1
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Mancari R, Cioffi R, Magazzino F, Attademo L, Sant’angelo M, Taccagni G, Mangili G, Pignata S, Bergamini A. Dermatofibrosarcoma Protuberans of the Vulva: A Review of the MITO Rare Cancer Group. Cancers (Basel) 2024; 16:222. [PMID: 38201649 PMCID: PMC10777898 DOI: 10.3390/cancers16010222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Vulvar dermatofibrosarcoma protuberans is an extremely rare disease. Its rarity can hamper the quality of treatment; deeper knowledge is necessary to plan appropriate management. The purpose of this review is to analyse the data reported in the literature to obtain evidence regarding appropriate disease management. METHODS We made a systematic search of the literature, including the terms "dermatofibrosarcoma protuberans", "vulva", and "vulvar", alone or in combination. We selected articles published in English from two electronic databases, PubMed and MEDLINE, and we analysed their reference lists to include other potentially relevant studies. RESULTS We selected 39 articles, with a total of 68 cases reported; they were retrospective case reports and case series. Dermatofibrosarcoma protuberans of the vulva tends towards local recurrence; an early and timely pathological diagnosis, together with an appropriate surgical approach, are of utmost importance to ensure free margins and maximise the curative potential. CONCLUSIONS Even if this is an indolent disease and it generally shows a good prognosis, appropriate management may help in reducing the rate of local recurrences that may hamper patients' quality of life. Management by a multidisciplinary team is highly recommended.
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Affiliation(s)
- Rosanna Mancari
- Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Raffaella Cioffi
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milan, Italy; (R.C.); (G.M.); (A.B.)
| | - Francescapaola Magazzino
- Complex Operating Unit Ginecologia E Ostetricia, Ospedale Civile Di San Dona’ Di Piave (Venezia), Aulss4 Veneto Orientale, 30027 San Donà di Piave, Italy;
| | | | - Miriam Sant’angelo
- Department of Surgical Pathology, San Raffaele Scientific Institute, 20132 Milan, Italy; (M.S.); (G.T.)
| | - Gianluca Taccagni
- Department of Surgical Pathology, San Raffaele Scientific Institute, 20132 Milan, Italy; (M.S.); (G.T.)
| | - Giorgia Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milan, Italy; (R.C.); (G.M.); (A.B.)
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS ‘Fondazione G Pascale’, 80144 Napoli, Italy;
| | - Alice Bergamini
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milan, Italy; (R.C.); (G.M.); (A.B.)
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
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2
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Capalbo G, Logoteta A, Gallo R, Cuccu I, Gentile G, Arienzo F, Musella A, Pernazza A, Perniola G, Di Donato V, Manganaro L, Bogani G, Palaia I. Chemo-surgical approach in vulvar leiomyosarcoma: A case report. TUMORI JOURNAL 2022; 108:NP26-NP29. [PMID: 36239461 DOI: 10.1177/03008916221130379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary sarcoma of the vulva is an extremely rare entity, representing only 1%-3% of all vulvar malignant neoplasms. Among sarcomas, leiomyosarcoma (LMS) is the most prevalent histologic variant. Due to the rarity of LMS, guidelines are lacking and phase III trials have not been carried out, so clinical management is based on local clinical practice and physician experience. CASE PRESENTATION Here, we described a case of primary LMS of the vulva and its successful management, with the adoption of neoadjuvant chemotherapy and surgery. We report a case of a 74-year-old woman with 12.5 cm vulvar LMS. The patient received three cycles of neoadjuvant chemotherapy with a partial response. Radical vulvectomy with vulvar reconstruction with V-F flap was carried out. Surgical margins were negative. Three additional cycles of adjuvant chemotherapy were delivered. RESULTS One year after treatment, the patient was disease-free. CONCLUSION There are no approved therapeutic protocols for this rare neoplasia. Surgery is the mainstay of treatment. However, it is not always feasible, so neoadjuvant chemotherapy was delivered for downstaging the vulvar lesion. We suppose that neoadjuvant chemotherapy has optimized the possibilities of radical surgery. Despite the anectodical nature of this case presentation, neoadjuvant chemotherapy seems a valid therapeutic option for managing patients with bulky vulvar sarcoma. Further large collaborative studies are warranted to identify the best therapeutic option for these patients.
