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Lancellotta V, Macchia G, Garganese G, Fionda B, Pezzulla D, De Angeli M, Autorino R, Zinicola T, Gui B, Russo L, Fragomeni SM, Ferrandina G, Rovirosa A, Sala E, Scambia G, Gambacorta MA, Tagliaferri L. TRImodal DEfinitive invasive vagiNal carcinoma Treatment (TRIDENT protocol): how a standardized approach may change prognostic outcomes. Int J Gynecol Cancer 2024:ijgc-2023-004956. [PMID: 38290784 DOI: 10.1136/ijgc-2023-004956] [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: 02/01/2024] Open
Abstract
OBJECTIVE Vaginal carcinoma is a rare malignancy accounting for 1-2% of all gynecological cancers. Surgery has a limited role, while definitive radiotherapy-chemotherapy followed by interventional radiotherapy is considered a valid alternative. The aim of the TRIDENT (TRImodal DEfinitive invasive vagiNal carcinoma Treatment) pilot study was to report the results of a modern standardized trimodal protocol treatment consisting of image guided definitive radiotherapy-chemotherapy followed by image guided interventional radiotherapy in terms of safety and efficacy. METHODS Between January 2019 and December 2021, we analyzed 21 consecutive patients with primary vaginal cancer who had received radiotherapy-chemotherapy followed by interventional radiotherapy. The primary study endpoint was local control, and secondary endpoints were metastasis free survival, overall survival, and rate and severity of acute and late toxicities. RESULTS 14 patients had FIGO (International Federation of Gynecology and Obstetrics) stage II, five patients had stage III, and two had stage IVB disease. Median total external beam radiotherapy dose for the tumor was 45 Gy. Median total dose on positive nodes was 60 Gy. Median total dose for interventional radiotherapy was 28 Gy over four high dose rate fractions to achieve between 85 and 95 Gy equivalent dose, in 2 Gy fractions (EQD2)α/β10, to the high risk clinical target volume, and 60 Gy EQD2α/β10 to the intermediate risk clinical target volume. All patients received weekly platinum based chemotherapy. Median follow-up was 20 months (range 10-56 months). Two year actuarial local control, metastasis free survival, and overall survival rate were 79.4%, 90.5%, and 79.4%, respectively. In terms of acute toxicity, there were no grade 4 events and only one acute grade (G) 3 toxicity (skin). Only vaginal stenosis (G3) was documented 12 months after therapy due to late toxicity. CONCLUSIONS In this study, definitive radiotherapy-chemotherapy followed by interventional radiotherapy was a safe and effective treatment modality for primary vaginal cancer.
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Affiliation(s)
- Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gabriella Macchia
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giorgia Garganese
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Martina De Angeli
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Rosa Autorino
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Tiziano Zinicola
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Benedetta Gui
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Russo
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Simona Maria Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angeles Rovirosa
- Radiation Oncology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Fonaments Clínics Department, Universitat de Barcelona, Barcelona, Spain
| | - Evis Sala
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Qian J, Gracious K, Chen L, Xu S. Primary vaginal cancer after hysterectomy for benign conditions: a systematic review of the literature. Front Oncol 2024; 14:1334778. [PMID: 38347832 PMCID: PMC10859505 DOI: 10.3389/fonc.2024.1334778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
Background Primary vaginal cancer is a rare condition. Some studies have revealed an increased risk of vaginal cancer among patients who have undergone hysterectomy for premalignant and malignant cervical disease. However, there is limited literature available on primary vaginal cancer following hysterectomy for benign conditions. Objectives This review aimed to investigate available evidence on clinical characteristics, treatments, and outcomes of primary vaginal cancer following hysterectomy for benign diseases. Additionally, we provide a case of a patient who developed primary vaginal cancer 10 years after undergoing hysterectomy for abnormal uterine bleeding. Search strategy We conducted a comprehensive literature search on PubMed, Scopus, Web of Science using a combination of title and abstract represented by "hysterectomy", and "vaginal cancer"; "vaginal neoplasm"; and "cancer of vagina". No article type restrictions were applied. Main results Eight studies with a total of 56 cases were included in this review. The main symptom observed was vaginal bleeding. Squamous cancer was found to be the most common type, followed by adenocarcinoma. The majority of vaginal cancer cases occurred approximately 10 years after undergoing hysterectomy. The most common location of the tumor was in the vaginal apex. The management approaches varied and details were available in 25 cases. Among these, 7 cases were treated with radiotherapy alone, 1 case received concurrent chemoradiation therapy, and the of rest of the cases underwent surgery as the primary treatment, with or without additional adjuvant therapy. Data of follow-up was available for 15 cases, with 2 cases resulting in death and 2 cases experiencing recurrence. The other cases were alive and well at the time of considered follow up. Conclusion Primary vaginal cancer after hysterectomy for benign conditions is an extremely rare condition. It is essential to have high-level evidence to guide the screening and treatment strategy for this rare condition. A part of women who have undergone hysterectomy for benign disorders can benefit from vaginal cytology evaluation. It is reasonable to postpone the initial screening after surgery and to extend the interval between subsequent screenings. Further retrospective case-control trials are expected to determine which specific subgroups of patients mentioned above might most potentially benefit from screening. The treatment decision for vaginal cancer after hysterectomy is more favorable to radiotherapy-based management rather than surgery. Vaginal endometrioid adenocarcinoma may arise from the malignant transformation of endometriosis. More studies are expected to investigate the correlation between these two diseases.
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Affiliation(s)
- Jing Qian
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
| | - Kaoma Gracious
- International Education College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Li Chen
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
| | - Song Xu
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
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3
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Margul D, Yu C, AlHilli MM. Tumor Immune Microenvironment in Gynecologic Cancers. Cancers (Basel) 2023; 15:3849. [PMID: 37568665 PMCID: PMC10417375 DOI: 10.3390/cancers15153849] [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: 06/07/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Gynecologic cancers have varying response rates to immunotherapy due to the heterogeneity of each cancer's molecular biology and features of the tumor immune microenvironment (TIME). This article reviews key features of the TIME and its role in the pathophysiology and treatment of ovarian, endometrial, cervical, vulvar, and vaginal cancer. Knowledge of the role of the TIME in gynecologic cancers has been rapidly developing with a large body of preclinical studies demonstrating an intricate yet dichotomous role that the immune system plays in either supporting the growth of cancer or opposing it and facilitating effective treatment. Many targets and therapeutics have been identified including cytokines, antibodies, small molecules, vaccines, adoptive cell therapy, and bacterial-based therapies but most efforts in gynecologic cancers to utilize them have not been effective. However, with the development of immune checkpoint inhibitors, we have started to see the rapid and successful employment of therapeutics in cervical and endometrial cancer. There remain many challenges in utilizing the TIME, particularly in ovarian cancer, and further studies are needed to identify and validate efficacious therapeutics.
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Affiliation(s)
| | | | - Mariam M. AlHilli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH 44195, USA; (D.M.); (C.Y.)
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4
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Perelli F, Mattei A, Scambia G, Cavaliere AF. Editorial: Methods in gynecological oncology. Front Oncol 2023; 13:1167088. [PMID: 36969075 PMCID: PMC10036035 DOI: 10.3389/fonc.2023.1167088] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- Federica Perelli
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, Florence, Italy
- *Correspondence: Federica Perelli,
| | - Alberto Mattei
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, Florence, Italy
| | - Giovanni Scambia
- Department of Science of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Franca Cavaliere
- Division of Gynecology and Obstetrics, Fatebenefratelli Isola Tiberina Gemelli Hospital, Rome, Italy
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5
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Kwolek DG, Gerstberger S, Tait S, Qiu JM. Ovarian, Uterine, and Vulvovaginal Cancers: Screening, Treatment Overview, and Prognosis. Med Clin North Am 2023; 107:329-355. [PMID: 36759101 DOI: 10.1016/j.mcna.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ovarian, uterine, and vulvovaginal cancers affect approximately 96,000 women per year in the United States, resulting in approximately 29,000 deaths annually. Routine screening protocols do not detect these malignancies; thus, the recognition of risk factors and evaluation of worrisome symptoms are essential for early detection and improved prognoses. Treatment is managed by gynecologic oncologists, and often involves a combination of surgery, chemotherapy, and possible radiation treatments. Survivor care is managed by the primary-care clinician: expert attention to the mental, physical, and sexual health of each patient will ensure the best outcomes and quality of life.
