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Martínez-Maestre MÁ, Castelo-Branco C, Calderón AM, Espigado I, Pérez-Simón JA, González-Cejudo C. Genital chronic graft-versus-host disease: an unmet need that requires trained gynecologists. Climacteric 2024; 27:275-281. [PMID: 38415712 DOI: 10.1080/13697137.2024.2314521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Menopause and chronic graft-versus-host disease (cGvHD) are the leading causes of morbidity after allogeneic hematopoietic stem cell transplantation (alloHSCT). Genitalia are one of the target organs of cGvHD causing sexual dysfunction and local symptoms, which may impair women's quality of life. The aim of this study is to describe the prevalence and clinical characteristics of genital cGvHD. METHODS A retrospective cross-sectional observational study was performed including 85 women with alloHSCT. All women were diagnosed and counseled by a trained gynecologist. Health-related quality of life was assessed by the Cervantes Short-Form Scale and sexual function was evaluated by the Female Sexual Function Index. RESULTS Seventeen women (20%) included in the study were diagnosed with genital cGvHD. The main complaints were vulvovaginal dryness (42.2%) and dyspareunia (29.4%), the presence of erythema/erythematous plaques (52.9%) being the most frequent sign. Median time from transplant to diagnosis of genital cGvHD was 17 months among those with mild involvement, 25 months for moderate and 42 months for severe forms. Mortality was 29.4% in patients who developed cGvHD with genital involvement versus 8.8% among those without (p = 0.012). CONCLUSION Early gynecological evaluation might allow to identify patients with mild forms of genital cGvHD, potentially enabling better management and improved outcomes.
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Affiliation(s)
| | - C Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A M Calderón
- Department of Gynecology, Virgen del Rocío University Hospital, Seville, Spain
| | - I Espigado
- Department of Haematology, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - J A Pérez-Simón
- Department of Haematology, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - C González-Cejudo
- Department of Gynecology, Virgen del Rocío University Hospital, Seville, Spain
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2
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Hollond CS, Ganti A, Streich-Tilles T, Debiec K, Galloway A, Inneh O, Cizek S. Adolescent and Young Adult Patients with Vaginal Graft-vs-Host Disease and Hematocolpos Managed with Vaginal Stents: A Case Series. J Pediatr Adolesc Gynecol 2024; 37:78-86. [PMID: 37797789 DOI: 10.1016/j.jpag.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023]
Abstract
STUDY OBJECTIVE Vaginal stenosis can be acquired as a result of vaginal graft-vs-host disease (GVHD) in patients who have undergone hematopoietic stem cell transplant (HSCT). Little data exist to guide the management of vaginal GVHD, particularly in adolescent and young adult patients. The objective of this study was to detail the management of vaginal stenosis with lysis of adhesions and vaginal stent placement in 3 young patients with vaginal GVHD. METHODS A retrospective chart review was done for 3 patients with vaginal GVHD causing vaginal stenosis with hematometrocolpos. All 3 were treated using vaginal stent placement. Additionally, a literature review was conducted through PubMed and Google Scholar to identify 21 case reports (with a total of 35 patients) of menstrual obstruction due to GVHD. RESULTS Obstructive vaginal stenosis secondary to vaginal GVHD occurred in our patients at ages 15, 16, and 24 years. Resolution of hematocolpos was obtained with lysis of vaginal adhesions with vaginal stent placement in all patients, with varying regimens of systemic and topical hormones, topical corticosteroids, and dilator therapy. DISCUSSION Vaginal stenosis secondary to vaginal GVHD should be considered in patients with a history of allogeneic HSCT presenting with amenorrhea, especially those with a diagnosis of primary ovarian insufficiency. The use of vaginal stents, along with postoperative medical and dilator management as appropriate, may prevent re-stenosis, although more information is needed regarding the efficacy of treatments.
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Affiliation(s)
| | - Amitha Ganti
- Department of OB/GYN, Division of Pediatric and Adolescent Gynecology, Stanford University School of Medicine, Stanford, California
| | - Tara Streich-Tilles
- Department of Surgery, Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kate Debiec
- Department of Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, University of Washington and Seattle Children's, Seattle, Washington
| | | | - Oyenmwen Inneh
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie Cizek
- Department of OB/GYN, Division of Pediatric and Adolescent Gynecology, Stanford University School of Medicine, Stanford, California.