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Affiliation(s)
- Giuseppe Capalbo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
| | - Alessandra Logoteta
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
| | - Roberta Gallo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
| | - Ilaria Cuccu
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
| | | | - Francesca Arienzo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Angela Musella
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
| | - Angelina Pernazza
- Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Polyclinic Umberto I, Rome, Italy
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3
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Williams EA, Montesion M, Lincoln V, Tse JY, Hiemenz MC, Mata DA, Shah BB, Shoroye A, Alexander BM, Werth AJ, Foley-Peres K, Milante RR, Ross JS, Ramkissoon SH, Williams KJ, Adhikari LJ, Zuna RE, LeBoit PE, Lin DI, Elvin JA. HPV51-associated Leiomyosarcoma: A Novel Class of TP53/RB1-Wildtype Tumor With Predilection for the Female Lower Reproductive Tract. Am J Surg Pathol 2022; 46:729-741. [PMID: 35034043 PMCID: PMC9093731 DOI: 10.1097/pas.0000000000001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Inactivating mutations in tumor suppressor genes TP53 and RB1 are considered central drivers in leiomyosarcomas (LMSs). In high-risk human papillomavirus (HPV)-related tumors, a similar functional outcome is achieved through oncoproteins E6 and E7, which inactivate the p53 and RB1 proteins, respectively. Here, we hypothesized that HPV infection could provide an alternative mechanism for tumorigenesis in a subset of TP53/RB1-wildtype LMS. We evaluated tumor samples from 2585 consecutive unique patients carrying a diagnosis of gynecologic or soft tissue LMS. Tumor DNA and available RNA were analyzed by hybrid-capture-based next-generation sequencing/comprehensive genomic profiling of 406 genes and transcripts (FoundationOneHeme). Of the initial 2585 cases, we excluded 16 based on the presence of molecular alterations that are considered defining for sarcomas other than LMS. In the remaining 2569 cases, we searched for LMS that were TP53/RB1-wildtype (n=486 of 2569; 18.9%). We also searched LMS tumors for HPV sequences that we then classified into genotypes by de novo assembly of nonhuman sequencing reads followed by alignment to the RefSeq database. Among TP53/RB1-wildtype LMS, we identified 18 unique cases harboring HPV sequences. Surprisingly, most (n=11) were HPV51-positive, and these 11 represented all HPV51-positive tumors in our entire LMS database (n=11 of 2569; 0.4%). The absence of genomic alterations in TP53 or RB1 in HPV51-positive LMS represented a marked difference from HPV51-negative LMS (n=2558; 0% vs. 72% [P<0.00001], 0% vs. 53% [P=0.0002]). In addition, compared with HPV51-negative LMS, HPV51-positive LMS were significantly enriched for genomic alterations in ATRX (55% vs. 24%, P=0.027) and TSC1 (18% vs. 0.6%, P=0.0047). All HPV51-positive LMS were in women; median age was 54 years at surgery (range: 23 to 74 y). All known primary sites were from the gynecologic tract or adjacent anogenital area, including 5 cases of vaginal primary site. Histology was heterogeneous, with evaluable cases showing predominant epithelioid (n=5) and spindle (n=5) morphology. In situ hybridization confirmed the presence of high-risk HPV E6/E7 mRNA in tumor cells in three of three evaluable cases harboring HPV51 genomic sequences. Overall, in our pan-LMS analysis, HPV reads were identified in a subset of TP53/RB1-wildtype LMS. For all HPV51-associated LMS, the striking absence of any detectable TP53 or RB1 mutations and predilection for the female lower reproductive tract supports our hypothesis that high-risk HPV can be an alternative tumorigenic mechanism in this distinct class of LMS.
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Affiliation(s)
- Erik A. Williams
- Departments of Pathology and Dermatology, UCSF Dermatopathology Service, Helen Diller Family Cancer Center, University of California, San Francisco, CA
- Foundation Medicine Inc., Cambridge
| | | | - Vadim Lincoln
- Departments of Pathology and Dermatology, UCSF Dermatopathology Service, Helen Diller Family Cancer Center, University of California, San Francisco, CA
| | | | | | | | | | | | | | - Adrienne J. Werth
- Department of Women’s Health Services, Hartford Hospital, Hartford, CT
| | | | - Riza R. Milante
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Jeffrey S. Ross
- Foundation Medicine Inc., Cambridge
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY
| | - Shakti H. Ramkissoon
- Foundation Medicine Inc., Cambridge
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kevin Jon Williams
- Departments of Physiology and Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Laura J. Adhikari
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rosemary E. Zuna
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Philip E. LeBoit
- Departments of Pathology and Dermatology, UCSF Dermatopathology Service, Helen Diller Family Cancer Center, University of California, San Francisco, CA
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4
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Lan H, Chai W, Gong F, Jia G. Epithelioid leiomyosarcoma of the vulva: report of a rare case and literature review. J Int Med Res 2022; 50:3000605221090473. [PMID: 35410510 PMCID: PMC9009142 DOI: 10.1177/03000605221090473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Leiomyosarcoma of the vulva is a rare soft tissue sarcoma that accounts for
approximately 1% of all primary vulvar neoplasms, but it is the most common type
of vulvar sarcoma. It usually originates from the smooth muscle within erectile
tissue or blood vessel walls, the round ligament, the dartos muscle or the
arrector pili muscle. No treatment algorithms have been established to date.
Surgical resection is preferred for vulvar leiomyosarcoma. Currently, the
recommended surgical method is extensive local resection with a safe surgical
margin of at least 2 cm. The use of chemoradiotherapy for vulvar sarcoma remains
controversial. This case report describes a 39-year-old female that underwent
resection of a vulvar mass in January 2019. Postoperative pathological
examination indicated that it was an epithelioid leiomyosarcoma. She presented
with tumour recurrence after 43 days. Based on the diagnosis, radical right
vulvectomy with a tumour margin of 2 cm was performed. The tumour margin was
negative. The patient refused to undergo auxiliary radiotherapy and
chemotherapy. The follow-up findings do not indicate any signs of recurrence. In
order to avoid recurrence, vulvar epithelioid leiomyosarcomas should be
completely resected with a margin of 2 cm at the time of first occurrence.