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Affiliation(s)
- Deborah Gomez Kwolek
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Stefanie Gerstberger
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sarah Tait
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeanna M Qiu
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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6
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Huang XS, Fan SF, Xu JX, Xu YJ, Song X, Xiang JY, Xue LM. Primary vaginal signet ring cell carcinoma. BJR Case Rep 2023; 9:20220050. [PMID: 36873240 PMCID: PMC9976718 DOI: 10.1259/bjrcr.20220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/08/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022] Open
Abstract
Primary vaginal cancer is rare, accounting for only 2% of all gynecological malignant tumors. Primary vaginal cell carcinoma is mainly squamous cell carcinoma, accounting for about 90%, and adenocarcinoma only accounts for 8-10%. Primary signet ring cell carcinoma of vagina is rare and has not been reported in the literature. This paper reports a case of signet ring cell carcinoma in vagina.
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Affiliation(s)
- Xiao-Shan Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shu-Feng Fan
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yong-Jie Xu
- Department of Computed Tomography and Magnetic Resonance Imaging, Handan First Hospital, Handan, China
| | - Xia Song
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jun-Yi Xiang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Li-Ming Xue
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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7
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Meixner E, Arians N, Bougatf N, Hoeltgen L, König L, Lang K, Domschke C, Wallwiener M, Lischalk JW, Kommoss FK, Debus J, Hörner-Rieber J. Vaginal cancer treated with curative radiotherapy with or without concomitant chemotherapy: oncologic outcomes and prognostic factors. TUMORI JOURNAL 2023; 109:112-120. [PMID: 34724840 PMCID: PMC9896533 DOI: 10.1177/03008916211056369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vaginal cancer is a rare disease for which prospective randomized trials do not exist. We aimed to assess survival outcomes, patterns of recurrence, prognostic factors, and toxicity in the curative treatment using image-guided radiotherapy (RT). METHODS In this retrospective review, we identified 53 patients who were treated at a single center with external beam radiotherapy and brachytherapy with or without concomitant chemotherapy from 2000 to 2021. RESULTS With a median follow-up of 64.5 months, the Kaplan-Meier 2-, 5-, and 7-year overall survival (OS) was found to be 74.8%, 62.8%, and 58.9%, respectively. Local and distant control were 67.8%, 65.0%, and 65.0% and 74.4%, 62.6%, and 62.6% at 2, 5, and 7 years, respectively. In univariate Cox proportional hazards ratio analysis, OS was significantly correlated to FIGO stage (hazard ratio [HR] 1.78, p = 0.042), postoperative RT (HR 0.41, p = 0.044), and concomitant chemotherapy (HR 0.31, p = 0.009). Local control rates were superior when an equivalent dose in 2-Gy fractions (EQD2) of ⩾65 Gy was delivered (HR 0.216, p = 0.028) and with the use of concurrent chemotherapy (HR 0.248, p = 0.011). Not surprisingly, local control was inferior for patients with a higher TNM stage (HR 3.303, p = 0.027). Minimal toxicity was observed with no patients having documentation of high-grade toxicity (CTCAE grade 3+). CONCLUSION In treatment of vaginal cancer, high-dose RT in combination with brachytherapy is well tolerated and results in effective local control rates, which significantly improve with an EQD2(α/β=10) ⩾65 Gy. Multivariate analyses revealed concomitant chemotherapy was a positive prognostic factor for overall and progression-free survival.
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Affiliation(s)
- Eva Meixner
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
- Eva Meixner, MD, Department of Radiation
Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg,
Baden-Württemberg 69120, Germany.
| | - Nathalie Arians
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and
Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and
Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonathan W. Lischalk
- Department of Radiation Oncology,
Perlmutter Cancer Center, New York University Langone Health, New York, NY,
USA
| | - Felix K.F. Kommoss
- Department of Pathology, Institute of
Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
- Heidelberg Ion Therapy Center (HIT),
Heidelberg, Germany
- Clinical Cooperation Unit Radiation
Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
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8
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Angeles MA, Boria F, Shushkevich AB, Bizzarri N, Theofanakis C, Schivardi G, Kacperczyk-Bartnik J, Strojna AN, Bilir E, Mahner S, Gultekin M, Cibula D, Rodolakis A, Lorusso D, Mirza MR, Fagotti A, Ledermann J, Fotopoulou C, Ramirez PT. Interviews conducted at the European Society of Gynaecological Oncology 2022 Congress: a ENYGO-IJGC Fellows initiative. Int J Gynecol Cancer 2022; 33:ijgc-2022-004160. [PMID: 36600507 DOI: 10.1136/ijgc-2022-004160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de Chirurgie, Toulouse, France
| | - Felix Boria
- Gynecologic Unit, Clinica Universidad de Navarra, Madrid, Spain
| | - Alexander B Shushkevich
- Institute of Biology and Medicine, Taras Shevchenko National University of Kyiv, Kiiv, Ukraine
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Universitario Agostino Gemelli Dipartimento Scienze della Salute della Donna e del Bambino, Rome, Italy
| | - Charalampos Theofanakis
- Unit of Gynaecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriella Schivardi
- Department of Gynecology, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | | | - Aleksandra Natalia Strojna
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany, Pomeranian Medical University in Szczecin, Essen, Germany
| | - Esra Bilir
- Department of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey
- Department of Global Health, Koc University Graduate School of Health Sciences, Istanbul, Turkey
| | - Sven Mahner
- AGO and Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Murat Gultekin
- Cancer Control Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Alexandros Rodolakis
- Unit of Gynaecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Domenica Lorusso
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Universitario Agostino Gemelli Dipartimento Scienze della Salute della Donna e del Bambino, Rome, Italy
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Universitario Agostino Gemelli Dipartimento Scienze della Salute della Donna e del Bambino, Rome, Italy
| | | | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Shen Y, Meng X, Wang L, Wang X, Chang H. Advanced primary vaginal squamous cell carcinoma: A case report and literature review. Front Immunol 2022; 13:1007462. [PMID: 36483563 PMCID: PMC9722770 DOI: 10.3389/fimmu.2022.1007462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Vaginal carcinoma is a gynecological malignancy with low incidence, and there are few relevant and specific guidelines for vaginal cancer in our country and abroad. Here, we report the case who was diagnosed with advanced, primary vaginal squamous cell carcinoma and underwent integrated treatment successfully. Case introduction A 64-year-old Chinese woman underwent subtotal hysterectomy for uterine fibroids in 1998 and laparoscopic extensive residual cervical resection, bilateral ovarian salpingectomy, and pelvic lymph node dissection for residual cervical adenocarcinoma (stage IB1) in the First Affiliated Hospital of China Medical University in 2018. There was no postoperative review. The patient experienced vaginal discharge in March 2020, and vaginal bleeding occurred in July 2020. Our patient was diagnosed with stage IVA vaginal squamous cell carcinoma, based on a gynecological examination, colposcopy biopsy with histopathological examination, computed tomography scan, and tumor marker levels by two professors. After three phases of treatment (sequential treatment with chemotherapy plus radiotherapy, chemotherapy combined with immune checkpoint inhibitors, and immune checkpoint inhibitors combined with tyrosine kinase inhibitors therapy), her condition improved. Her current state is generally good, and she has achieved complete remission. Conclusion We report a rare case of a patient with primary advanced vaginal carcinoma combined with cervical adenocarcinoma. The patient was treated for approximately 2 years, and her personalized treatment showed promising results. We will continue to follow up with the patient and monitor her response to the current treatment process.