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Ganesan K, Duraisamy S, Meena SK, Yenigalla N, Swaminathan VV, Uppuluri R, Raj R. Genital Graft-versus-Host Disease in Children: An Underdiagnosed and Undertreated Entity. Transplant Cell Ther 2024; 30:228.e1-228.e5. [PMID: 37926190 DOI: 10.1016/j.jtct.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/09/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
Genital graft-versus-host disease (GVHD) is an underdiagnosed and poorly recognized complication, especially in the pediatric population. We report our data on children with genital manifestations of GVHD and their unique clinical features. The study included children up to age 18 years who underwent hematopoietic stem cell transplantation (HSCT) over a 20-year period from February 2002 to February 2022. A total of 1035 children underwent HSCT during the study period. Genital GVHD was documented in 164 children (15.8%). Among these 164 children, 23 (14%) were age <2 years, 98 (59.8%) were age 2 to 10 years, and 43 (26.2%) were age ≥10 years. The conditioning regimen was myeloablative in 122 children (74.4%) and reduced intensity in 42 children (25.6%). Donor type was matched related donor in 62 (37.8%), matched unrelated donor in 44 (26.8%), and haploidentical in 34 (20.7%). Peripheral blood stem cells (PBSCs) were used in 78.7% of the children (n = 129), and sex mismatch was noted in 31.1% of genital GVHD cases (51 of 164). The overall incidence of chronic oral GVHD was 33% (342 of 1035), and of these, 47.9% (164 of 342) also had genital GVHD. Patients with genital GVHD ultimately may require surgical management; 21.5% (22 of 103) of boys with genital GVHD ultimately required circumcision for phimosis, and 1 female patient developed hematocolpos necessitating surgical management. Our case series highlights the significant association between chronic oral GVHD and genital GVHD. Given the strong association between oral GVHD and genital GVHD in children, it is imperative to examine the genital area in all children on follow-up for chronic GVHD. Donor-recipient sex mismatch and use of PBSC grafts predispose to chronic genital GVHD. Early identification and treatment of genital GVHD may help prevent complications, including scarring and phimosis.
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Affiliation(s)
- Kavitha Ganesan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India.
| | - Suresh Duraisamy
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Satish Kumar Meena
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Navyasri Yenigalla
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | | | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
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4
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Appiah LC, Moravek M, Hoefgen H, Rotz S, Childress K, Samis J, Benoit J, Rodriguez-Wallberg K, Anazodo A. Reproductive late effects after hematopoietic stem cell transplant in pediatric, adolescent, and young adult cancer survivors. Pediatr Blood Cancer 2023; 70 Suppl 5:e30551. [PMID: 37470746 DOI: 10.1002/pbc.30551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023]
Abstract
Reproductive late effects after hematopoietic stem cell transplant can have a significant impact on cancer survivors' quality of life. Potential late effects include gonadal insufficiency, genital graft-versus-host disease, uterine injury, psychosexual dysfunction, and an increased risk of breast and cervical cancer in patients treated with total body irradiation. Despite guidelines, screening and treatment are not standardized among at-risk patients. Provider barriers include lack of knowledge of at-risk therapies and evidenced-based guidelines. Patient barriers include a reluctance to report symptoms and lack of awareness of treatment options. System barriers include inefficient implementation of screening tools and poor dissemination of guidelines to providers who serve as the medical home for survivors. This review guides the clinician in identifying and managing reproductive late effects after hematopoietic stem cell transplant to improve outcomes.