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Affiliation(s)
- Honghe Lan
- Department of Gynaecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Wei Chai
- Department of Gynaecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Fengyan Gong
- Department of Gynaecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Guifeng Jia
- Department of Gynaecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
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5
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Aljehani AM, Quatei A, Qattea L, Aljohani RM, Alkushi A. Vulvar Leiomyosarcoma in Pregnancy. Cureus 2021; 13:e18772. [PMID: 34796063 PMCID: PMC8590387 DOI: 10.7759/cureus.18772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/05/2022] Open
Abstract
Vulvar leiomyosarcoma is a rare smooth muscle malignant neoplasm but it is the commonest type of vulvar sarcomas. It may mimic benign tumors and misdiagnosis could delay proper management. We report a case of a 38-year-old pregnant woman with leiomyosarcoma of the vulva. The patient presented to her primary general practitioner with a small vulvar mass that she had first noticed one year prior. The tumor was suspected to be benign Bartholin's cyst and treated with antibiotics. The patient declined improvement and had many consultations to different clinics where she had been diagnosed and treated the same. The tumor size started to grow rapidly after she got pregnant, and the patient was referred to our hospital where she underwent tumor resection. Histopathology revealed leiomyosarcoma. The patient had further assessment and close follow-up and has had no recurrence for 12 months. There is little literature available on vulvar leiomyosarcoma, most of which are case reports, and most gynecologic oncologists will go through their whole careers without seeing a single case.
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Affiliation(s)
- Ala M Aljehani
- Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Amani Quatei
- Obstetrics and Gynecology, King Fahad Medical City, Riyadh, SAU
| | - Lina Qattea
- Obstetrics and Gynecology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Renad M Aljohani
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulmohsen Alkushi
- Pathology and Laboratory Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, SAU
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6
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Akrivi S, Varras M, Anastasiadi Z, Pappa C, Vlachioti A, Varra VK, Varra FN, Balasi E, Akrivis C. Primary vulvar leiomyosarcoma localized in the Bartholin's gland area: A case report and review. Mol Clin Oncol 2021; 14:69. [PMID: 33680460 PMCID: PMC7890440 DOI: 10.3892/mco.2021.2231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 01/14/2021] [Indexed: 01/14/2023] Open
Abstract
Vulvar sarcomas located in the Bartholin's gland area are extremely uncommon mesenchymal vulvar tumors. These neoplasms can be mistaken as Bartholin' gland benign lesions such as cysts or abscesses, leading to a delay in the diagnosis of underlying malignancy. Currently, only a few cases of these aggressive cancers have been reported in the literature. A 42-year-old female patient without any previous complaint presented to Obstetrics and Gynecology Department of ‘G. Chaztikosta’ General Hospital due to a vulvar lump in the area of the left Bartholin's gland with a 6-month history of progressive swelling. Pelvic examination showed a solid mass of 6.5-cm in maximum diameter, localized in the left Bartholin's gland. The patient underwent wide local excision and histopathological examination of hematoxylin and eosin-stained sections indicated intersecting fascicles of spindle cells, with moderate to severe atypia. The number of mitoses was up to 8 per 10 high power fields. The neoplasm to its greatest extent was circumscribed and in places had an invasive growth pattern. Tumoral necrosis was not seen. Involved Bartholin' gland by the tumor was identified. The tumor extended focally to the surgical margin. The neoplastic cells showed positive staining for smooth muscle actin, desmin, HHF35, caldesmon, vimentin and estrogen and progesterone receptors. Immunohistochemistry was negative for S100, myoglobulin, keratin 116, CD117, CD34 and CD31. The patient denied further surgery or/and local radiotherapy, although the mass was >5-cm and a focally infiltrative surgical margin was found. During the close follow-up, no local recurrences or metastases were observed 53 months after surgery. In conclusion, wide local tumor excision with free surgical margins is a good option of surgery for vulvar leiomyosarcomas. In recurrences, a new extensive surgical resection of the lesion and radiotherapy are suggested. Ipsilateral lympadenectomy is indicated when there is a pathologic lymph node. Chemotherapy is provided in cases of distal metastases.
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Affiliation(s)
- Stella Akrivi
- Department of Obstetrics and Gynecology, Royal Jubille Maternity Hospital, Belfast Trust, Belfast BT12 6BA, UK
| | - Michail Varras
- Fourth Department of Obstetrics and Gynecology, 'Elena Venizelou' General Hospital, Athens 11521, Greece
| | - Zoi Anastasiadi
- Department of Obstetrics and Gynecology, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
| | - Christina Pappa
- Department of Obstetrics and Gynecology, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
| | - Aikaterini Vlachioti
- Department of Obstetrics and Gynecology, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
| | | | - Fani-Niki Varra
- Department of Pharmacy, Frederick University, Nicosia 1036, Cyprus
| | - Eufemia Balasi
- Pathology Department, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
| | - Christos Akrivis
- Department of Obstetrics and Gynecology, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
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7
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Leiomyosarcoma of the vulva: a case report. MENOPAUSE REVIEW 2021; 19:184-187. [PMID: 33488330 PMCID: PMC7812529 DOI: 10.5114/pm.2020.101949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
Introduction Leiomyosarcoma of the vulva is a rare disease accounting for about 1% of all primary vulvar neoplasia but it is the most common type of vulvar sarcomas. Usually it arises from the smooth muscles, blood vessels, rough ligaments, and erector-pili muscles. No treatment algorithms have been established yet. Tumour excision with clean resection lines is considered sufficient, with radiation therapy applied in certain cases. Case report We report a case of a 73-year old patient in whom the disease was manifested by pain syndrome and rapidly growing mass with irregular margins in the symphysis area and satellite nodules. She underwent extensive local excision followed by radiation therapy. Discussion Isolated cases and limited series of LMS cases have been described in literature. Leiomyosarcoma is most commonly localized to the labia majora, the Bartholin gland area, clitoris and labia minora. It most often affected perimenopausal women but in younger and pregnant patients was described. The diagnosis is not always easy and different histological markers has to be used. There are no definitive therapeutic algorithms due to the rarity of the disease. The management is surgical treatment and the entire tumour must be removed with histologically verified clean resection margins, followed by radiation therapy in some cases. Conclusions Vulvar tumours are difficult to distinguish macroscopically. Accurate histological diagnosis allows adequate treatment.
