were 2.8% and 11.3% while lymphocysts were present in 11.3% of groins. The negative nodal recurrence rate was 1.7%. Results showed that this reproducible technique allows access to 96.7% of SLNs, including both deep and superficial SLNs whilst minimising the need for extensive dissection and complications associated with overharvesting of lymph nodes.
Topics: Female; Humans; Sentinel Lymph Node Biopsy; Sentinel Lymph Node; Lymph Node Excision; Lymphatic Metastasis; Lymph Nodes; Vulvar Neoplasms; Neoplasm Staging
PubMed: 37170959
DOI: 10.1080/01443615.2023.2207205 -
In Vivo (Athens, Greece) 2023Data regarding the clinicopathological factors predicting recurrence and prognosis in patients with vulvar extramammary Paget disease (VPD) are limited. Therefore, we... (Review)
Review
BACKGROUND/AIM
Data regarding the clinicopathological factors predicting recurrence and prognosis in patients with vulvar extramammary Paget disease (VPD) are limited. Therefore, we aimed to identify predictive factors for recurrence and outcomes in patients with VPD.
PATIENTS AND METHODS
Forty-five patients with VPD were included in this study. We reviewed electronic medical records and pathology slides to collect clinicopathological information.
RESULTS
Eighteen cases (40.0%) had resection margin (RM) involvement. Twelve patients (26.7%) received adjuvant radiation therapy (RT). Ten patients (22.2%) experienced recurrence. The recurrence rate was higher in patients who underwent wide local excision or simple vulvectomy than in those who underwent radical vulvectomy. Positive RM involvement was a significant and independent predictive factor for worse recurrence-free survival (RFS). The overall survival rate of patients who received adjuvant RT was significantly higher than that of those who underwent surgery alone.
CONCLUSION
A positive RM involvement independently predicted worse RFS. The recurrence rate was significantly associated with the type of surgical procedure performed. Additionally, adjuvant RT can improve the prognosis of patients with VPD.
Topics: Female; Humans; Paget Disease, Extramammary; Vulvar Neoplasms; Prognosis; Gynecologic Surgical Procedures; Margins of Excision; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 37905666
DOI: 10.21873/invivo.13369 -
In Vivo (Athens, Greece) 2021The aims of the study were: i) to assess the incidence of perineural invasion (PNI) in squamous cell carcinoma of the vulva and ii) to correlate PNI with common...
Perineural Invasion Correlates With Common Pathological Variables and Clinical Outcomes of Patients With Squamous Cell Carcinoma of the Vulva Treated With Primary Radical Surgery and Inguinal-femoral Lymphadenectomy.
BACKGROUND/AIM
The aims of the study were: i) to assess the incidence of perineural invasion (PNI) in squamous cell carcinoma of the vulva and ii) to correlate PNI with common pathological prognostic variables and clinical outcome of patients.
PATIENTS AND METHODS
The hospital records of 64 patients with vulvar squamous cell carcinoma who underwent primary radical surgery were reviewed.
RESULTS
PNI was significantly related to stage (p=0.038), size (p=0.038), lymph-vascular space involvement (p=0.013) and nodal status (p=0.038), but not to patient age, tumor grade and stromal invasion. Five-year disease-free survival was 30.0% in patients with PNI and 53.1% in those without PNI (p=0.018), and the corresponding 5-year overall survival was 50.0% and 77.1% (p=0.031), respectively.
CONCLUSION
PNI was associated with common pathological prognostic variables and with a poorer clinical outcome in patients with vulvar squamous cell carcinoma.
Topics: Carcinoma, Squamous Cell; Disease-Free Survival; Female; Humans; Lymph Node Excision; Neoplasm Invasiveness; Neoplasm Staging; Prognosis; Retrospective Studies; Vulvar Neoplasms
PubMed: 33622901
DOI: 10.21873/invivo.12349 -
Cancer Reports (Hoboken, N.J.) Oct 2022Verrucous vulvar carcinoma (VC) is an uncommon and distinct histologic subtype of squamous cell carcinoma (SCC). The available literature on VC is currently limited to...
BACKGROUND
Verrucous vulvar carcinoma (VC) is an uncommon and distinct histologic subtype of squamous cell carcinoma (SCC). The available literature on VC is currently limited to case reports and small single institution studies.