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Affiliation(s)
- Leslie C Appiah
- Department of Obstetrics and Gynecology, Division of Academic Specialists in Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, Colorado, USA
- Department of Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Denver, Colorado, USA
| | - Molly Moravek
- Department of Reproductive Endocrinology and Infertility, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Holly Hoefgen
- Washington University in St. Louis, St. Louis, Michigan, USA
| | - Seth Rotz
- Department of Pediatric Hematology Oncology and Bone Marrow Transplant, Cleveland Clinic, Cleveland, Ohio, USA
| | - Krista Childress
- Department of Pediatric and Adolescent Gynecology, Primary Children's Medical Center, Salt Lake, Utah, USA
| | - Jill Samis
- Department of Endocrinology, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Janie Benoit
- Université de Montreal, Montreal, Quebec, Canada
| | | | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Tsimeki M, Tsimpidakis A, Roidi S, Gregoriadis T, Soldatou A, Kitra V, Michala L. Genital GVHD in Female Children and Adolescents: A Systematic Review of Case Reports and Case Series. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1463. [PMID: 37761424 PMCID: PMC10527655 DOI: 10.3390/children10091463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Genital graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT) is an underdiagnosed manifestation of chronic GVHD. Few articles have been published in pediatric populations, and there are no established guidelines for the management of this condition in children. This study aims to provide a systematic literature review of the published studies and cases of genital (vulvovaginal) GVHD in girls and adolescents post HSCT, with a focus on the time of diagnosis and clinical manifestations. The authors searched for English-language articles published after 1990, which included full patient details. Thirty-two cases of female patients under 20 years of age were identified. The median time of diagnosis was 381 days (IQR: 226-730 days), and 83% of patients developed Grade 3 vulvovaginal GVHD. Based on these observations, an early pediatric gynecologic examination of these patients, soon within the first year after HSCT, could be suggested for early diagnosis, treatment initiation and prevention of long-term complications.
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Affiliation(s)
- Maria Tsimeki
- First Department of Obstetrics and Gynecology, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.T.); (S.R.); (T.G.)
| | - Antonios Tsimpidakis
- First Department of Dermatology-Venereology, School of Medicine, Andreas Syngros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece;
| | - Stella Roidi
- First Department of Obstetrics and Gynecology, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.T.); (S.R.); (T.G.)
| | - Themos Gregoriadis
- First Department of Obstetrics and Gynecology, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.T.); (S.R.); (T.G.)
| | - Alexandra Soldatou
- Second Department of Pediatrics, School of Medicine, Children’s Hospital of Athens “P. & A. Kyriakou”, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vasiliki Kitra
- Stem Cell Transplant Unit, “Agia Sofia Children’s Hospital” Infectious Diseases Unit, Department of Pathophysiology, School of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Lina Michala
- First Department of Obstetrics and Gynecology, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.T.); (S.R.); (T.G.)
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Preston M, Richards A. Vulvar and Vaginal Graft Versus Host Disease After Allogeneic Stem Cell Transplant-A Systematic Review. J Low Genit Tract Dis 2023; 27:266-274. [PMID: 37379441 DOI: 10.1097/lgt.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To conduct a systematic literature search to identify and determine the prevalence, signs and symptoms, and clinical management of vulvar and vaginal graft versus host disease (GVHD). METHODS A systematic literature search of articles from 1993 to August 2022 was performed. Studies were included if full text was available in the English language and provided reports on female subjects with more than four patients. Review articles, conference abstracts, case reports, and case series of less than 5 patients were excluded. Included studies had their reference list searched for further manuscripts. Two authors reviewed the search results and independently identified studies that met the selection criteria and summarized available data. RESULTS There were 29 studies available in the literature that met the inclusion criteria. There was a high risk of bias within the available literature. The prevalence of vulval and vaginal GVHD varied between 27% and 66% of women after allogeneic stem cell transplant. Other organ GVHD, most commonly the skin, mouth, and eyes, may be present concurrently in these patients, or they may be asymptomatic. Specialist gynecology review, topical estrogen, topical steroids, topical immunosuppression, and vaginal dilatation led to a reduction in complications associated with the condition, and surgery was helpful in some severe refractory cases. These patients remain at higher risk of developing cervical dysplasia, and regular human papillomavirus screening is recommended. CONCLUSIONS Female genital GVHD is a rare phenomenon. Early, coordinated, and regular gynecological reviews after stem cell transplant are essential to reduce the long-term complications.