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8
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Saquib S, Cherawala M, Abdel Rahman O, Keloth TE. Leiomyosarcoma of the Vulva Mimicking as Chronic Bartholin Cyst: A Case Report. Oman Med J 2020; 35:e153. [PMID: 32760601 PMCID: PMC7391323 DOI: 10.5001/omj.2020.74] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/26/2019] [Indexed: 11/13/2022] Open
Abstract
Smooth muscle neoplasms of the vulva are rare, and when localized in the Bartholin’s gland, it can be mistaken as a benign lesion leading to a delay in diagnosis. We report a case of leiomyosarcoma of the Bartholin’s gland in a 63-year-old postmenopausal woman, which clinically mimicked a chronic Bartholin’s gland cyst. This case report emphasizes the importance of suspecting malignancy in any vulvar lesion in women of postmenopausal age, despite its location and asymptomatic appearance. A prompt, careful evaluation with adequate clinical judgment will help to manage such cases efficiently.
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Affiliation(s)
- Shabnam Saquib
- Department of Obstetrics and Gynecology, Dubai Hospital, Dubai, UAE
| | - Masuma Cherawala
- Department of Obstetrics and Gynecology, Dubai Hospital, Dubai, UAE
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9
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Johnson S, Renz M, Wheeler L, Diver E, Dorigo O, Litkouhi B, Behbakht K, Howitt B, Karam A. Vulvar sarcoma outcomes by histologic subtype: a Surveillance, Epidemiology, and End Results (SEER) database review. Int J Gynecol Cancer 2020; 30:1118-1123. [PMID: 32641392 DOI: 10.1136/ijgc-2020-001516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Vulvar cancers account for 5% of all gynecologic malignancies; only 1%-3% of those vulvar cancers are primary vulvar sarcomas. Given the rarity of vulvar sarcomas, outcome data specific to histopathologic subtypes are sparse. The aim of this study was to identify clinical and pathologic factors of primary vulvar sarcomas that are associated with survival and may inform treatment decisions. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was searched for women diagnosed with vulvar sarcoma between 1973 and 2018. We identified 315 patients and reviewed their demographic, clinicopathologic, surgical, and survival information. Statistical analyses included χ2 and t-tests, Kaplan-Meier survival, and Cox regression analyses. RESULTS The most common histopathologies of vulvar sarcomas were dermatofibrosarcomas (85/315, 27%) and leiomyosarcomas (72/315, 22.9%). Rhabdomyosarcomas (18/315, 5.7%), liposarcomas (16/315, 5.1%), and malignant fibrous histiocytomas (16/315, 5.1%) were less frequent. The majority of patients underwent surgery (292/315, 92.7%), which included lymph node dissections in 21.6% (63/292). Survival and lymph node involvement varied significantly with histologic subtype. The 5-year disease-specific survival for dermatofibrosarcomas, liposarcomas, and fibrosarcomas was 100% and only 60.3% and 62.5% for malignant fibrous histiocytomas and rhabdomyosarcomas, respectively. None of the patients with (dermato)fibrosarcomas, liposarcomas, or leiomyosarcomas had positive lymph nodes, in contrast to rhabdomyosarcomas and malignant fibrous histiocytomas with 77.8% and 40% positive lymph nodes, respectively. The 5-year disease-specific survival for women with positive lymph nodes was 0%. CONCLUSIONS Vulvar sarcomas are heterogeneous with survival highly dependent on the histopathologic subtype. While surgical excision is the mainstay of treatment for all vulvar sarcomas, staging lymphadenectomy should be deferred for (dermato)fibrosarcomas, liposarcomas, and leiomyosarcomas as there were no cases of lymph nodes metastases.