AIMS
The goals of this study were to analyze data from the National Cancer Database (NCDB) to quantitate the incidence of VC and to investigate the effects of patient demographics, tumor characteristics, and treatment regimens on overall survival (OS) in women with verrucous vulvar carcinoma.
METHODS AND RESULTS
Patients diagnosed with vulvar SCC or VC between the years of 2004 and 2016 were identified in the NCDB. OS was assessed with Kaplan-Meier curves and the log-rank test. Construction of a Cox model compared survival after controlling for confounding variables. The reported incidence of SCC of the vulva has significantly increased since 2004 (p < .0001). In contrast, the incidence of VC has remained stable (p = .344) since 2004. Compared to SCC, VC was significantly more likely to be diagnosed in older women (p < .0001) and treated with surgery alone (p < .0001). However, on propensity score weighted analysis there was a trend toward improved 5-year OS in women with VC compared to those with SCC (63.4% vs. 57.7%, p = .0794). Multivariable Cox survival analysis showed an improvement in OS in VC patients treated with both primary site and regional lymph node surgery compared to primary site surgery alone (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI] 0.46-0.97, p = .0357).
CONCLUSION
Verrucous carcinoma is more likely to present in older women. Regional lymph node surgery in addition to primary site surgery significantly improves OS in VC patients.
Topics: Aged; Carcinoma, Squamous Cell; Carcinoma, Verrucous; Female; Humans; Treatment Outcome; Vulva; Vulvar Neoplasms
PubMed: 35075817
DOI: 10.1002/cnr2.1591 -
Taiwanese Journal of Obstetrics &... Feb 2016
Review
Topics: Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Rhabdoid Tumor; Vulvar Neoplasms
PubMed: 26927265
DOI: 10.1016/j.tjog.2014.08.013 -
International Journal of Gynaecology... Oct 2021To revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic...
To revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic Oncology reviewed the recent literature to gain an insight into the impact of the 2009 vulvar cancer staging revision. The Committee resolved to revise the staging with a goal of simplification and actively collaborated with the United States National Cancer Database to analyze prospectively collected data on carcinoma of the vulva. Many tumor characteristics were collected for all stages of vulvar cancer treated between 2010 and 2017. Statistical analysis was performed with SAS software. Overall survival was estimated based on tumor characteristics. Log-rank and Wilcoxon tests were used to analyze overall survival similarities between and within groups of tumor characteristics. Characteristics with similar survivals were then grouped into the same stages and substages. Kaplan-Meier overall survival curves were generated for the resulting stages and substages. There were 12 063 cases with available data. The resulting new staging for carcinoma of the vulva has two substages in Stage I, no substage in Stage II, three substages in Stage III, and two substages in Stage IV. The Kaplan-Meier overall survival curves showed clear separation between stages and substages. The 2021 vulvar cancer staging is the first from the FIGO Committee for Gynecologic Oncology to be derived from data analyses. This revision has a new definition for depth of invasion, uses the same definition for lymph node metastases utilized in cervical cancer, and allows findings from cross-sectional imaging to be incorporated into vulvar cancer staging. The 2021 FIGO staging for carcinoma of the vulva is data-derived, validated, and much simpler than earlier revisions.
Topics: Female; Humans; Lymphatic Metastasis; Neoplasm Staging; Prognosis; Vulvar Neoplasms
PubMed: 34520062
DOI: 10.1002/ijgo.13880 -
International Journal of Gynaecology... Oct 2015
Topics: Female; Humans; Mass Screening; Neoplasm Staging; Practice Guidelines as Topic; Vulvar Neoplasms
PubMed: 26433678
DOI: 10.1016/j.ijgo.2015.06.002 -
The Pan African Medical Journal 2019Leiomyomas represent about 3.8% of all benign soft tissue tumors. Vulvar localization is very rare. We present a case of a vulvar leiomyoma and discuss diagnostic and...
Leiomyomas represent about 3.8% of all benign soft tissue tumors. Vulvar localization is very rare. We present a case of a vulvar leiomyoma and discuss diagnostic and therapeutic features of this disease. A 30-year-old female patient with no medical history, had a 5cm mass located in the left large lip causing a discomfort at the perineum especially in sitting and walking. She underwent a complete surgical excision of the mass. The pathological examination confirmed the diagnosis of a leiomyoma. There was no recurrence after 24-months' follow-up. The vulvar leiomyoma is a rare benign tumor. The diagnosis is made only postoperatively after resection of the mass. The treatment is essentially based on total excision of the mass with a good prognosis.