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10
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Zhou WL, Yue YY. Trends in the Incidence of Vulvar and Vaginal Cancers With Different Histology by Race, Age, and Region in the United States (2001–2018). Int J Public Health 2022; 67:1605021. [PMID: 36105176 PMCID: PMC9464823 DOI: 10.3389/ijph.2022.1605021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: The race, age, and region-stratified incidence of vulvar (VUC) and vaginal (VAC) cancers with different histology were unclear. Methods: Data was retrieved from the United States Cancer Statistics database. Average annual percent change (AAPC) and incidence rate ratio (IRR) were calculated. Results: Overall, VUC incidence increased from 18.3 (per 1,000,000 woman-years) to 19.6, but VAC incidence decreased from 5.6 to 4.4. VUC squamous cell carcinoma (SCC) incidence increased (AAPC, 0.96; 95% CI, 0.66–1.25), VUC adenocarcinoma (ADE) incidence stabilized (AAPC, −0.24; 95% CI, −1.44 to 0.98), and VUC other malignancies (OM) incidence decreased (AAPC, −1.31; 95% CI, −2.58 to −0.02). While VAC incidence decreased for any histology (AAPC, -0.63; 95% CI, −1.03 to −0.22; AAPC, −1.60; 95% CI, −2.80 to −0.39; and AAPC, −1.57; 95% CI, −2.24 to −0.89 for SCC, ADE, and OM). Similar trends were observed in most of the stratifications. Conclusion: VUC and VAC incidences varied by histology overall and within stratifications by race, age, and region. The incidence decreased for VUC and VAC with all histologies, except for the increasing VUC SCC incidence.
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Affiliation(s)
- Wei-Li Zhou
- Department of General Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Yang-Yang Yue
- Department of Health Management, ShengJing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yang-Yang Yue,
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11
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Zhou WL, Yue YY. Development and validation of models for predicting the overall survival and cancer-specific survival of patients with primary vaginal cancer: A population-based retrospective cohort study. Front Med (Lausanne) 2022; 9:919150. [PMID: 36106318 PMCID: PMC9464817 DOI: 10.3389/fmed.2022.919150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background No models have been developed to predict the survival probability for women with primary vaginal cancer (VC) due to VC’s extreme rareness. We aimed to develop and validate models to predict the overall survival (OS) and cancer-specific survival (CSS) of VC patients. Methods A population-based multicenter retrospective cohort study was carried out using the 2004–2018 Surveillance, Epidemiology, and End Results Program database in the United States. The final multivariate Cox model was identified using the Brier score and Harrell’s C concordance statistic (C-statistic). The decision curve, calibration plot, and area under the time-dependent receiver operating characteristic curve (AUC) were used to evaluate model prediction performance. Multiple imputation followed by bootstrap was performed. Bootstrap validation covered the entire statistic procedure from model selection to baseline survival and coefficient calculation. Nomograms predicting OS and CSS were generated. Results Of the 2,417 eligible patients, 1,692 and 725 were randomly allocated to the training and validation cohorts. The median age (Interquartile range) was 66 (56–78) and 65 (55–76) for the two cohorts, respectively. Our models had larger net benefits in predicting the survival of VC patients than the American Joint Committee on Cancer stage, presenting great discrimination ability and excellent agreement between the expected and observed events. The performance metrics of our models were calculated in three cohorts: the training cohort, complete cases of the validation cohort, and the imputed validation cohort. For the OS model in the three cohorts, the C-statistics were 0.761, 0.752, and 0.743. The slopes of the calibration plots were 1.017, 1.005, and 0.959. The 3- and 5-year AUCs were 0.795 and 0.810, 0.768 and 0.771, and 0.770 and 0.767, respectively. For the CSS model in the three cohorts, the C-statistics were 0.775, 0.758, and 0.755. The slopes were 1.021, 0.939, and 0.977. And the 3- and 5-year AUCs were 0.797 and 0.793, 0.786 and 0.788, and 0.757 and 0.757, respectively. Conclusion We were the first to develop and validate exemplary survival prediction models for VC patients and generate corresponding nomograms that allow for individualized survival prediction and could assist clinicians in performing risk-adapted follow-up and treatment.
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Affiliation(s)
- Wei-Li Zhou
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yang-Yang Yue
- Department of Health Management, Shengjing Hospital, China Medical University, Shenyang, China
- *Correspondence: Yang-Yang Yue,
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12
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Baral SK, Biswas P, Kaium MA, Islam MA, Dey D, Saber MA, Rahaman TI, M A, Emran TB, Hasan MN, Jeong MK, Han I, Rahman MA, Kim B. A Comprehensive Discussion in Vaginal Cancer Based on Mechanisms, Treatments, Risk Factors and Prevention. Front Oncol 2022; 12:883805. [PMID: 35924174 PMCID: PMC9341270 DOI: 10.3389/fonc.2022.883805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/23/2022] [Indexed: 12/27/2022] Open
Abstract
Vaginal cancer is a rare and uncommon disease that is rarely discussed. Although vaginal cancer traditionally occurs in older postmenopausal women, the incidence of high-risk human papillomavirus (HPV)-induced cancers is increasing in younger women. Cervical cancer cells contain high-risk human papillomavirus (HPV) E6 and E7 proteins and inhibiting HPV gene expression leads the cells to stop proliferating and enter senescence. As E6, and E7 protein promoted the carcinogenesis mechanism, and here not only regulate the cellular degradation of P53, and pRb but also enhances the cell proliferation along with E6 protein targets the p53 for breakdown and subsequently promote the apoptotic cell death, and DNA repair inhibition, that is indispensable to the continue the lifecycle of the HPV. As a synchronous or metachronous tumor, vaginal cancer is frequently found in combination with cervical cancer. It is uncertain what causes invasive female vaginal organ cancer. HPV type 16 is the most often isolated HPV type in female vaginal organ cancers. Due to cancer’s rarity, case studies have provided the majority of etiologic findings. Many findings demonstrate that ring pessaries, chronic vaginitis, sexual behavior, birth trauma, obesity, vaginal chemical exposure, and viruses are all risk factors. Because of insufficient understanding and disease findings, we are trying to find the disease’s mechanism with the available data. We also address different risk factors, therapy at various stages, diagnosis, and management of vaginal cancer in this review.
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Affiliation(s)
| | - Partha Biswas
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Science and Technology, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
- ABEx Bio-Research Center, Dhaka, Bangladesh
| | - Md. Abu Kaium
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Science and Technology, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Md. Aminul Islam
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Science and Technology, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Dipta Dey
- Biochemistry and Molecular Biology department, Life Science faculty, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalgonj, Bangladesh
| | - Md Al Saber
- Biotechnology, University of Pécs, Medical School, Pécs, Hungary
| | - Tanjim Ishraq Rahaman
- Department of Biotechnology and Genetic Engineering, Faculty of Life Science, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - A. M
- Department of Microbiology, Chittagong University, Chittagong, Bangladesh
| | - Talha Bin Emran
- Department of Pharmacy, Begum Gulchemonara (BGC) Trust University Bangladesh, Chittagong, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Md. Nazmul Hasan
- Laboratory of Pharmaceutical Biotechnology and Bioinformatics, Department of Genetic Engineering and Biotechnology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Mi-Kyung Jeong
- Korean Medicine (KM) Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ihn Han
- Plasma Bioscience Research Center, Kwangwoon University, Seoul, South Korea
| | - Md. Ataur Rahman
- Global Biotechnology & Biomedical Research Network (GBBRN), Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia, Bangladesh
- Department of Pathology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Korean Medicine-Based Drug Repositioning Cancer Research Center, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- *Correspondence: Md. Ataur Rahman, ; Bonglee Kim,
| | - Bonglee Kim
- Department of Pathology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Korean Medicine-Based Drug Repositioning Cancer Research Center, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- *Correspondence: Md. Ataur Rahman, ; Bonglee Kim,
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13
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Vieira GV, Somera dos Santos F, Lepique AP, da Fonseca CK, Innocentini LMAR, Braz-Silva PH, Quintana SM, Sales KU. Proteases and HPV-Induced Carcinogenesis. Cancers (Basel) 2022; 14:cancers14133038. [PMID: 35804810 PMCID: PMC9264903 DOI: 10.3390/cancers14133038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Human papillomavirus (HPV) infection is a sexually transmitted disease with high prevalence worldwide. Although most HPV infections do not lead to cancer, some HPV types are correlated with the majority of cervical cancers, and with some anogenital and oropharyngeal cancers. Moreover, enzymes known as proteases play an essential role in the pathogenic process in HPV-induced carcinogenesis. This review highlights the role of proteases and recent epidemiological data regarding HPV-dependent carcinogenesis. Abstract Persistent infection with Human papillomavirus (HPV) is the main etiologic factor for pre-malignant and malignant cervical lesions. Moreover, HPV is also associated with oropharynx and other anogenital carcinomas. Cancer-causing HPV viruses classified as group 1 carcinogens include 12 HPV types, with HPV 16 and 18 being the most prevalent. High-risk HPVs express two oncoproteins, E6 and E7, the products of which are responsible for the inhibition of p53 and pRB proteins, respectively, in human keratinocytes and cellular immortalization. p53 and pRB are pleiotropic proteins that regulate the activity of several signaling pathways and gene expression. Among the important factors that are augmented in HPV-mediated carcinogenesis, proteases not only control processes involved in cellular carcinogenesis but also control the microenvironment. For instance, genetic polymorphisms of matrix metalloproteinase 1 (MMP-1) are associated with carcinoma invasiveness. Similarly, the serine protease inhibitors hepatocyte growth factor activator inhibitor-1 (HAI-1) and -2 (HAI-2) have been identified as prognostic markers for HPV-dependent cervical carcinomas. This review highlights the most crucial mechanisms involved in HPV-dependent carcinogenesis, and includes a section on the proteolytic cascades that are important for the progression of this disease and their impact on patient health, treatment, and survival.