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Affiliation(s)
- Sarah Johnson
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Malte Renz
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Lindsay Wheeler
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado, USA
| | - Elisabeth Diver
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Oliver Dorigo
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Babak Litkouhi
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Kian Behbakht
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado, USA
| | - Brooke Howitt
- Deprtment of Pathology, Stanford University, Palo Alto, California, United States
| | - Amer Karam
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
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10
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Wohlmuth C, Wohlmuth-Wieser I. Vulvamalignome: eine interdisziplinäre Betrachtung. J Dtsch Dermatol Ges 2019; 17:1257-1276. [PMID: 31885177 DOI: 10.1111/ddg.13995_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022]
Abstract
Vulvamalignome stellen die vierthäufigste Gruppe von gynäkologischen Krebserkrankungen dar. Erste Ansprechpartner sind typischerweise niedergelassene Dermatologen und Gynäkologen. Mit der jeweiligen Fachexpertise findet die Diagnose und Therapie idealerweise interdisziplinär zwischen spezialisierten Dermatoonkologen und gynäkologischen Onkologen statt. Vulvamalignome sind überwiegend Erkrankungen des höheren Lebensalters, obwohl alle histologischen Subtypen auch bei Frauen unter 30 Jahren vorkommen. Die Diagnose erfolgt oft verzögert. Eine genaue Kartierung von Biopsien (Mapping) ist von großer Bedeutung, da Lokalisation und Entfernung von der Mittellinie in Abhängigkeit von der zugrunde liegenden Histologie das operative Vorgehen bestimmen. Plattenepithelkarzinome machen mehr als 76 % der Vulvamalignome aus und vulväre intraepitheliale Neoplasien (VIN) sind dabei wichtige Vorstufen. Der zweithäufigste Typ der Vulvakarzinome ist das Basalzellkarzinom. Melanome machen 5,7 % der vulvären Malignome aus und ihre Prognose ist schlechter als die der kutanen Melanome. Die meisten Studien zu Checkpoint-Inhibitoren und zielgerichteten Therapien haben Patientinnen mit vulvären Melanomen nicht ausgeschlossen. Die vorliegende Evidenz wird im folgenden diskutiert. Die Methode der Wahl bei lokal resezierbaren Vulvamalignomen ist die Exzision. Angesichts ihrer Seltenheit sollte die Behandlung in spezialisierten Zentren erfolgen, um eine optimale Krankheitskontrolle zu erreichen und Kontinenz und sexuelle Funktion bestmöglich zu erhalten.
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Affiliation(s)
- Christoph Wohlmuth
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.,Division of Gynecologic Oncology, Department of Surgical Oncology, University Health Network, Toronto, ON, Kanada.,Department of Obstetrics and Gynecology, University of Toronto, ON, Kanada
| | - Iris Wohlmuth-Wieser
- Universitätsklinik für Dermatologie und Allergologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
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11
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Wohlmuth C, Wohlmuth-Wieser I. Vulvar malignancies: an interdisciplinary perspective. J Dtsch Dermatol Ges 2019; 17:1257-1276. [PMID: 31829526 PMCID: PMC6972795 DOI: 10.1111/ddg.13995] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022]
Abstract
Vulvar cancer represents the fourth most common gynecologic malignancy and is often encountered by the general Dermatologist or Gynecologist. Dermatooncologists and Gynecologic Oncologists share expertise in this field and the diagnosis and treatment should ideally be interdisciplinary. All subtypes are typically seen in the later decades of life, although all histologic subtypes have been described in women younger than 30 years. The diagnosis is often delayed. Exact mapping of biopsies is of high importance, as the location and distance from the midline guides the surgical approach depending on the underlying histology. Squamous cell carcinoma accounts for more than 76 % of vulvar cancer with vulvar intraepithelial neoplasia being an important precursor. Basal cell carcinoma is the second most common vulvar malignancy. Melanoma accounts for 5.7 % of vulvar cancer and has a worse prognosis compared to cutaneous melanoma. Most of the trials on checkpoint inhibitors and targeted therapy have not excluded patients with vulvar melanoma and the preliminary evidence is reviewed in the manuscript. Surgery remains the primary treatment modality of locally resectable vulvar cancer. In view of the rarity, the procedure should be performed in dedicated cancer centers to achieve optimal disease control and maintain continence and sexual function whenever possible.
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Affiliation(s)
- Christoph Wohlmuth
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.,Division of Gynecologic Oncology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, University of Toronto, ON, Canada
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12
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Ghirardi V, Bizzarri N, Guida F, Vascone C, Costantini B, Scambia G, Fagotti A. Role of surgery in gynaecological sarcomas. Oncotarget 2019; 10:2561-2575. [PMID: 31069017 PMCID: PMC6493462 DOI: 10.18632/oncotarget.26803] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/19/2019] [Indexed: 12/13/2022] Open
Abstract
Gynaecological sarcomas account for 3-4% of all gynaecological malignancies and have a poorer prognosis compared to gynaecological carcinomas. Pivotal treatment for early-stage uterine sarcoma is represented by total hysterectomy. Whereas oophorectomy provides survival advantage in endometrial stromal sarcoma is still controversial. When the disease is confined to the uterus, systematic pelvic and para-aortic lymphadenectomy is not recommended. Removal of enlarged lymph-nodes is indicated in case of disseminated or recurrent disease, where debulking surgery is considered the standard of care. Fertility sparing surgery for uterine leiomyosarcoma is not supported by strong evidence, whilst available data on fertility sparing treatment for endometrial stromal sarcoma are more promising. For ovarian sarcomas, in the absence of specific data, it is reasonable to adapt recommendations existing for uterine sarcomas, also regarding the role of lymphadenectomy in both early and advanced stage disease. Specific recommendations on cervical sarcomas' surgery are lacking. Existing data on surgical approach vary from radical hysterectomy to fertility-preserving surgery in the form of trachelectomy or wide local excision, however no definite conclusions can be drafted on the recommended surgical approach. For vulval sarcomas, complete surgical excision with at least 2 cm of free margin is considered to be the primary treatment which is associated with good prognosis. The aim of this review is to provide highest quality evidence to guide gynaecologic oncologists throughout surgical management of gynaecological sarcomas.