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Affiliation(s)
- Marta Preston
- Obstetrics and Gynaecology Department, Sunshine Hospital, Western Health, St Albans, Victoria, Australia
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Dowlut-McElroy T, Shin S, Stepanek E, Jacobsohn D, Gomez-Lobo V. Pediatric Vulvovaginal Graft-Versus-Host Disease: A Retrospective Cohort Study and Literature Review. J Pediatr Adolesc Gynecol 2022; 35:552-557. [PMID: 35472468 PMCID: PMC9560972 DOI: 10.1016/j.jpag.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To assess genital symptomatology, characterize the findings of genital examination, and describe the incidence and treatment of vulvovaginal graft-versus-host disease (vvGvHD) in girls and adolescents after allogeneic hematopoietic stem cell transplantation (HSCT). DESIGN Retrospective cohort. SETTING Metropolitan-area children's hospital. PARTICIPANTS Female allogeneic HSCT recipients ages 0 to 22 years. MAIN OUTCOME MEASURES Genital symptoms, genital examination, diagnosis, and treatment of vvGvHD. RESULTS A total of 57 participants were included in the analysis. The median age at the time of HSCT was 10 years (range 4 months-23 years). Most (n = 40, 71%) underwent transplant for a nonmalignant condition, most commonly sickle cell anemia (n = 19, 33%). The median time of onset of GvHD post HSCT was 62 days (IQR = 42 to 151 days). The most common initial site of GvHD was skin (n = 21, 64%), followed by GI tract (n = 10, 30%). Three patients (5%) were diagnosed with vvGvHD. The time of onset of vvGvHD post HSCT ranged from 62 to 1565 days. One patient (33%) was asymptomatic at the time of diagnosis. There was no difference in diagnosis of vvGvHD when race (P = 0.15), age at allogeneic HSCT (P = 0.64), nonmalignant vs malignant indication (P = 0.21), source of stem cells (P = 0.25), partial vs full human leukocyte antigens (HLA) donor match (P = 0.34), and GvHD prophylaxis regimen (P = 0.18) were compared. None had isolated vvGvHD. Vulvovaginal GvHD was preceded by skin GvHD in 1 patient, was preceded by lung GvHD in 1 patient, and occurred concurrently with skin GvHD in the third patient. CONCLUSIONS Pediatric vvGvHD can occur within the first 100 days after transplant and can be asymptomatic. Routine gynecologic evaluation post allogeneic HSCT in children and adolescents should include a thorough review of vulvovaginal symptoms and a gynecologic exam for the detection and treatment of vvGvHD.
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Affiliation(s)
- Tazim Dowlut-McElroy
- Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, United States; Department of Surgery, Children's National Hospital, Washington, DC, United States.
| | - Stephanie Shin
- Georgetown University School of Medicine, Washington, DC, United States
| | - Elizabeth Stepanek
- Division of Hematology, Children's National Hospital, Washington DC, United States
| | - David Jacobsohn
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington DC, United States
| | - Veronica Gomez-Lobo
- Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, United States; Department of Surgery, Children's National Hospital, Washington, DC, United States
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Ten Hagen PL, Bowe C, Dains JE. Early Detection of Vulvovaginal Graft-Versus-Host Disease: An Integrative Review. J Adv Pract Oncol 2021; 12:725-737. [PMID: 34671502 PMCID: PMC8504929 DOI: 10.6004/jadpro.2021.12.7.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Vulvovaginal graft-vs.-host disease (VVGvHD) is a condition caused by a T-cell mounted immune response after allogeneic hematopoietic stem cell transplant (alloHSCT), which can lead to sclerotic changes of the external genital organs. A common complication of alloHSCT, VVGvHD is underreported and underdiagnosed in female patients. Without detection and treatment, VVGvHD can progress to complete obliteration of the vaginal canal requiring surgical intervention in severe cases. Design: This review summarizes findings to assist providers in detecting and treating VVGvHD. It utilized PubMed, Scopus, and CINAHL databases. Inclusion criteria consisted of female patients, a history of stem cell transplantation, and a history of VVGvHD. Studies not published in English and dated more than 15 years were excluded. After the evaluation of 333 articles, 10 were included based on relevance and applicability. Limitations of this review included small sample sizes, retrospective nature of articles, and lack of randomized control trials. Findings: Early identification of VVGvHD requires identifying the rate of occurrence and risk factor profile, recognizing the presenting symptoms, improving VVGvHD assessment techniques, ascertaining when to biopsy, and establishing clinically targeted surveillance programs. Conclusion: For female patients who have undergone alloHSCT, targeted surveillance for early identification of VVGvHD results in earlier treatment initiation. Subsequently, this can improve sexual health, partner relationships, and quality of life in patients after stem cell transplant.
