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Samba S, Soufia EO, Bouhout T, Al Jarroudi O, Berhili S, Moukhlissi M, Brahmi SA, Serji B, Afqir S, Mezouar L. A Pigmented Lesion of the Vulva Revealing Aggressive Melanoma: A Case Report. Cureus 2024; 16:e60257. [PMID: 38872659 PMCID: PMC11170315 DOI: 10.7759/cureus.60257] [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] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Vulvar melanoma (VM) is a rare and aggressive malignancy presenting unique challenges in diagnosis and management. This report presents the case of a 61-year-old female patient and explores the clinical characteristics, diagnostic modalities, treatment strategies, and prognosis associated with VM. The patient presented with a painless mass on the labia majora, which turned out to be an undifferentiated malignant tumor process consistent with melanoma on examination. Immunohistochemical analysis confirmed the diagnosis and subsequent imaging revealed metastatic disease necessitating palliative chemotherapy following radiotherapy. VM is a rare and aggressive form of melanoma. While surgery is the standard of care for early stages, advanced stages require a combination of immunotherapy and targeted treatments. Clinical trials are vital to improve our understanding of this condition and the various aspects of its care. Collaboration among experts is essential to achieve progress in managing these patients.
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Affiliation(s)
- Soumiya Samba
- Department of Radiation Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - El Ouardani Soufia
- Department of Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Tariq Bouhout
- Department of Surgical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Ouissam Al Jarroudi
- Department of Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Soufiane Berhili
- Department of Radiation Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Mohamed Moukhlissi
- Department of Radiation Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Sami Aziz Brahmi
- Department of Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Badr Serji
- Department of Surgical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Said Afqir
- Department of Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Loubna Mezouar
- Department of Radiation Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
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Pedrão PG, Guimarães YM, Godoy LR, Possati-Resende JC, Bovo AC, Andrade CEMC, Longatto-Filho A, dos Reis R. Management of Early-Stage Vulvar Cancer. Cancers (Basel) 2022; 14:cancers14174184. [PMID: 36077719 PMCID: PMC9454625 DOI: 10.3390/cancers14174184] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Vulvar cancer is a rare gynecological malignancy that affects mainly postmenopausal women. Recently, however, an alarming increase in the rates among young women has been observed due to human papillomavirus infection. The standard treatment for vulvar cancer is surgery with or without radiotherapy as adjuvant treatment. In recent decades, sentinel lymph node biopsy has been included as part of the surgical treatment. Thus, our objective was to review and discuss the advances found in the literature about early-stage vulvar cancer. For this, we searched PubMed for publications in the English language. Relevant articles, such as the GROINS-V studies, and the GOG protocols, are presented in this review exhibiting the evolution of early-stage vulvar cancer treatment and the decrease in surgical morbidity rates. Abstract Vulvar cancer is a rare gynecological malignancy since it represents 4% of all cancers of the female genital tract. The most common histological type is squamous cell carcinoma (90%). This type can be classified into two clinicopathological subtypes according to the etiology. The first subtype is associated with persistent human papillomavirus infection and is usually diagnosed in younger women. The second subtype is associated with lichen sclerosus condition, and in most cases is diagnosed in postmenopausal women. Currently, an increase in first subtype cases has been observed, which raised the concern about associated mortality and treatment morbidity among young women. Vulvar cancer treatment depends on histopathology grade and staging, but surgery with or without radiotherapy as adjuvant treatment is considered the gold standard. In recent decades, sentinel lymph node biopsy has been incorporated as part of the treatment. Therefore, we sought to review and discuss the advances documented in the literature about vulvar cancer focusing on the treatment of early-stage disease. Relevant articles, such as the GROINS-V studies and the GOG protocols, are presented in this review. Additionally, we discuss key points such as the evolution of treatment from invasive surgery with high morbidity, to more conservative approaches without compromising oncologic safety; the role of sentinel lymph node mapping in the initial staging, since it reduces the complications caused by inguinofemoral lymphadenectomy; the recurrences rates, since local recurrence is common and curable, however, groin-associated, or distant recurrences have a poor prognosis; and, finally, the long-term follow-up that is essential for all patients.