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Affiliation(s)
- Valentina Ghirardi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Nicolò Bizzarri
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Francesco Guida
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Carmine Vascone
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
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13
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Alnafisah F, Alfieri J. Lung Metastasis in a Case of Recurrent Poorly Differentiated Leiomyosarcoma of the Bartholin Gland: A Case Report and Review of the Literature. Cureus 2016; 8:e550. [PMID: 27158579 PMCID: PMC4852189 DOI: 10.7759/cureus.550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Vulvar neoplasms represent four percent of all gynecological cancers. While most cases of vulvar neoplasms are benign, two percent of patients present with malignant disease. We present the case of a 37-year-old premenopausal female who presented to an outside institution with a lump in her left vulva, which had progressively enlarged to the size of an egg. A wide local excision of the left vulva was performed, and the pathology revealed a high-grade sarcoma, not otherwise specified (NOS), with negative margins. Imaging showed enlarged bilateral external iliac lymph nodes, likely metastatic. After discussion at a multidisciplinary gynecology oncology tumor board, she was treated with gemcitabine/docetaxel chemotherapy, followed by a left inguinal lymph node dissection and a left radical vulvectomy after being referred to our centre. The final pathology at that time showed a residual sarcoma of 3.5 mm in the left vulva with no lympho-vascular invasion (LVI) and negative margins, with the closest, laterally, at 2 mm. A total of three lymph nodes were negative. She received additional chemotherapy postoperatively. Approximately one year later, she returned to her gynecologist with a 1 cm mass on the left vulva. She underwent a left hemi-vulvectomy and lymph node dissection, and pathology confirmed the presence of a high-grade sarcoma with close margins. She received adjuvant radiotherapy. Three months later, she presented with persistent cough and pneumonia. Imaging revealed a 10 cm lung mass, which was believed to be metastasis from the vulva. This was confirmed with biopsy and was completely resected. Any mass in the Bartholin gland area should be investigated carefully. Poorly differentiated vulvar leiomyosarcoma in the Bartholin gland can recur locally but may also lead to distant metastasis. Despite surgical and systemic treatment, as well as adjuvant radiation, the tumor recurred. Due to the rarity of this condition, there are no clear recommendations for treatment of this disease. To our knowledge, this is the first report of vulvar leiomyosarcoma of the Bartholin gland with metastasis to the lung.
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Affiliation(s)
- Fatimah Alnafisah
- Obstetrics & Gynecology Department, King Saud Hospital, Saudi Arabia
| | - Joanne Alfieri
- Department of Radiation Oncology, McGill University Health Centre
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14
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Korkmaz V, Kurdoğlu Z, Karadag B, Arslanca T, Caydere M, Ergun Y. A rare case of leiomyosarcoma localized in the Bartholin's gland area and review of the literature. J Obstet Gynaecol Res 2016; 42:589-592. [PMID: 26889877 DOI: 10.1111/jog.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/11/2015] [Accepted: 12/05/2015] [Indexed: 11/28/2022]
Abstract
Sarcomas of the vulva in the Bartholin's gland area are extremely rare in adults and only a few cases have been reported in the literature. A 65-year-old female patient without any previous complaint presented to our hospital complaining of a genital lump with progressive enlargement over the last six months. Pelvic examination revealed a 6 × 5 cm solid mass lesion with irregular margins localized in the left Bartholin's gland. Preoperative pathology results indicated a benign lesion, which was subsequently totally excised. Histopathological examination of the lesion revealed leiomyosarcoma. When a lesion is localized in the Bartholin's gland area, preoperative biopsy may suggest benign cytology, which can lead to a delay in diagnosis and curative treatment. Total local excision is the first choice for vulvar-complicated masses in the Bartholin's gland area. The present case is the ninth well-documented case reported in the literature.
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Affiliation(s)
- Vakkas Korkmaz
- Departments of Obstetrics and Gynecology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Zehra Kurdoğlu
- Departments of Obstetrics and Gynecology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Burak Karadag
- Departments of Obstetrics and Gynecology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Tufan Arslanca
- Departments of Obstetrics and Gynecology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Muzaffer Caydere
- Department of Pathology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Yusuf Ergun
- Departments of Obstetrics and Gynecology, Ankara Training and Research Hospital, Ankara, Turkey
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15
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Dermatofibrosarcoma protuberans of the vulva: margins assessment and reconstructive options - a report of two cases. World J Surg Oncol 2014; 12:399. [PMID: 25547686 PMCID: PMC6389240 DOI: 10.1186/1477-7819-12-399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/29/2014] [Indexed: 11/12/2022] Open
Abstract
Background Dermatofibrosarcoma Protuberans (DFSP) of the vulva is rare and oncologic surgery with free margins may lead to severe functional damage, requiring multidisciplinary approach regarding resection, margin assessment and reconstruction. Case Report Two cases of DFSP in vulva were treated in a single institution. A 28-year-old patient with an incisional biopsy in the vulvar region revealing DFSP underwent a partial vulvectomy with clitoris preservation. Pathological studies revealed free margins and reconstructive surgery was performed. This patient is disease free in a 40 months follow up. The other, a 57-year-old patient was also referred after an incomplete resection of a DFSP in the vulvar region. A 1-cm margim resection followed by Complete Circumferential and Peripheral Deep Margin Assessment (CCPDMA) was performed. Although the upper lateral margin was positive, it was possible to perform another wide local excision with preservation of the clitoris and primary closure. Conclusion DFSP of the vulva requires an accurate evaluation of margins, resections following oncological principles and reconstruction. Although being a very challenging lesion that usually implies difficult surgical management, if treated in a multidisciplinary environment, with surgical oncologists, experienced dermatopathologists and reconstructive surgeons can achieve good results. Even in difficult cases that presents with large lesions and compromising challenging areas, a complete oncologic resection can be performed minimizing functional damage for the patient. Electronic supplementary material The online version of this article (doi:10.1186/1477-7819-12-399) contains supplementary material, which is available to authorized users.