Topics: Adult; Female; Follow-Up Studies; Humans; Leiomyoma; Vulvar Neoplasms
PubMed: 31312320
DOI: 10.11604/pamj.2019.32.208.18480 -
International Journal of Molecular... Oct 2020Vulvar cancer (VC) is a specific form of malignancy accounting for 5-6% of all gynaecologic malignancies. Although VC occurs most commonly in women after 60 years of... (Review)
Review
Vulvar cancer (VC) is a specific form of malignancy accounting for 5-6% of all gynaecologic malignancies. Although VC occurs most commonly in women after 60 years of age, disease incidence has risen progressively in premenopausal women in recent decades. VC demonstrates particular features requiring well-adapted therapeutic approaches to avoid potential treatment-related complications. Significant improvements in disease-free survival and overall survival rates for patients diagnosed with post-stage I disease have been achieved by implementing a combination therapy consisting of radical surgical resection, systemic chemotherapy and/or radiotherapy. Achieving local control remains challenging. However, mostly due to specific anatomical conditions, the need for comprehensive surgical reconstruction and frequent post-operative healing complications. Novel therapeutic tools better adapted to VC particularities are essential for improving individual outcomes. To this end, cold atmospheric plasma (CAP) treatment is a promising option for VC, and is particularly appropriate for the local treatment of dysplastic lesions, early intraepithelial cancer, and invasive tumours. In addition, CAP also helps reduce inflammatory complications and improve wound healing. The application of CAP may realise either directly or indirectly utilising nanoparticle technologies. CAP has demonstrated remarkable treatment benefits for several malignant conditions, and has created new medical fields, such as "plasma medicine" and "plasma oncology". This article highlights the benefits of CAP for the treatment of VC, VC pre-stages, and postsurgical wound complications. There has not yet been a published report of CAP on vulvar cancer cells, and so this review summarises the progress made in gynaecological oncology and in other cancers, and promotes an important, understudied area for future research. The paradigm shift from reactive to predictive, preventive and personalised medical approaches in overall VC management is also considered.
Topics: Female; Humans; Incidence; Plasma Gases; Precancerous Conditions; Premenopause; Vulvar Neoplasms; Wound Healing
PubMed: 33121141
DOI: 10.3390/ijms21217988 -
Viruses Sep 2022Persistent infection with high-risk HPV leads to cervical cancers and other anogenital cancers and head and neck carcinomas in both men and women. There is no effective...
Persistent infection with high-risk HPV leads to cervical cancers and other anogenital cancers and head and neck carcinomas in both men and women. There is no effective drug fortreating HPV infection and HPV-associated carcinomas, largely due to a lack of models of natural HPV infection and the complexity of the HPV life cycle. There are no available cell lines from vulvar, anal, or penile lesions and cancers in the field. In this study, we established the first human cell line from vulvar intraepithelial neoplasia (VIN) with naturally infected HPV18 by conditional reprogramming (CR) method. Our data demonstrated that VIN cells possessed different biological characteristics and diploid karyotypes from HPV18-positive cancer cells (HeLa). Then, we determined that VIN cells contained episomal HPV18 using approaches including the ratio of HPV E2/E7, rolling cycle amplification, and sequencing. The VIN cells expressed squamous epithelium-specific markers that are different from HeLa cells, a cervical adenocarcinoma cell line. When cultured under 3D air-liquid interface (ALI) system, we observed the expression of both early and late differentiation markers involucrin and filaggrin. Most importantly, we were able to detect the expression of viral late gene L1 in the cornified layer of ALI 3D culture derived from VIN cells, suggesting quite different HPV genomic status from cancer cells. We also observed progeny viral particles under transmission electron microscopy (TEM) in ALI 3D cultures, confirming the episomal HPV18 genome and active viral life cycle in the new cell line. To our knowledge, this is the first human VIN cell line with naturally infected HPV18 genome and provides a valuable model for HPV biology studies, HPV-associated cancer initiation and progression, and drug-screening platforms.
Topics: Carcinoma; DNA, Viral; Female; HeLa Cells; Humans; Papillomaviridae; Papillomavirus Infections; Vulvar Neoplasms
PubMed: 36146860
DOI: 10.3390/v14092054