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Affiliation(s)
- Priscila Grecca Pedrão
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
| | | | - Luani Rezende Godoy
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
| | | | - Adriane Cristina Bovo
- Department of Prevention Oncology, Barretos Cancer Hospital, Mato Grosso do Sul 79085-040, Brazil
| | - Carlos Eduardo Mattos Cunha Andrade
- Department of Gynecologic Oncology, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- Barretos School of Health Sciences, Dr. Paulo Prata-FACISB, Barretos, São Paulo 14785-002, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- Medical Laboratory of Medical Investigation (LIM) 14, Department of Pathology, Medical School, University of São Paulo, São Paulo 01246-903, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
| | - Ricardo dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- Correspondence: ; Tel.: +55-3321-6600 (ext. 7126)
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Spînu Ș, Sur D, Pârv A. Biventricular cardiac metastasis from vulvar squamous cell carcinoma. Arch Clin Cases 2022; 9:62-68. [PMID: 35813496 PMCID: PMC9262084 DOI: 10.22551/2022.35.0902.10205] [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] [Indexed: 11/29/2022] Open
Abstract
Vulvar cancers make up just 3% to 5% of all gynecological cancers, and they are most typically found in postmenopausal women. Vulvar cancer distant metastases are uncommon and usually arise late. Only six cases of vulvar cancer metastasizing to the heart have been reported in the literature, and none of them included both the left and right ventricles. We describe the case of a 68-year-old patient diagnosed with vulvar cancer arising from lichen sclerosus, initially localized, treated with chemotherapy, surgery, and radiation therapy. Less than two months after the end of the treatment sequence, the patient returned to our clinic with bone pain. Imaging investigations have shown multiple disseminated metastases, but not in the heart at that moment. Chemotherapy was initiated, and after two cycles, the patient developed an arrhythmia (atrial fibrillation with rapid ventricular rate), which was later determined to be caused by cardiac metastases discovered by echocardiography and computed tomography. Vulvar cancer metastatic to the heart represents a rare clinical condition, requiring multidisciplinary care. The case's uniqueness is the biventricular metastasis, which resulted in STEMI despite angiographically normal epicardial coronary arteries
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Mao Y, He M, Tang Z, Chen M, Wu L, Liang T, Huang J. Prognostic nomograms to predict overall survival and cause specific death in vulvar squamous cell carcinoma. Int J Gynecol Cancer 2022; 32:706-715. [DOI: 10.1136/ijgc-2021-003211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe incidence of vulvar squamous cell carcinoma has been rising in recent decades. The prognosis of patients with vulvar squamous cell carcinoma was explored, and nomograms were constructed to predict survival rates.MethodsVulvar squamous cell carcinoma patient data were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into a training dataset and testing dataset. Univariable and multivariable Cox regression were used to identify risk factors affecting vulvar squamous cell carcinoma overall survival in the training dataset. Cumulative incidence function and Fine–Gray regression were used to analyze cancer specific death in the training dataset. Overall survival and cancer specific death nomograms were constructed and validated in the testing and whole datasets. Receiver operating characteristic and calibration were used to verify the predictive value and clinical applicability of the models.ResultsAge ≥60 years, grade 3, American Joint Committee on Cancer stages III and IV, TNM (tumor, nodes, metastasis) stages T2, T3, N1, and M1 had a negative effect on overall survival in vulvar cancer patients. Surgery (hazard ratio (HR)=0.416, 95% confidence interval (CI) 0.349 to 0.496, p<0.001) and chemotherapy (HR=0.637, 95% CI 0.544 to 0.746, p<0.001) may improve overall survival. Age, tumor grade, American Joint Committee on Cancer stage, T stage, N stage, M stage, surgery, and chemotherapy significantly affected vulvar cancer specific death. For area under the receiver operating characteristic curve, the predictive ability of the nomograms for overall survival and cancer specific death for 1 year (area under the curve (AUC)=0.862), 3 years (AUC=0.832), and 5 years (AUC=0.808) were all >0.800.ConclusionThe nomograms established in our study had an excellent predictive ability for overall survival and cancer specific death in vulvar cancer patients.