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16
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Abstract
BACKGROUND Myxoid leiomyosarcomas originating from the Bartholin gland are exceedingly rare. Only one other case of a Bartholin gland myxoid leiomyosarcoma has been reported. CASE Our patient presented with a 10 cm mass on her vulva, which was presumed to be a Bartholin gland cyst. Pathology showed a high-grade myxoid leiomyosarcoma with positive margins. She was treated with left radical hemivulvectomy, laparoscopic hysterectomy with bilateral salpingo-oophorectomy, and six cycles of adjuvant chemotherapy. She is now 1 year from completion of therapy and remains disease-free. CONCLUSION All solid vulvar masses should be thoroughly evaluated with a low threshold for biopsy. Treatment should consist of complete resection. Hormonal manipulation, chemotherapy, and radiation should be considered as potential adjuvant treatment options.
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17
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Levy RA, Winham WM, Bryant CS, Quick CM. Smooth muscle neoplasms of the vulva masquerading as Bartholin gland duct cysts. Proc (Bayl Univ Med Cent) 2014; 27:25-7. [PMID: 24381397 DOI: 10.1080/08998280.2014.11929043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Smooth muscle neoplasms of the vulva can be mistaken for Bartholin duct cysts, which can lead to a delay in diagnosis. We present a case of vulvar leiomyoma and a case of leiomyosarcoma that clinically mimicked Bartholin duct cysts. Identification of leiomyosarcomas in this region is particularly important; due to the risk of recurrence, patients may need radiation and/or chemotherapy in addition to adequate surgical treatment and appropriate follow up. Prior series have shown that risk of recurrence is related to inadequate resection and not to the size or grade of tumor. It is critical that pathologists recognize smooth muscle tumors of the vulva and communicate to clinicians the importance of clear margins and wide local excision in cases of malignancy.
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Affiliation(s)
- Rebecca A Levy
- Department of Pathology, Baylor University Medical Center at Dallas (Levy); Pathology Associates of Albuquerque, Albuquerque, New Mexico (Winham); the Department of Gynecologic Oncology, NEA Baptist Clinic, Jonesboro, Arkansas (Bryant); and the Department of Pathology, the University of Arkansas for Medical Sciences, Little Rock, Arkansas (Quick)
| | - Whitney M Winham
- Department of Pathology, Baylor University Medical Center at Dallas (Levy); Pathology Associates of Albuquerque, Albuquerque, New Mexico (Winham); the Department of Gynecologic Oncology, NEA Baptist Clinic, Jonesboro, Arkansas (Bryant); and the Department of Pathology, the University of Arkansas for Medical Sciences, Little Rock, Arkansas (Quick)
| | - Christopher S Bryant
- Department of Pathology, Baylor University Medical Center at Dallas (Levy); Pathology Associates of Albuquerque, Albuquerque, New Mexico (Winham); the Department of Gynecologic Oncology, NEA Baptist Clinic, Jonesboro, Arkansas (Bryant); and the Department of Pathology, the University of Arkansas for Medical Sciences, Little Rock, Arkansas (Quick)
| | - Charles M Quick
- Department of Pathology, Baylor University Medical Center at Dallas (Levy); Pathology Associates of Albuquerque, Albuquerque, New Mexico (Winham); the Department of Gynecologic Oncology, NEA Baptist Clinic, Jonesboro, Arkansas (Bryant); and the Department of Pathology, the University of Arkansas for Medical Sciences, Little Rock, Arkansas (Quick)
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18
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Murakami Y, Tsubamoto H, Hao H, Nishimoto S, Shibahara H. Long-term disease-free survival after radical local excision of low-grade myofibroblastic sarcoma of the vulva. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 5:34-6. [PMID: 24371691 DOI: 10.1016/j.gynor.2013.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/29/2013] [Indexed: 10/27/2022]
Abstract
•A second case of low-grade myofibroblastic sarcoma of the vulva.•Six-year follow-up with no evidence of disease after radical local excision.•Adequate margin resection is important.
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Affiliation(s)
- Yumi Murakami
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroyuki Hao
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Soh Nishimoto
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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19
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Ong AC, Lim TYK, Tan TC, Wang S, Raju GC. Proximal epithelioid sarcoma of the vulva: A case report and review of current medical literature. J Obstet Gynaecol Res 2012; 38:1032-5. [DOI: 10.1111/j.1447-0756.2011.01819.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Caucanas M, Müller G, Vanhooteghem O. Vulvar basal cell carcinoma: report of a case involving the mucosa and review of the literature. Dermatol Reports 2011; 3:e37. [PMID: 25386289 PMCID: PMC4211515 DOI: 10.4081/dr.2011.e37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 08/31/2011] [Indexed: 11/22/2022] Open
Abstract
We report the case of woman who presented a vulvar basal cell carcinoma (BCC) on the inner part of the labium majus, treated with local resection. Vulvar BCC is a rare cancer but can be long misdiagnosed due to a non-specific presentation. Though even rarer, BCC involving the mucosal side of the labium majus has to be considered in the differential diagnosis of the vulvar tumors. A complete excision with free margins is the treatment most recommended. Other recommendations include the early identification of aggressive subtypes, which carry a greater risk of recurrence and spreading potential as well as a long-term follow-up with exhaustive muco-cutaneous examination.