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Affiliation(s)
- Gabriel Viliod Vieira
- Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (G.V.V.); (C.K.d.F.); (L.M.A.R.I.)
| | - Fernanda Somera dos Santos
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (F.S.d.S.); (S.M.Q.)
| | - Ana Paula Lepique
- Department of Immunology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo 05508-000, SP, Brazil;
| | - Carol Kobori da Fonseca
- Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (G.V.V.); (C.K.d.F.); (L.M.A.R.I.)
| | - Lara Maria Alencar Ramos Innocentini
- Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (G.V.V.); (C.K.d.F.); (L.M.A.R.I.)
- Clinical Hospital of Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Paulo Henrique Braz-Silva
- Department of Stomatology, School of Dentistry, University of Sao Paulo, São Paulo 05508-000, SP, Brazil;
- Laboratory of Virology, Institute of Tropical Medicine of Sao Paulo, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (F.S.d.S.); (S.M.Q.)
| | - Katiuchia Uzzun Sales
- Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil; (G.V.V.); (C.K.d.F.); (L.M.A.R.I.)
- Correspondence: ; Tel.: +55-16-3315-9113
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14
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Kulkarni A, Dogra N, Zigras T. Innovations in the Management of Vaginal Cancer. Curr Oncol 2022; 29:3082-3092. [PMID: 35621640 PMCID: PMC9139564 DOI: 10.3390/curroncol29050250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022] Open
Abstract
Primary vaginal cancer is a rare gynecologic malignancy. Given the rarity of the disease, standardized approaches to management are limited, and a great variety of therapeutic conditions are endorsed. This paper reviews advances in surgical approaches, radiation, chemoradiation, and immunotherapy. Advances in surgical management including the increasing use of laparoscopic and endoscopic approaches, as well as the novel techniques in vaginal reconstruction, are reviewed. Concurrent chemoradiation remains a mainstay of treatment for vaginal cancer and has improved local control of disease and overall survival. Additionally, with metastatic disease or situations where toxicity from CCRT is unacceptable, systemic therapies including immunotherapy approaches are reviewed.
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Affiliation(s)
- Anjali Kulkarni
- Division of Gynecologic Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Nupur Dogra
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada;
| | - Tiffany Zigras
- Trillium Health Partners, Division of Gynecologic Oncology, Mississauga, ON L5M 2N1, Canada
- Correspondence:
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15
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Jhingran A. Updates in the treatment of vaginal cancer. Int J Gynecol Cancer 2022; 32:344-351. [PMID: 35256422 PMCID: PMC8921584 DOI: 10.1136/ijgc-2021-002517] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
Vaginal cancer is a rare cancer. A lot of the data used in the treatment of this cancer are extrapolated from cervical cancer data. Radiation therapy plays a significant role in the treatment of vaginal cancer. The advances in radiation therapy in both external beam and brachytherapy have improved local control, survival, and toxicity. Brachytherapy plays an important role in treating vaginal cancer, but treatment should be individualized to each tumor. Imaging, particularly magnetic resonance imaging, plays an essential role in the management of patients with vaginal cancer, from diagnosis to staging to treatment management to surveillance.
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Affiliation(s)
- Anuja Jhingran
- Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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16
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Barcellini A, Mirandola A, Fiore M, Orlandi E, Cobianchi L. Omentum flap as a spacer before carbon ion radiotherapy for gynecological recurrences. A technical note. Cancer Radiother 2022; 26:599-603. [DOI: 10.1016/j.canrad.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 10/18/2022]
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17
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Ranhem C, Larsson GL, Lindqvist D, Sorbe B, Karlsson MG, Farnebo M, Hellman K, Kovaleska L, Kashuba E, Andersson S. Evaluation of dyskerin expression and the Cajal body protein WRAP53β as potential prognostic markers for patients with primary vaginal carcinoma. Oncol Lett 2021; 23:30. [PMID: 34868367 PMCID: PMC8630817 DOI: 10.3892/ol.2021.13148] [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] [Received: 04/01/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
Abstract
Primary vaginal cancer (PVC) is a rare gynaecological malignancy, which, at present, lacks appropriate biomarkers for prognosis. The proteins dyskerin and WD repeat containing antisense to TP53 (WRAP53β), both of which exert their functions in the telomerase holoenzyme complex, have been shown to be upregulated in different cancer types. These proteins have also been proposed as prognostic markers in some types of cancer. The aim of the present study was to examine the expression patterns of dyskerin and WRAP53β in patients with PVC. Moreover, as part of a search for effective biomarkers to evaluate prognosis in PVC, the expression of these two proteins and their potential association with clinical variables and survival were also evaluated. The expression of dyskerin and WRAP53β was assessed in PVC tumour samples from 68 patients using immunohistochemistry. The majority of tumour samples showed low and moderate expression levels of dyskerin. Upregulation of dyskerin in tumour samples was significantly associated with a shorter survival time and a poorer cancer-specific survival rate. WRAP53β was also expressed in most of the cells but was not significantly associated with clinical variables or survival. This study demonstrates that upregulation of dyskerin is significantly associated with poor prognosis. Thus, dyskerin may serve as a promising prognostic marker and a potential putative therapeutic target in PVC.
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Affiliation(s)
- Cecilia Ranhem
- Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden.,Centre for Clinical Research Region Västmanland, Uppsala University, Västmanlands Hospital Västerås, 721 89 Västerås, Sweden
| | - Gabriella Lillsunde Larsson
- School of Health and Medical Sciences, Örebro University, Campus USÖ, 701 82 Örebro, Sweden.,Department of Laboratory Medicine, Örebro University Hospital, 701 85 Örebro, Sweden
| | - David Lindqvist
- Department of Radiation Sciences, Umeå Universitet, 901 87 Umeå, Sweden
| | - Bengt Sorbe
- Department of Oncology, Örebro University Hospital, 701 85 Örebro, Sweden
| | - Mats G Karlsson
- School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden
| | - Marianne Farnebo
- Department of Bioscience and Nutrition, Karolinska Institutet, 141 83 Stockholm, Sweden.,Department of Cell and Molecular Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Kristina Hellman
- Department of Oncology-Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden
| | - Larysa Kovaleska
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology of National Academy of Sciences of Ukraine, 03022 Kiev, Ukraine
| | - Elena Kashuba
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology of National Academy of Sciences of Ukraine, 03022 Kiev, Ukraine.,Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden
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18
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Kilcoyne A, Gottumukkala RV, Kang SK, Akin EA, Hauck C, Hindman NM, Huang C, Khanna N, Paspulati R, Rauch GM, Said T, Shinagare AB, Stein EB, Venkatesan AM, Maturen KE. ACR Appropriateness Criteria® Staging and Follow-up of Primary Vaginal Cancer. J Am Coll Radiol 2021; 18:S442-S455. [PMID: 34794599 DOI: 10.1016/j.jacr.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
Primary vaginal cancer is rare, comprising 1% to 2% of gynecologic malignancies and 20% of all malignancies involving the vagina. More frequently, the vagina is involved secondarily by direct invasion from malignancies originating in adjacent organs or by metastases from other pelvic or extrapelvic primary malignancies. Data on the use of imaging in vaginal cancer are sparse. Insights are derived from the study of imaging in cervical cancer and have reasonable generalizability to vaginal cancer due to similar tumor biology. Given the trend toward definitive chemoradiation for both cancers in all but early stage lesions, principles of postchemoradiation tumor response evaluation are largely analogous. Accordingly, many of the recommendations outlined here are informed by principles translated from the literature on cervical cancer. For pretreatment assessment of local tumor burden and in the case of recurrent vaginal cancer, MRI is the preferred imaging modality. PET/CT has demonstrated utility for the detection of nodal metastatic and unexpected distant metastatic disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Aoife Kilcoyne
- Panel Vice Chair, Massachusetts General Hospital, Boston, Massachusetts.