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Early Diagnostics of Vulvar Intraepithelial Neoplasia. Cancers (Basel) 2022; 14:cancers14071822. [PMID: 35406594 PMCID: PMC8997501 DOI: 10.3390/cancers14071822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The spectrum of vulvar disorders is wide and varies from infections, dermatoses, manifestations of hormonal and systemic conditions to vulvar intraepithelial neoplasia (VIN) and invasive cancer. It is not always possible to distinguish vulvar lesions on the basis of macroscopical aspects and the distribution of changes. For definite diagnosis of a vulvar lesion, a biopsy is needed. However, in practice, the decision to perform a biopsy is often delayed due to a lack of specificity of symptoms at the early stages of the neoplastic disease. The aim of this article is to provide clinicians, both gynecologists and dermatologists, with the main features of vulvar precancerous lesions, in order to recognize and treat them on time, thus preventing vulvar cancer. Clinical appearance of VIN is variable with significant variations present in color, surface, and topography. Evaluation of all VIN lesions should be conducted very carefully, because an underlying early invasive squamous cancer appears to be present in a significant percentage of patients. Abstract The spectrum of vulvar lesions ranges from infective and benign dermatologic conditions to vulvar precancer and invasive cancer. Distinction based on the characteristics of vulvar lesions is often not indicative of histology. Vulvoscopy is a useful tool in the examination of vulvar pathology. It is more complex than just colposcopic examination and presumes naked eye examination accompanied by magnification, when needed. Magnification can be achieved using a magnifying glass or a colposcope and may aid the evaluation when a premalignant or malignant lesion is suspected. It is a useful tool to establish the best location for biopsies, to plan excision, and to evaluate the entire lower genital system. Combining features of vulvar lesions can help prediction of its histological nature. Clinically, there are two distinct premalignant types of vulvar intraepithelial neoplasia: HPV-related VIN, more common in young women, multifocal and multicentric; VIN associated with vulvar dermatoses, more common in older women and usually unicentric. For definite diagnosis, a biopsy is required. In practice, the decision to perform a biopsy is often delayed due to a lack of symptoms at the early stages of the neoplastic disease. Clinical evaluation of all VIN lesions should be conducted very carefully, because an underlying early invasive squamous cancer may be present.
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Ding J, Teng P, Guan X, Luo Y, Ding H, Shi S, Zhou X, Ni G. Analysis of Short-Term Efficacy of Gasless Single-Port Laparoscopic Inguinal Lymphadenectomy Through Vulva Incision for Vulvar Cancer. Front Surg 2022; 9:813711. [PMID: 35402502 PMCID: PMC8987365 DOI: 10.3389/fsurg.2022.813711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate the feasibility and short-term efficacy of gasless single-port laparoscopic inguinal lymphadenectomy through vulva incision (VEIL-V). Methods The data of 9 patients diagnosed as vulvar squamous cell carcinoma who underwent single-port laparoscopic inguinal lymph node dissection through vulvectomy incision were retrospectively analyzed. And 13 patients who underwent laparoscopic inguinal lymph node dissection through lower abdominal subcutaneous approach as the control group (VEIL-H). The operation time, blood loss, numbers of unilateral lymph nodes, hospitalization time, and complications between the two groups were compared. Results The operation time of VEIL-V was 56.11 ± 5.94 min, which were shorter than that of VEIL-H (74.62 ± 5.50 min; P = 0.013). Bleeding amount in the VEIL-H was 29.44 ± 2.56, which was significantly lower than that of the VEIL-H group (43.08 ± 4.14 ml; P = 0.021). In the two groups, the numbers of unilateral lymph nodes harvested were similar. The differences in the postoperative hospital stay, skin, and lymphatic complications were not statistically significant. Conclusion Compared with VEIL-H, gasless single-port laparoscopic inguinal lymphadenectomy through vulva incision reduces the difficulty of operation with shorter operation time, and less blood loss, which can be a safe and mini-invasive surgical approach.