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Affiliation(s)
| | - Christi Bowe
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joyce E Dains
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Hillard PJA. Pediatric and Adolescent Gynecology Is Care for the Underserved. J Pediatr Adolesc Gynecol 2021; 34:109-111. [PMID: 33766326 DOI: 10.1016/j.jpag.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Paula J Adams Hillard
- Editor-in-Chief, JPAG, Stanford University School of Medicine, Stanford, CA, United States
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10
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Hillard PJA. COVID, Science, Vaccines, and Public Trust. J Pediatr Adolesc Gynecol 2020; 33:617-618. [PMID: 33288129 PMCID: PMC7832689 DOI: 10.1016/j.jpag.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Allen SM, Liang CS, Chesnokova AE, Childress KJ, Pascoe KF, Dietrich JE. Patterns of Genital Examination and Vulvovaginal Graft-Versus-Host Disease in a Pediatric Post-Hematopoietic Stem Cell Transplant Population. J Pediatr Adolesc Gynecol 2020; 33:658-666. [PMID: 32781233 DOI: 10.1016/j.jpag.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/29/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To determine vulvovaginal graft-versus-host disease (vvGVHD) incidence among pediatric patients who have received hematopoietic stem cell transplantation (HSCT) and who already have graft-versus-host disease (GVHD) involving any organ system and characterize patterns of genital examination and referral to pediatric and adolescent gynecology (PAG) in the post-HSCT population. DESIGN Retrospective chart review. SETTING Large tertiary children's hospital in Texas. PARTICIPANTS Eighty-six post-HSCT female patients 21 years old and younger with GVHD involving any organ system. INTERVENTIONS None. MAIN OUTCOME MEASURES vvGVHD among post-HSCT children, referrals to PAG, genital examinations documented by any clinician. RESULTS Eighty-six patients met inclusion criteria. Most HSCTs were bone marrow transplants, typically for leukemia. Median ages of indication diagnosis and HSCT were 5.1 and 7.5 years, respectively. Median time from HSCT to first GVHD diagnosis (eg, skin, intestine) was 96 days. Nearly all patients had at least 1 genital exam documented in the first 2 years post-HSCT, with a median of 17 exams. Twenty-eight patients were seen by PAG post-HSCT, with 7 of these patients seen within the first 2 years post-HSCT. Four symptomatic patients were diagnosed with vvGVHD. Median time from HSCT to vvGVHD was 398 days. CONCLUSION The small number of vvGVHD cases in our study population is likely because of lack of symptom reporting from patients and families and difficulty with vvGVHD diagnosis. Further training for non-PAG physicians, including pediatricians and oncologists, in identifying and managing vvGVHD might prevent delayed diagnosis and severe sequelae. Earlier referral to PAG or a gynecologist versed in post-HSCT survivorship is also recommended.
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Affiliation(s)
- Stephanie M Allen
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota.
| | - Cynthia S Liang
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Arina E Chesnokova
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Krista J Childress
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Kristin F Pascoe
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Texas
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12
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Shalin SC, Racher LM, Campbell KK. Lichenoid dermatoses involving the vulva: A clinical-pathologic correlation ✰. Semin Diagn Pathol 2020; 38:3-18. [PMID: 32951943 DOI: 10.1053/j.semdp.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
The lichenoid tissue reaction pattern generally signifies cytotoxic damage to the epithelium. When such reaction pattern occurs on vulvar skin or mucosa, the effects can result in considerable morbidity. None of the entities discussed in this review are entirely unique to the vulva, however, some entities may classically occur at this site, while others tend to be widespread diseases that may incidentally affect vulvar skin and mucosa. Given the complex anatomy of the vulva and the bridging of a site showing both keratinizing squamous epithelium and non-keratinizing squamous mucosa, histopathologic features may display variation in presentation. Although identification of a "lichenoid reaction pattern" alone may provide insight into the disease process, understanding of clinical presentation and specific sites of involvement, along with recognition of the nuanced features of the disease entities can help establish a specific diagnosis. Accurate histopathologic diagnoses by pathologists can improve the ability for treating clinicians to implement timely and effective treatment.
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Affiliation(s)
- Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Luann M Racher
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Katelynn K Campbell
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
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