| | | | - Stella K Kang
- Panel Chair, New York University Medical Center, New York, New York
| | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; ABNM Board Member; and IAC Board Member
| | - Carlin Hauck
- Sutter Medical Center Sacramento, Sacramento, California
| | - Nicole M Hindman
- Associate Chair, Diversity & Health Equity, MR Safety Officer, and Director, Female Pelvic Imaging, New York University Medical Center, New York, New York; and Fellow Rep., Board of the Society for Advanced Body Imaging
| | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Namita Khanna
- Emory University, Atlanta, Georgia; Society of Gynecologic Oncology
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tamer Said
- Program Director, Family Medicine Residency Program, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Primary care physician
| | - Atul B Shinagare
- Chief, Abdominal Imaging and Intervention, Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Erica B Stein
- Director, Body CT, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Katherine E Maturen
- Specialty Chair, University of Michigan, Ann Arbor, Michigan; and Member, Society of Abdominal Radiology Board of Directors
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19
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Abstract
Diagnosis of a primary vaginal cancer is rare, as most vaginal tumors are metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This is associated with persistence of high‐risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, as with cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer. A review of the different histologic subtypes of primary vaginal cancer in terms of staging and role of imaging, as well as treatment options and prognoses.
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Affiliation(s)
- Tracey S Adams
- Department of Gynecological Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council University of Cape Town Gynecological Cancer Research Centre (SA MRC UCT GCRC), Cape Town, South Africa.,University of Cape Town Global Surgery, Cape Town, South Africa
| | - Linda J Rogers
- Department of Gynecological Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council University of Cape Town Gynecological Cancer Research Centre (SA MRC UCT GCRC), Cape Town, South Africa
| | - Mauricio A Cuello
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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20
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Tomita Y, Takabayashi E, Yuzawa S, Okizaki A. Superficial myofibroblastoma of the vagina with a stalk: case report of a rare vaginal tumor with notable radiological findings. Radiol Case Rep 2021; 16:3690-3694. [PMID: 34630802 PMCID: PMC8493509 DOI: 10.1016/j.radcr.2021.08.064] [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: 07/21/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 01/24/2023] Open
Abstract
Superficial myofibroblastoma is a rare benign mesenchymal tumor which predominantly occurs in the female lower genital tract. Here we present a case of a 42-year-old female patient with prolonged vaginal bleeding. Radiological imaging revealed a well circumscribed mass in the vagina with a stalk. The patient underwent surgery and the tumor was histologically diagnosed as superficial myofibroblastoma. Notably, this is the first report of the radiological imaging of a superficial myofibroblastoma harboring a stalk arising from the vaginal wall. We compared the radiological images with histological findings and discuss major differential diagnosis of vaginal tumors. Despite the challenging nature of preoperative diagnosis of mesenchymal vaginal tumors, radiological features may aid in differentiating them from other more aggressive entities or malignant tumors.
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Affiliation(s)
- Yui Tomita
- Department of Radiology, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
- Corresponding author.
| | - Eriko Takabayashi
- Department of Radiology, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
- Yoshida Hospital, 4jyo-Nishi4-1-2, Asahikawa, Hokkaido, 070-0054, Japan
| | - Sayaka Yuzawa
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Atsutaka Okizaki
- Department of Radiology, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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21
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Rasmussen CL, Bertoli HK, Sand FL, Kjaer AK, Thomsen LT, Kjaer SK. The prognostic significance of HPV, p16, and p53 protein expression in vaginal cancer: A systematic review. Acta Obstet Gynecol Scand 2021; 100:2144-2156. [PMID: 34546565 DOI: 10.1111/aogs.14260] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV), p16, and p53 have been investigated as prognostic markers in various HPV-related cancers. Within the field of vaginal cancer, however, the evidence remains sparse. In this systematic review, we have compiled the presently published studies on the prognostic significance of HPV and immunohistochemical expression of p16 and p53 among women with vaginal cancer. MATERIAL AND METHODS We conducted a systematic search of PubMed, Embase, and Cochrane Library to identify relevant studies published until April 2021. We included studies reporting survival after histologically verified vaginal cancers tested for HPV, p16, and/or p53. Survival outcomes included overall survival, disease-free survival, disease-specific survival, and progression-free survival. RESULTS We included a total of 12 studies. The vast majority of vaginal cancer cases included in each study were squamous cell carcinomas (84%-100%). Seven studies reported survival after vaginal cancer according to HPV status, and the majority of these studies found a tendency towards improved survival for women with HPV-positive vaginal cancer. Three out of four studies reporting survival according to p16 status found an improved survival among women with p16-positive vaginal cancer. For p53, only one of six studies reported an association between p53 expression and survival. CONCLUSIONS This systematic review suggests that women with HPV- and p16-positive vaginal cancer have an improved prognosis compared with those with HPV- or p16-negative vaginal cancer. Results for p53 were varied, and no conclusion could be reached. Only 12 studies could be included in the review, of which most were based on small populations. Hence, further and larger studies on the prognostic impact of HPV, p16, and p53 in vaginal cancer are warranted.
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Affiliation(s)
- Christina L Rasmussen
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Hanna K Bertoli
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Freja L Sand
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Alexander K Kjaer
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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22
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Rosalik K, Tarney C, Han J. Human Papilloma Virus Vaccination. Viruses 2021; 13:v13061091. [PMID: 34201028 PMCID: PMC8228159 DOI: 10.3390/v13061091] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 12/30/2022] Open
Abstract
Human papilloma virus (HPV) is the most common sexually transmitted infection worldwide causing a variety of benign and malignant conditions. A significant portion of the global population is infected with HPV, with the virus attributed to causing up to 5% of cancers worldwide. Bivalent, quadrivalent, and nine-valent vaccinations exist to aid in the prevention of these diseases and have been proven to be effective at preventing both benign and malignant disease. While vaccination is readily accessible in more developed countries, barriers exist to worldwide distribution and acceptance of vaccination. Vaccination and screening of HPV infection when used in combination are proven and predicted to decrease HPV related pathology. Improvements in vaccination formulations, for treatment as well as prevention, are actively being sought from a variety of mechanisms. Despite these advancements, and the data supporting their efficacy, there has been substantial delay in obtaining adequate vaccination coverage. In reviewing these challenges and looking forward to new vaccine development—especially within the current pandemic—it is clear from the challenges of HPV we require methods to more effectively encourage vaccination, ways to dispel vaccination myths as they occur, and implement better processes for vaccine distribution globally.