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Affiliation(s)
- Jin Ding
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Piaopiao Teng
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Yonghong Luo
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Huafeng Ding
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Suhua Shi
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiufen Zhou
- Department of Gynecology, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, China
| | - Guantai Ni
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Wannan Medical College, Wuhu, China
- *Correspondence: Guantai Ni
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Study on the application and imaging characteristics of optical coherence tomography in vulva lesions. Sci Rep 2022; 12:3659. [PMID: 35256649 PMCID: PMC8901679 DOI: 10.1038/s41598-022-07634-1] [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: 07/18/2021] [Accepted: 02/17/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractIn this study, a prospective study was conducted by using optical coherence tomography (OCT) in the in vivo detection of vulvar diseases. The clinical efficacy of the OCT we investigated in the detection of vulvar diseases, and the characteristics of the OCT images were defined. Overall, this study recruited 63 patients undergoing the colposcopy for vulvar lesions in three Chinese hospitals from December 20th, 2018 and September 24th, 2019. The colposcopy and the OCT examination were performed successively, and the OCT images were compared with the relevant tissue sections to characterize different lesions. The OCT diagnoses where categorized into 7 types, including normal and inflammatory vulva, condyloma acuminata, papilloma, lichen sclerosus, atrophic sclerosing lichen, fibrous epithelial polyp as well as cysts. The structural characteristics of the vulva tissue can be clearly observed in the OCT image, which are consistent with the characteristics of the tissue section. Compared with the pathological results, the sensitivity, specificity and accuracy of the OCT examination reached 83.82% (95% confidence interval, CI 72.5%–91.3%), 57.89% (95% CI 34.0%–78.9%) and 78.16%, respectively. The OCT is found with the advantages of being noninvasive, real-time and sensitive and with high resolution. It is of high significance to screening vulva diseases, and it is expected as one of the methods to clinically diagnose vulva diseases.
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Raposio G, Moioli M, Baldelli I, Spinaci S, Cagnacci A, Raposio E. Perforator flaps for vulvar reconstruction: basic principles. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022076. [PMID: 36300233 PMCID: PMC9686156 DOI: 10.23750/abm.v93i5.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM In vulvar cancer, the standard treatment is radical local excision, with immediate reconstruction. Reconstruction aims to restore anatomy and function of the external female genitalia, facilitating preservation of normal body image, sexual function, and micturition and defecation functions. METHODS The purpose of this paper is to describe the principles of perforator flaps for vulvar reconstruction. RESULTS Basic concepts, indications and operative technique are discussed and detailed. CONCLUSIONS In vulvar reconstruction, the use of perforator flaps is a superior surgical technique when compared to the use of conventional flaps.