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Affiliation(s)
- Marie Caucanas
- Department of Dermatology, Sainte Elisabeth Hospital, Namur
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21
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Mckenzie M, Pintilie H, Wilkinson N, Lane G, Orton J, El-Ghobashy A. A rare case of vulval leiomyosarcoma: Management and an updated review of the literature. J OBSTET GYNAECOL 2011; 31:675-6. [DOI: 10.3109/01443615.2011.595519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Sawada M, Tochigi N, Sasajima Y, Hasegawa T, Kasamatsu T, Kitawaki J. Primary extraskeletal myxoid chondrosarcoma of the vulva. J Obstet Gynaecol Res 2011; 37:1706-10. [PMID: 21651669 DOI: 10.1111/j.1447-0756.2011.01559.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Morio Sawada
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Japan.
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23
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Hammonds LM, Hendi A. Dermatofibrosarcoma protuberans of the vulva treated using mohs micrographic surgery. Dermatol Surg 2010; 36:558-63. [PMID: 20402935 DOI: 10.1111/j.1524-4725.2010.01493.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L Mark Hammonds
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida, USA
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24
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Dermatofibrosarcoma Protuberans of the Vulva: A Clinicopathologic and Immunohistochemical Study of 13 Cases. Am J Surg Pathol 2010; 34:393-400. [DOI: 10.1097/pas.0b013e3181cf7fc1] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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González-Bugatto F, Añón-Requena MJ, López-Guerrero MA, Báez-Perea JM, Bartha JL, Hervías-Vivancos B. Vulvar leiomyosarcoma in Bartholin's gland area: a case report and literature review. Arch Gynecol Obstet 2008; 279:171-4. [PMID: 18437406 DOI: 10.1007/s00404-008-0652-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 04/07/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Malignant tumours of the vulvar soft tissue are very uncommon. When localized in the Bartholin's gland area these tumours can be mistaken for benign lesions, leading to a delayed diagnosis. CASE A 52-year-old woman presenting with a vulvar nodule, which was diagnosed as a Bartholin's gland cyst and was referred to the hospital for surgical excision of the lesion. Pathologist report informed of a 6 cm diameter leiomyosarcoma of the vulva with compromised resection margins; extension studies did not suggest any additional lesions and radical hemivulvectomy with ipsilateral inguinal lymphadenectomy was performed. The patient subsequently received radiotherapy and chemotherapy. Twelve months later, a local recurrence was diagnosed and was removed surgically. After 4 years of follow-up the patient remains disease free. CONCLUSION Any vulvar lesion with unusual characteristics or insidious evolution in labia majora or Bartholin's glands area should be carefully and promptly studied. This is particularly important in order to perform an effective surgical treatment in cases of leiomyosarcoma.
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Affiliation(s)
- F González-Bugatto
- Department of Obstetrics and Gynecology, University Hospital Puerta del Mar, Avenida Ana de Viya 21, Cádiz, Spain.
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26
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Fernández-Villarrenaga L, Gómez Álvarez S, Ortiz C, Erasun F, Martino M. Leiomiosarcoma de vulva. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2007. [DOI: 10.1016/s0210-573x(07)74486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Finan MA, Barre G. Bartholin's gland carcinoma, malignant melanoma and other rare tumours of the vulva. Best Pract Res Clin Obstet Gynaecol 2003; 17:609-33. [PMID: 12965135 DOI: 10.1016/s1521-6934(03)00039-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-squamous cancers of the vulva encompass an exciting and broad group of tumours, including Bartholin's gland carcinoma, malignant melanoma, Paget's disease, sarcomas and lymphoma. These tumours range from innocuous lesions treatable with simple local excision, such as basal-cell carcinoma, to cancers with very poor prognosis, such as Merkel-cell tumours. All of these tumours are thoroughly reviewed, with emphasis on presenting symptoms, pathological diagnosis and optimal management approaches. The literature supporting these recommendations is reviewed. Of the utmost importance in the management of these tumours is a thorough review of the pathological diagnosis by a specialist pathologist and a gynaecological oncologist. Establishing the correct diagnosis is essential to reaching appropriate treatment decisions. Frequently this will necessitate a second opinion by a referral centre.
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Affiliation(s)
- Michael A Finan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
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28
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Abstract
The purpose of this study is to report clinical aspects and treatment results of patients seen at Johns Hopkins. A search of the tumor registry of the Sidney Kimmel Comprehensive Cancer Center found 453 patients with malignancies of the vulva registered between 1977 and 1997. Patient and tumor characteristics, treatment methods, and follow-up were obtained from charts. Seven patients were identified with sarcoma of the vulva. Of these, one was removed from analysis due to histology. Three patients had leiomyosarcoma, two had fibrosarcoma, and one had epithelioid sarcoma. The mean age was 41. Mean time to diagnosis was 6 months. All but one of the tumors was located on the labia majora. Median tumor size was 3.5 cm. Surgery varied from wide local excision to radical vulvectomy with inguinal lymph node dissection. Surgical margins were microscopically negative in five of the six cases. Two patients had received adjuvant external beam radiation. One of them had a tumor greater than 5 cm and close surgical margins and the other had high-grade tumor, which recurred after previous surgery. Mean follow-up was 127.8 months. There have been no recurrences to date.
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Affiliation(s)
- H C Ulutin
- The Sidney Kimmel Comprehensive Cancer at Johns Hopkins Divison of Radiation Oncology, USA.
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