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Affiliation(s)
- Kendal Rosalik
- Madigan Army Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA;
- Correspondence:
| | - Christopher Tarney
- Madigan Army Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA;
| | - Jasmine Han
- General Leonard Wood Army Community Hospital, Department of Obstetrics and Gynecology, 4430 Missouri Ave, Ford Leonard Wood, MO 65473, USA;
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Barcellini A, Ditto A, Mirandola A, Roccio M, Imparato S, Raspagliesi F, Orlandi E. Is a tailored strategy using proton beam radiotherapy for reirradiation advantageous for elderly women? A case report. TUMORI JOURNAL 2021; 107:NP67-NP72. [PMID: 33896256 DOI: 10.1177/03008916211007930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The management of primary or recurrent vaginal tumours in an aging population is challenging for gynecologic and radiation oncologists. In patients unsuited for surgery and already irradiated on the pelvis, proton beam radiotherapy may be worthwhile due to its ballistic advantages. CASE REPORT We report the case of an 80-year-old woman with a squamous cell carcinoma of the vagina after a history of pelvic radiation and vaginal brachytherapy delivered for a previous endometrial adenocarcinoma. She received proton beam radiotherapy with a complete response after 12 months and mild toxicity. CONCLUSIONS The complexity of reirradiation management in the frail and elderly population requires attention. Efforts should be focused on maintaining autonomy and quality of life in order to improve adherence and clinical compliance to the treatment. In the era of the tailored approach, hadrontherapy can play an important role to minimize toxicity, obtain good local control, and reduce the overall treatment time.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Antonino Ditto
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - Alfredo Mirandola
- Medical Physics, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Marianna Roccio
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Sara Imparato
- Diagnostic Imaging Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | - Ester Orlandi
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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Wang X, Praça MSL, Wendel JRH, Emerson RE, DeMayo FJ, Lydon JP, Hawkins SM. Vaginal Squamous Cell Carcinoma Develops in Mice with Conditional Arid1a Loss and Gain of Oncogenic Kras Driven by Progesterone Receptor Cre. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1281-1291. [PMID: 33882289 DOI: 10.1016/j.ajpath.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/26/2021] [Accepted: 03/19/2021] [Indexed: 12/16/2022]
Abstract
Oncogenic KRAS mutations are a common finding in endometrial cancers. Recent sequencing studies indicate that loss-of-function mutations in the ARID1A gene are enriched in gynecologic malignant tumors. However, neither of these genetic insults alone are sufficient to develop gynecologic cancer. To determine the role of the combined effects of deletion of Arid1a and oncogenic Kras, Arid1aflox/flox mice were crossed with KrasLox-Stop-Lox-G12D/+ mice using progesterone receptor Cre (PgrCre/+). Histologic analysis and immunohistochemistry of survival studies were used to characterize the mutant mouse phenotype. Hormone dependence was evaluated by ovarian hormone depletion and estradiol replacement. Arid1aflox/flox; KrasLox-Stop-Lox-G12D/+; PgrCre/+ mice were euthanized early because of invasive vaginal squamous cell carcinoma. Younger mice had precancerous intraepithelial lesions. Immunohistochemistry supported the pathological diagnosis with abnormal expression and localization of cytokeratin 5, tumor protein P63, cyclin-dependent kinase inhibitor 2A, and Ki-67, the marker of proliferation. Ovarian hormone deletion in Arid1aflox/flox; KrasLox-Stop-Lox-G12D/+; PgrCre/+ mice resulted in atrophic vaginal epithelium without evidence of vaginal tumors. Estradiol replacement in ovarian hormone-depleted Arid1aflox/flox; KrasLox-Stop-Lox-G12D/+; PgrCre/+ mice resulted in lesions that resembled the squamous cell carcinoma in intact mice. Therefore, this mouse can be used to study the transition from benign precursor lesions into invasive vaginal human papillomavirus-independent squamous cell carcinoma, offering insights into progression and pathogenesis of this rare disease.
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Affiliation(s)
- Xiyin Wang
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mariana S L Praça
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jillian R H Wendel
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert E Emerson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Francesco J DeMayo
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - John P Lydon
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Shannon M Hawkins
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana.
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25
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[Interdisciplinary S2k guidelines on the diagnosis and treatment of vaginal carcinoma and its precursors-recommendations on surgical pathology for histopathological workup, diagnostics, and reporting]. DER PATHOLOGE 2021; 42:116-124. [PMID: 33346872 DOI: 10.1007/s00292-020-00876-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary vaginal carcinoma is rare. There are two pathogenetic pathways, one associated with HPV high-risk infection and another one with inactivation of p53. Vaginal Paget's disease is rare and mostly associated with vulvar disease or represents intravaginal spread of associated locoregional cancer. Diagnostic vaginal biopsies should be examined by step sections on H&E. Sentinel lymph nodes should be processed completely using ultrastaging. Morphology-based prognostic factors with good clinical evidence are tumour stage and lymph node status. Molecular markers are not currently relevant for treatment decision and prognosis.
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26
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Gupta N, Patel BM, Dave P, Warikoo V, Saraiya H. Managing a Rare Case of Primary Mucinous Adenocarcinoma of the Vagina at a Tertiary Cancer Center. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nidhi Gupta
- Gynecology Oncology Department, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Bijal M. Patel
- Gynecology Oncology Department, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Pariseema Dave
- Gynecology Oncology Department, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Vikas Warikoo
- Surgical Oncology Department, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Hemant Saraiya
- Surgical Oncology Department, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Zhou WL, Yue YY. Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study. Front Oncol 2020; 10:570933. [PMID: 33392073 PMCID: PMC7775586 DOI: 10.3389/fonc.2020.570933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background The efficacy of radiotherapy plus chemotherapy (RTCT) versus radiotherapy alone (RT) in the treatment of primary vaginal carcinoma has been controversial. We aimed to evaluate the up-to-date efficacy of RTCT on primary vaginal carcinoma in a real-world cohort. Methods We performed a retrospective analysis in patients with primary vaginal carcinoma retrieved from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Kaplan-Meier survival curves were plotted and compared by the log-rank test. Inverse probability weighting (IPW)-adjusted multivariate Cox proportional hazards and Fine-Gray competing-risk model was applied. Results Of the 1,813 qualified patients with primary vaginal carcinoma from 2004 to 2016, 1,137 underwent RTCT and 676 underwent RT. The median survival time was 34 months for the RT group and 63 months for the RTCT group. RTCT was significantly associated with improved overall survival (unadjusted HR = 0.71, 95% CI 0.62-0.82, p < 0.001; adjusted HR = 0.73, 95% CI 0.63-0.84, p < 0.001) and cancer-specific survival (unadjusted sHR = 0.81, 95% CI 0.69-0.95, p = 0.012; adjusted sHR = 0.81, 95% CI 0.69-0.96, p = 0.016). Age, histological type, tumor size, surgery, and FIGO stage were all independent prognostic factors for survival (p < 0.05 for all). Subgroup analysis demonstrated that RTCT was significantly associated with better survival in most subgroups, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I. Moreover, sensitivity analysis did not alter the beneficial effects of RTCT. Conclusion RTCT is significantly correlated with prolonged survival in patients with primary vaginal carcinoma. RTCT should be applied to most patients with primary vaginal carcinoma instead of RT alone, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I.
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Affiliation(s)
- Wei-Li Zhou
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang-Yang Yue
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
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Sonoda K, Okadome M, Sugimoto R, Fujimoto T, Taguchi K, Saito T. Diagnostic benefit of cytological and histopathological examinations for recurrent vaginal cancer metastasizing to the duodenum: A case report. Clin Case Rep 2020; 8:2907-2913. [PMID: 33363849 PMCID: PMC7752391 DOI: 10.1002/ccr3.3288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022] Open
Abstract
This is the first case report of a vaginal squamous cell carcinoma that metastasized to the duodenum. Cytological and histopathological examinations are useful for the diagnosis of a duodenal metastasis.
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Affiliation(s)
- Kenzo Sonoda
- Gynecology ServiceNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Masao Okadome
- Gynecology ServiceNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Rie Sugimoto
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Takahiro Fujimoto
- Department of PathologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Kenichi Taguchi
- Department of PathologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Toshiaki Saito
- Gynecology ServiceNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
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29
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Goncalves A, Soper B, Nygård M, Nygård JF, Ray P, Widemann D, Sales AP. Improving five-year survival prediction via multitask learning across HPV-related cancers. PLoS One 2020; 15:e0241225. [PMID: 33196642 PMCID: PMC7668590 DOI: 10.1371/journal.pone.0241225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/11/2020] [Indexed: 12/12/2022] Open
Abstract
Oncology is a highly siloed field of research in which sub-disciplinary specialization has limited the amount of information shared between researchers of distinct cancer types. This can be attributed to legitimate differences in the physiology and carcinogenesis of cancers affecting distinct anatomical sites. However, underlying processes that are shared across seemingly disparate cancers probably affect prognosis. The objective of the current study is to investigate whether multitask learning improves 5-year survival cancer patient survival prediction by leveraging information across anatomically distinct HPV related cancers. Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program database. The study cohort consisted of 29,768 primary cancer cases diagnosed in the United States between 2004 and 2015. Ten different cancer diagnoses were selected, all with a known association with HPV risk. In the analysis, the cancer diagnoses were categorized into three distinct topography groups of varying specificity. The most specific topography grouping consisted of 10 original cancer diagnoses differentiated by the first two digits of the ICD-O-3 topography code. The second topography grouping consisted of cancer diagnoses categorized into six distinct organ groups. Finally, the third topography grouping consisted of just two groups, head-neck cancers and ano-genital cancers. The tasks were to predict 5-year survival for patients within the different topography groups using 14 predictive features which were selected among descriptive variables available in the SEER database. The information from the predictive features was shared between tasks in three different ways, resulting in three distinct predictive models: 1) Information was not shared between patients assigned to different tasks (single task learning); 2) Information was shared between all patients, regardless of task (pooled model); 3) Only relevant information was shared between patients grouped to different tasks (multitask learning). Prediction performance was evaluated with Brier scores. All three models were evaluated against one another on each of the three distinct topography-defined tasks. The results showed that multitask classifiers achieved relative improvement for the majority of the scenarios studied compared to single task learning and pooled baseline methods. In this study, we have demonstrated that sharing information among anatomically distinct cancer types can lead to improved predictive survival models.