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Affiliation(s)
- Giorgio Raposio
- Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy
| | - Melita Moioli
- Gynecological Division, IRCCS Ospedale San Martino, Genova, Italy
| | - Ilaria Baldelli
- Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy, Plastic and Reconstructive Surgery Division, IRCCS Ospedale San Martino, Genova, Italy
| | | | - Angelo Cagnacci
- Gynecological Division, IRCCS Ospedale San Martino, Genova, Italy, Gynecology Chair, Department of Neurosciences, Rehabilitation, Oftalmology, Genetics, Maternal and Pediatric Sciences (DINOGMI), University of Genova, Italy
| | - Edoardo Raposio
- Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy, Plastic and Reconstructive Surgery Division, IRCCS Ospedale San Martino, Genova, Italy
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Next-Generation Sequencing Whole-Genome Analysis for Targeted Treatment Approach of Metastatic Bartholin Gland Adenocarcinoma: An Emblematic Case Report and Review of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11112085. [PMID: 34829431 PMCID: PMC8624694 DOI: 10.3390/diagnostics11112085] [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: 10/17/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Bartholin gland adenocarcinoma (BGA) is extremely rare and is characterized by high rates of lymph-node recurrence and distant metastases. No effective palliative treatments are available for metastatic BGA; therefore, advanced BGA remains a challenge for gynecologic oncologists. Considering the rarity of this disease and the lack of a standardized approach, the present study aims to discuss the available literature on current therapies for BGA and to describe an emblematic case treated with a novel tailored approach. A postmenopausal woman with advanced BGA was referred to our department for an adequate evaluation, staging and treatment. Notably, we used PET/CT as a fundamental imaging technique for staging and follow-up. The patient underwent primary surgery followed by standard chemotherapy and pelvic radiotherapy. Three months later, she relapsed, with the appearance of multiple metastatic sites. Considering the evident chemoresistance to standard chemotherapy and the absence of valid therapeutic alternatives for this rare cancer, she was treated with a combination of repeated minimally invasive surgical procedures for all the resectable metastatic lesions and innovative approaches comprising, firstly, chemoimmunotherapy with Nivolumab combined with metronomic vinorelbine, which resulted in a clinical response for approximately 7 months. Upon disease progression, we used a targeted systemic approach based on the whole genomic profile of the primary tumor, which showed PTEN loss, which is predictive of a benefit from an mTOR inhibitor, and a CCND1 amplification, which predicts sensitivity to CDK4/6 inhibitors. Therefore, she received Everolimus, resulting in a significant metabolic response that lasted 12 months. Thereafter, upon further progression of the disease, the patient started Palbociclib treatment, which is currently ongoing, with evidence of a metabolic response. The patient has survived for 54 months from diagnosis, with a good performance status. In conclusion, the present paper confirms the lack of efficacy of conventional therapeutic regimens in the context of advanced, recurrent or metastatic adenocarcinomas of the Bartholin gland. The case report shows how a personalized multidisciplinary approach based on repeated minimally invasive surgery and tailored anticancer treatment based on whole-genome sequencing analysis could be effective and associated with prolonged survival in this rare gynecological cancer.
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Takahashi K, Kikuchi A, Horiuchi A, Tamura R, Haino K, Yamaguchi M, Kawasaki T. Vulvar Extramammary Paget Disease Detected by Cytology for Cervical Cancer Screening: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933655. [PMID: 34679073 PMCID: PMC8546272 DOI: 10.12659/ajcr.933655] [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] [Indexed: 11/17/2022]
Abstract
Patient: Female, 77-year-old
Final Diagnosis: Secondary extramammary Paget’s disease
Symptoms: Erythema
Medication:—
Clinical Procedure: Biopsy
Specialty: Dermatology • Obstetrics and Gynecology • Oncology • Urology
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Affiliation(s)
- Kotaro Takahashi
- Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Akira Kikuchi
- Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Ayano Horiuchi
- Department of Obstetrics and Gynecology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Ryo Tamura
- Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masayuki Yamaguchi
- Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Takashi Kawasaki
- Department of Pathology, Niigata Cancer Center Hospital, Niigata, Japan
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Vulvar and Vaginal Melanomas-The Darker Shades of Gynecological Cancers. Biomedicines 2021; 9:biomedicines9070758. [PMID: 34209084 PMCID: PMC8301463 DOI: 10.3390/biomedicines9070758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 12/26/2022] Open
Abstract
Melanomas of the skin are poorly circumscribed lesions, very frequently asymptomatic but unfortunately with a continuous growing incidence. In this landscape, one can distinguish melanomas originating in the mucous membranes and located in areas not exposed to the sun, namely the vulvo-vaginal melanomas. By contrast with cutaneous melanomas, the incidence of these types of melanomas is constant, being diagnosed in females in their late sixties. While hairy skin and glabrous skin melanomas of the vulva account for 5% of all cancers located in the vulva, melanomas of the vagina and urethra are particularly rare conditions. The location in areas less accessible to periodic inspection determines their diagnosis in advanced stages, often metastatic. Moreover, despite the large number of drugs newly approved in recent decades for the treatment of cutaneous melanoma, especially in the category of biological drugs, the mortality of vulvo-vaginal melanomas has remained almost constant. This, together with the absence of specific treatment guidelines due to the lack of a sufficient number of cases to conduct randomized clinical trials, makes melanomas with this localization a discouraging diagnosis, associated with a very poor prognosis. Our aim is therefore to draw attention to this oftentimes overlooked entity in order to encourage the community to employ various strategies meant to increase research in this area. By highlighting the main risk factors of vulvar and vaginal melanomas, as well as the clinical manifestations and molecular changes underlying these neoplasms, ideally novel therapeutic schemes will, in time, be brought into effect.
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Li W, Song J, Sun Y, Cui Z. Multiple metastases after surgery for a rare vulvar malignant melanoma combined with immunotherapy: a case report. J Int Med Res 2021; 48:300060520965398. [PMID: 33203293 PMCID: PMC7683920 DOI: 10.1177/0300060520965398] [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] [Indexed: 01/05/2023] Open
Abstract
We herein describe the preoperative and postoperative clinical data of a patient with a rare case of vulvar malignant melanoma and discuss her clinical characteristics and prognosis. After surgical resection and immunotherapy, the patient’s illness continued to worsen. She then received local vulvar radiotherapy. However, further treatment was discontinued because of intolerable complications of radiotherapy, and the patient died about 18 months postoperatively. Management of vulvar malignant melanoma is challenging. No unified, effective, and standardized diagnostic and treatment plan has been established for this disease. Surgery remains the primary treatment modality for locally resectable vulvar malignant melanoma. Radiation therapy and chemotherapy do not benefit survival. Encouragingly, however, immunotherapy and targeted therapy have shown clinical efficacy in metastatic vulvar malignant melanoma.
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Affiliation(s)
- Wenjing Li
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingzhi Song
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yiming Sun
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhumei Cui
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Liu J, Wang M. Development and validation of nomograms predicting cancer-specific survival of vulvar cancer patients: based on the Surveillance, Epidemiology, and End Results Program. Int J Gynaecol Obstet 2021; 156:529-538. [PMID: 33899929 DOI: 10.1002/ijgo.13722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 04/22/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore potential prognostic factors and develop nomograms to predict the cancer-specific survival of patients with vulvar squamous cell carcinoma (SCC) and patients with vulvar melanoma. METHODS Cases of vulvar SCC and melanoma were retrieved from the Surveillance, Epidemiology, and End Results (SEER) Program, and randomly segregated into training and test sets. Based on the training set, univariate and multivariate Cox proportional hazard regressions evaluate the association between key demographic/clinical characteristics and vulvar cancer survival. Potential prognostic factors were included to construct nomograms for the prediction of 3-year and 5-year survival probabilities. RESULTS Age, tumor size, stage, surgery, and chemotherapy were potential factors associated with vulvar cancer survival. The C-indices for the training and test sets were 0.82 and 0.81 for SCC, and 0.73 and 0.70 for melanoma. Calibration curves revealed correlated agreements between nomogram-based probability and actual survival status. CONCLUSION Nomograms were developed to predict cancer-specific survival of patients with vulvar cancer, accordingly identifying the subgroup at high risk of cancer-specific mortality.