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Affiliation(s)
- Andre Goncalves
- Lawrence Livermore National Laboratory, Livermore, CA, United States of America
| | - Braden Soper
- Lawrence Livermore National Laboratory, Livermore, CA, United States of America
| | | | | | - Priyadip Ray
- Lawrence Livermore National Laboratory, Livermore, CA, United States of America
| | - David Widemann
- Lawrence Livermore National Laboratory, Livermore, CA, United States of America
| | - Ana Paula Sales
- Lawrence Livermore National Laboratory, Livermore, CA, United States of America
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30
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Pelvic Exenteration for Primary Advanced and Recurrent Vaginal Cancer: Clinical Outcome for 37 Patients. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Zhou W, Yue Y, Pei D. Survival benefit of vaginectomy compared to local tumor excision in women with FIGO stage I and II primary vaginal carcinoma: a SEER study. Arch Gynecol Obstet 2020; 302:1429-1439. [PMID: 32780160 DOI: 10.1007/s00404-020-05737-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The effectiveness of vaginectomy compared to that of local tumor excision (LTE) for the International Federation of Gynecology and Obstetrics (FIGO) stage I and II vaginal carcinoma is unclear. We aimed to clarify if the effectiveness of vaginectomy is comparable to that of LTE in the real world. METHODS We retrospectively evaluated data of patients with primary vaginal carcinoma registered in the Surveillance, Epidemiology, and End Results Program (SEER) database from 2004 to 2016. The multivariate Cox proportional hazards models and Fine-Gray competing risk models were used to estimate the overall survival (OS) and disease-specific survival (DSS) after propensity score matching. RESULTS Of the 533 patients with FIGO stage I and II primary vaginal carcinoma, 243 and 290 patients were treated with vaginectomy and LTE, respectively. Vaginectomy was significantly associated with improved OS [unadjusted hazard ratio (HR) = 0.70, 95% confidence interval (CI) 0.53-0.95, P = 0.020; adjusted HR = 0.63, 95% CI 0.46-0.87, P = 0.005] and DSS [unadjusted subdistribution HR (sHR) = 0.75, 95% CI 0.52-1.07, P = 0.115; adjusted sHR = 0.65, 95% CI 0.44-0.97, P = 0.036]. Age, marital status, histology type, FIGO stage, chemotherapy, and lymph node metastases were significant prognostic factors of survival. Moreover, radiotherapy did not influence the effectiveness of vaginectomy. Subgroup and sensitivity analysis confirmed the consistent beneficial effectiveness of vaginectomy. CONCLUSION Compared with LTE, vaginectomy results in significantly prolonged survival in patients with FIGO stage I and II primary vaginal carcinoma. Thus, it can be the preferred treatment for FIGO I and II vaginal cancer regardless of radiotherapy status.
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Affiliation(s)
- Weili Zhou
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yangyang Yue
- Department of Health Management, Shengjing Hospital, China Medical University, Shenyang, China
| | - Dongmei Pei
- Department of Health Management, Shengjing Hospital, China Medical University, Shenyang, China. .,Department of Family Medicine, Shengjing Hospital, China Medical University, Shenyang, China.
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Xu Y, Li C, Wei B, Wang W. Rare case of pregnancy with vaginal adenocarcinoma. Int J Surg Case Rep 2020; 72:647-649. [PMID: 32623043 PMCID: PMC7365771 DOI: 10.1016/j.ijscr.2020.05.096] [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] [Received: 04/10/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/02/2022] Open
Abstract
Primary vaginal cancer accounts for only 3% of the female reproductive tract malignant tumors, of which primary vaginal adenocarcinoma accounts for 5%. There is no guidance for its diagnosis and treatment. For pregnant women with vaginal adenocarcinoma, comprehensive assessment and individualized treatment are needed.
Introduction Primary vaginal cancer accounts for only 3% of female reproductive tract malignant tumours, and 5% of primary vaginal cancers are adenocarcinomas. Reports of pregnancy with vaginal adenocarcinoma are very rare. There is no guidance for its diagnosis and treatment. Case presentation A 27-year-old pregnant woman who had found a vaginal tumour due to vaginal bleeding during pregnancy was diagnosed with vaginal adenocarcinoma by biopsy. The patient chose to wait to treat the cancer until after delivery at full term of pregnancy and then underwent simple vaginal tumour resection and chemotherapy. Discussion and conclusion For pregnant women with vaginal adenocarcinoma, a comprehensive assessment and an individualized treatment are needed.
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Ugwu AO, Haruna M, Okunade KS, Ohazurike E, Anorlu RI, Banjo AAF. Primary vaginal adenocarcinoma of intestinal-type: case report of a rare gynaecological tumour. Oxf Med Case Reports 2019; 2019:omz088. [PMID: 31772753 PMCID: PMC6765377 DOI: 10.1093/omcr/omz088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/23/2019] [Accepted: 07/28/2019] [Indexed: 11/14/2022] Open
Abstract
Vaginal cancer is rare and accounts for only 1 to 2% of all gynaecological malignancies. They arise as primary squamous cell cancers or are the result of extension from the cervix or vulva. Primary mucinous vaginal adenocarcinoma of intestinal-type is an extremely rare malignancy of unknown histogenesis with a diagnostic dilemma for the clinician and histopathologist. We presented the case of a 40-year-old Para 0+2 woman with the complaint of a mass in the vagina and recurrent vaginal bleeding who was evaluated and worked-up for examination under anaesthesia and biopsy of the vaginal mass. The histological examination revealed the unusual intestinal-type variant of adenocarcinoma of the vagina. Recognition of this rare entity is important, particularly to avoid the pitfall of misdiagnosing metastatic disease as primary vaginal cancer.
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Affiliation(s)
- Aloy O Ugwu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital LUTH, Idi-Araba, Lagos, Nigeria
| | - Muibat Haruna
- Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital LUTH, Idi-Araba, Lagos, Nigeria
| | - Kehinde S Okunade
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital LUTH, Idi-Araba, Lagos, Nigeria
| | - Ephraim Ohazurike
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital LUTH, Idi-Araba, Lagos, Nigeria
| | - Rose I Anorlu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital LUTH, Idi-Araba, Lagos, Nigeria
| | - Aina A F Banjo
- Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital LUTH, Idi-Araba, Lagos, Nigeria
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Schnürch HG, Ackermann S, Alt-Radtke CD, Angleitner L, Barinoff J, Beckmann MW, Böing C, Dannecker C, Fehm T, Gaase R, Gass P, Gebhardt M, Gieseking F, Günthert A, Hack CC, Hantschmann P, Horn LC, Koch MC, Letsch A, Mallmann P, Mangold B, Marnitz S, Mehlhorn G, Paradies K, Reinhardt MJ, Tholen R, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up of Vaginal Cancer and Its Precursors. Guideline of the DGGG and the DKG (S2k-Level, AWMF Registry No. 032/042, October 2018). Geburtshilfe Frauenheilkd 2019; 79:1060-1078. [PMID: 31680701 DOI: 10.1055/a-0919-4959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose This is an official guideline, published and coordinated by the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Society for Gynecology and Obstetrics (DGGG). Vaginal cancers are rare tumors, which is why there is very little evidence on these tumors. Knowledge about the optimal clinical management is limited. This first German S2k guideline on vaginal cancer has aimed to compile the most current expert knowledge and offer new recommendations on the appropriate treatment as well as providing pointers about individually adapted therapies with lower morbidity rates than were previously generally available. The purpose of this guideline is also to set up a register to record data on treatment data and the course of disease as a means of obtaining evidence in future. Methods The present S2k guideline was developed by members of the Vulvar und Vaginal Tumors Commission of the AGO in an independently moderated, structured, formal consensus process and the contents were agreed with the mandate holders of the participating scientific societies and organizations. Recommendations To optimize the daily care of patients with vaginal cancer: 1. Monitor the spread pattern; 2. Follow the step-by-step diagnostic workup based on initial stage at detection; 3. As part of individualized clinical therapeutic management of vaginal cancer, follow the sentinel lymph node protocol described here, where possible; 4. Participate in the register study on vaginal cancer.