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Affiliation(s)
- Jin Liu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Mengqiao Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
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Wohlmuth C, Wohlmuth-Wieser I, Laframboise S. Clinical Characteristics and Treatment Response With Checkpoint Inhibitors in Malignant Melanoma of the Vulva and Vagina. J Low Genit Tract Dis 2021; 25:146-151. [PMID: 33252450 PMCID: PMC7984764 DOI: 10.1097/lgt.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aims of the study were to assess the clinical and histopathological characteristics of a comprehensive cohort of women with vulvovaginal melanoma (VVM) treated at our institution and to study the treatment response of checkpoint inhibitors in this patient cohort. MATERIALS AND METHODS This is a retrospective study of women with invasive VVM treated at the Princess Margaret Cancer Centre in Toronto, Ontario, Canada, over a period of 15 years. Clinical and histopathological characteristics, treatment, as well as treatment-related outcome were analyzed in 32 women. Treatment response was evaluated retrospectively using the "response criteria for use in trials testing immunotherapeutics" (iRECIST). The objective response rate was defined as the proportion of patients with complete or partial response based on the best overall response. RESULTS At a median follow-up of 37.8 months (5.8-110.4), 26 women (81.3%) had disease progression and 16 (50%) died. Thirteen patients with locally unresectable or metastatic melanoma were treated with immune checkpoint inhibitors. Ten additional cases were identified from previously published reports. The best objective response rate for immune checkpoint inhibitors was 30.4% (95% CI = 11.6%-49.2%) and the clinical benefit rate was 52.2% (95% CI = 31.8%-72.6%). The clinical benefit rate was significantly better for programmed cell death protein 1 inhibitors (or a combination) compared with ipilimumab alone (Fisher exact, p = .023). Grade 3/4 adverse events were observed in 3 (13.0%) of the 23 patients. CONCLUSIONS Women with VVM constitute a high-risk group with poor overall prognosis. Immune checkpoint inhibitors are effective in the treatment of metastatic melanoma in this patient cohort.
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Affiliation(s)
- Christoph Wohlmuth
- Division of Gynecologic Oncology, Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Iris Wohlmuth-Wieser
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Stéphane Laframboise
- Division of Gynecologic Oncology, Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
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Gynecologic Malignancies in Children and Adolescents: How Common is the Uncommon? J Clin Med 2021; 10:jcm10040722. [PMID: 33673108 PMCID: PMC7918615 DOI: 10.3390/jcm10040722] [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: 01/04/2021] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 01/07/2023] Open
Abstract
The aim of this study is to assess the projected incidence and prognostic indicators of gynecologic malignancies in the pediatric population. In this population-based retrospective cohort study, girls ≤18 years with ovarian, uterine, cervical, vaginal and vulvar malignancies diagnosed between 2000 and 2016 were identified from the Surveillance, Epidemiology and End Results (SEER)-18 registry. The Kaplan-Meier method was used to analyze overall survival (OS). The age-adjusted annual incidence of gynecologic malignancies was 6.7 per 1,000,000 females, with neoplasms of the ovary accounting for 87.5%, vagina 4.5%, cervix 3.9%, uterus 2.5% and vulva 1.6% of all gynecologic malignancies. Malignant germ-cell tumors represented the most common ovarian neoplasm, with an increased incidence in children from 5-18 years. Although certain subtypes were associated with advanced disease stages, the 10-year OS rate was 96.0%. Sarcomas accounted for the majority of vaginal, cervical, uterine and vulvar malignancies. The majority of vaginal neoplasms were observed in girls between 0-4 years, and the 10-year OS rate was 86.1%. Overall, gynecologic malignancies accounted for 4.2% of all malignancies in girls aged 0-18 years and the histologic subtypes and prognosis differed significantly from patients in older age groups.
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Abstract
Background Vulvar cancer accounts for 3-5% of malignant diseases of the female genital tract. The Slovenian incidence rate is 5.5/100,000, which means 57 new cases per year. The most common histological type (90%) is squamous cell carcinoma. Based on etiology, it can be classified into the first type which correlates with human papillomavirus (HPV) infection and the second type which is not associated with HPV. The most common and long-lasting symptom of vulvar cancer is pruritus. The preferred diagnostic procedure to confirm the diagnosis is a punch or incision biopsy. Surgery in combination with radiotherapy is the standard treatment for vulvar cancer. Sentinel lymph node biopsy with lymphoscintigraphy is now a standard part of surgical treatment. Chemotherapy is a palliative treatment option. Conclusions Vulvar cancer is a rare disease. Because of the pathogenesis, surgery and radiotherapy are the main treatment modalities. The sentinel node biopsy (SNB) represents a contemporary approach to the vulvar cancer treatment and significantly reduces morbidity. Improvements in treatment of vulvar cancer contributed to the decrease of mortality among Slovenian women.
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