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Affiliation(s)
| | | | - Celine D Alt-Radtke
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf, Germany
| | | | - Jana Barinoff
- St.-Gertrauden-Krankenhaus GmbH Berlin, Berlin, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Carsten Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen, Germany
| | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität München, Campus Großhadern, München, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Gaase
- Gemeinschaftspraxis für Frauenheilkunde Gaase+Hugger, Worms, Germany
| | - Paul Gass
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | | | - Friederike Gieseking
- Dysplasiesprechstunde/Gynäkologisches Laserzentrum in der Frauenarztpraxis Heussweg, Hamburg, Germany
| | | | - Carolin C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Peer Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting, Germany
| | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Anne Letsch
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Berlin, Berlin, Germany
| | - Peter Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität Köln, Köln, Germany
| | | | - Simone Marnitz
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Berlin, Germany
| | | | - Reina Tholen
- Deutscher Verband für Physiotherapie, Köln, Germany
| | - Uwe Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Wolfgang Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz, Germany
| | - Linn Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Hampl
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
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Abstract
Diagnosis of a primary vaginal cancer is rare because most of these lesions will be metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This will be associated with persistence of high-risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, similar to cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer.
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Affiliation(s)
- Tracey S Adams
- Department of Gynecological Oncology, Groote Schuur Hospital/University of Cape Town, Cape Town, South Africa.,South African Medical Research Council/University of Cape Town Gynaecological Cancer Research Centre (SA MRC/UCT GCRC), Cape Town, South Africa
| | - Mauricio A Cuello
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Haley CT, Mui UN, Vangipuram R, Rady PL, Tyring SK. Human oncoviruses: Mucocutaneous manifestations, pathogenesis, therapeutics, and prevention: Papillomaviruses and Merkel cell polyomavirus. J Am Acad Dermatol 2018; 81:1-21. [PMID: 30502418 DOI: 10.1016/j.jaad.2018.09.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022]
Abstract
In 1964, the first human oncovirus, Epstein-Barr virus, was identified in Burkitt lymphoma cells. Since then, 6 other human oncoviruses have been identified: human papillomavirus, Merkel cell polyomavirus, hepatitis B and C viruses, human T-cell lymphotropic virus-1, and human herpesvirus-8. These viruses are causally linked to 12% of all cancers, many of which have mucocutaneous manifestations. In addition, oncoviruses are associated with multiple benign mucocutaneous diseases. Research regarding the pathogenic mechanisms of oncoviruses and virus-specific treatment and prevention is rapidly evolving. Preventative vaccines for human papillomavirus and hepatitis B virus are already available. This review discusses the mucocutaneous manifestations, pathogenesis, diagnosis, treatment, and prevention of oncovirus-related diseases. The first article in this continuing medical education series focuses on diseases associated with human papillomavirus and Merkel cell polyomavirus, while the second article in the series focuses on diseases associated with hepatitis B and C viruses, human T-cell lymphotropic virus-1, human herpesvirus-8, and Epstein-Barr virus.
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Affiliation(s)
| | | | - Ramya Vangipuram
- Center for Clinical Studies, Webster, Texas; Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Peter L Rady
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Stephen K Tyring
- Center for Clinical Studies, Webster, Texas; Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
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Song EJ, Park JS, Ryu KN, Park SY, Jin W. Perineural Spread Along Spinal and Obturator Nerves in Primary Vaginal Carcinoma: A Case Report. World Neurosurg 2018; 115:85-88. [PMID: 29660549 DOI: 10.1016/j.wneu.2018.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Perineural spread is not an uncommon feature in carcinoma of the head and neck. On the contrary, perineural spread in pelvic malignancies has been rarely reported. This is the first report on perineural spread of the obturator nerve and the lumbosacral plexus from primary vaginal cancer. CASE DESCRIPTION A 50-year-old woman diagnosed with infectious spondylitis at an outside hospital was referred to our institution. She presented with persistent lower back pain and right anterior thigh pain. Magnetic resonance imaging and subsequent 18F-fluorodeoxyglucose-positron emission tomography/computed tomography revealed primary vaginal cancer with metastatic lymphadenopathy and perineural spread of the lumbosacral plexus, including L3, L4 nerve roots and branches, and obturator nerve along with soft tissue masses in the right psoas and proximal adductor muscles. CONCLUSIONS Clinical diagnosis of perineural spread in pelvic malignancies is difficult to establish, as it has nonspecific symptoms as an initial manifestation. Clinicians should recognize the possibility of perineural spread of malignancies if radiologic findings, such as thickening of lumbosacral nerves and perineural mass, are observed on magnetic resonance imaging. Further evaluation is necessary to detect possible pelvic malignancy and differentiate from other diseases.
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Affiliation(s)
- Eun Jee Song
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea.
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital, Gangdong, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital, Gangdong, Seoul, Republic of Korea
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Abstract
Pathologists use immunohistochemistry is their day-to-day practices to assist in distinguishing site of origin of metastatic carcinomas. Here, the work-up is discussed neuroendocrine carcinomas, squamous cell carcinomas and adenocarcinomas with particular attention to tumor incident rates and predictive values of the best-performing immunohistochemical markers.
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Affiliation(s)
- Edward B Stelow
- Department of Pathology, University of Virginia, Charlottesville, VA, United States.
| | - Hadi Yaziji
- Vitro Molecular Laboratories, Miami, FL, United States
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Horn LC, Brambs CE, Handzel R, Mehlhorn G, Schmidt D, Schierle K. [Nomenclature of squamous cell precursor lesions of the lower female genital tract : Current aspects]. DER PATHOLOGE 2017; 37:526-533. [PMID: 27738814 DOI: 10.1007/s00292-016-0239-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The majority of precancerous lesions of the lower female genital tract (intraepithelial neoplasia, IN) are caused by human papillomavirus (HPV) infections resulting in cellular atypia and in turn an altered tissue architecture. Depending on the pathogenesis, a distinction is made between vulvar intraepithelial neoplasia (VIN) classified as classical VIN associated with high-risk HPV infections (u-VIN) and differentiated VIN (d-VIN), which is associated with lichen sclerosus et atrophicus and p53 alterations. In the current World Health Organization (WHO) classification a novel grading system for squamous cell precancerous lesions of the lower female genital tract has been proposed, differentiating low grade squamous intraepithelial lesions (L-SIL) including condyloma and HPV-associated alterations plus VIN 1, vaginal intraepithelial neoplasia (VaIN 1) and cervical intraepithelial neoplasia (CIN 1) from high grade squamous intraepithelial lesions (H-SIL) with VIN 2 and 3, VaIN 2 and 3 as well as CIN 2 and 3. The use of p16 immunohistochemistry can assist the differentiation. The new binary classification, however, contradicts the German cytological nomenclature (Munich nomenclature III), which differentiated three grades of dysplasia in order to avoid overtreatment of patients with moderate IN. The individual nomenclatures are compared to each other. It is recommended to report the grade of precancerous lesions in addition to the SIL classification of the WHO.
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Affiliation(s)
- L-C Horn
- Institut für Pathologie, Abteilung Mamma-, Gynäko- und Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland.
| | - C E Brambs
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München, Deutschland
| | - R Handzel
- Universitätsfrauenklinik Leipzig (Triersches Institut) im Zentrum für Frauen- und Kindermedizin, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - G Mehlhorn
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - D Schmidt
- Institut für Pathologie, Viersen, Deutschland
| | - K Schierle
- Institut für Pathologie, Abteilung Mamma-, Gynäko- und Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
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