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Chen T, Hou S. Vulvar intraepithelial neoplasia, grade III, treated with photodynamic therapy: A case report. Photodiagnosis Photodyn Ther 2023; 42:103537. [PMID: 36965757 DOI: 10.1016/j.pdpdt.2023.103537] [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: 12/26/2022] [Revised: 02/25/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Abstract
Vulvar intraepithelial neoplasia (VIN) is a precancerous lesion on the vulvar epidermis that does not invade or metastasize to surrounding stroma; it manifests as atypical intraepithelial hyperplasia on the vulva. Most patients with VIN are diagnosed early, and treatment with standardised therapy often leads to complete regression of symptoms. The treatment of VIN is still a challenge for clinicians because, in most cases, surgery is destructive and risky. However, photodynamic therapy (PDT) was recommended as a new treatment for VIN. Herein, we report the case of a patient with a large-area high-grade VIN lesion complicated by human papillomavirus infection. The patient could not undergo surgical treatment. However, treatment with PDT was performed in our outpatient department. There was slight pain during the treatment after multi-point injection of micro-lidocaine (0.05 mL/dot) was given. No recurrence was noted after 13 months of follow-up. More importantly, scarring and other major side effects were not detected. Therefore, PDT can be a useful alternative treatment for patients with VIN with large lesions or multifocal high-grade VIN.
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Affiliation(s)
- Tudi Chen
- Tianjin Medical University General Hospital, China
| | - Shuping Hou
- Tianjin Medical University General Hospital, China.
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Wiehe A, O'Brien JM, Senge MO. Trends and targets in antiviral phototherapy. Photochem Photobiol Sci 2019; 18:2565-2612. [PMID: 31397467 DOI: 10.1039/c9pp00211a] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Photodynamic therapy (PDT) is a well-established treatment option in the treatment of certain cancerous and pre-cancerous lesions. Though best-known for its application in tumor therapy, historically the photodynamic effect was first demonstrated against bacteria at the beginning of the 20th century. Today, in light of spreading antibiotic resistance and the rise of new infections, this photodynamic inactivation (PDI) of microbes, such as bacteria, fungi, and viruses, is gaining considerable attention. This review focuses on the PDI of viruses as an alternative treatment in antiviral therapy, but also as a means of viral decontamination, covering mainly the literature of the last decade. The PDI of viruses shares the general action mechanism of photodynamic applications: the irradiation of a dye with light and the subsequent generation of reactive oxygen species (ROS) which are the effective phototoxic agents damaging virus targets by reacting with viral nucleic acids, lipids and proteins. Interestingly, a light-independent antiviral activity has also been found for some of these dyes. This review covers the compound classes employed in the PDI of viruses and their various areas of use. In the medical area, currently two fields stand out in which the PDI of viruses has found broader application: the purification of blood products and the treatment of human papilloma virus manifestations. However, the PDI of viruses has also found interest in such diverse areas as water and surface decontamination, and biosafety.
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Affiliation(s)
- Arno Wiehe
- biolitec research GmbH, Otto-Schott-Str. 15, 07745 Jena, Germany. and Institut für Chemie und Biochemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - Jessica M O'Brien
- Medicinal Chemistry, Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, Trinity College Dublin, The University of Dublin, St. James's Hospital, Dublin 8, Ireland.
| | - Mathias O Senge
- Medicinal Chemistry, Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, Trinity College Dublin, The University of Dublin, St. James's Hospital, Dublin 8, Ireland.
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Perceived Health-Related Quality of Life in Women With Vulvar Neoplasia: A Cross Sectional Study. Int J Gynecol Cancer 2016; 26:1313-9. [DOI: 10.1097/igc.0000000000000770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of the study was to determine health-related quality of life (HRQoL) of women with surgically treated vulvar intraepithelial neoplasia (VIN) and vulvar cancer (VC) during the first week after hospital discharge. Further objectives were to investigate differences between women with VIN and VC as well as to examine whether correlations exist between women’s symptom experience and HRQoL.MethodsThis cross-sectional study was conducted in 8 hospitals in Germany and Switzerland. Women with VIN and VC rated HRQoL with the validated German Short-Form 36. Differences between HRQoL in women with VIN and VC were tested with Wilcoxon rank-sum score. The WOMen with vulvAr Neoplasia (WOMAN) - Patient reported Outcome (PRO) self-report instrument was used to measure women’s symptom experience. Correlations between symptoms and HRQoL were calculated using Spearman correlation coefficient.ResultsWomen with VIN and VC (n = 65) reported lower HRQoL in physical aspects (Physical Component Summary [PCS], 34.9) than that in mental aspects (Mental Component Summary, 40.5). Women with VC had lower HRQoL than women with VIN, as manifested by significant differences concerning the dimensions of “physical functioning” and “role-physical.” “Difficulties in daily life” as a distressing symptom correlated with MCS and PCS. Wound-related symptoms correlated with PCS and psychosocial symptoms/issues with MCS.ConclusionsAnalysis showed that women with vulvar neoplasia reported lower HRQoL in the physical and mental dimensions 1 week after discharge than comparable studies referring to months or years after surgery. Health-related quality of life is influenced by physical impairment because physical symptoms are prevalent 1 week after discharge. Patient education should focus on symptom management in an early postsurgical phase to enhance women’s HRQoL.
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Grimes C, Cunningham C, Lee M, Murina A. Use of topical imiquimod in the treatment of VIN: a case report and review of the literature. Int J Womens Dermatol 2016; 2:35-38. [PMID: 28492000 PMCID: PMC5412099 DOI: 10.1016/j.ijwd.2015.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 11/28/2022] Open
Abstract
Vulvar intraepithelial neoplasia (VIN) is a premalignant disease of the vulvar squamous epithelium. Standard treatment for VIN lesions is surgical excision. Alternative therapeutic options for conservative treatment have been sought by patients to prevent disfigurement and to preserve sexual function. We present such a patient in whom topical imiquimod was used with a successful outcome. Imiquimod is effective in the treatment of VIN, as well as convenient, self-administered, and generally well tolerated.
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Affiliation(s)
- Chelsea Grimes
- Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Michael Lee
- Department of Pathology, Tulane Medical Center, New Orleans, Louisiana
| | - Andrea Murina
- Department of Dermatology, Tulane University, New Orleans, Louisiana
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Senn B, Kobleder A, Raphaelis S, Mueller MD, Kammermann B, White K, Eicher M. Prevention and Reduction of Complications in Women with Vulvar Cancer: Development of an Algorithm for Safer Multidisciplinary Care. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jct.2015.610090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Senn B, Eicher M, Mueller MD, Hornung R, Fink D, Baessler K, Hampl M, Denhaerynck K, Spirig R, Engberg S. A patient-reported outcome measure to identify occurrence and distress of post-surgery symptoms of WOMen with vulvAr Neoplasia (WOMAN-PRO) — A cross sectional study. Gynecol Oncol 2013; 129:234-40. [DOI: 10.1016/j.ygyno.2012.12.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 11/28/2022]
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Senn B, Mueller MD, Hasenburg A, Blankenstein T, Kammermann B, Hartmann A, Donovan H, Eicher M, Spirig R, Engberg S. Development of a Postsurgical Patient-Reported Outcome Instrument for Women With Vulvar Neoplasia. Oncol Nurs Forum 2012; 39:E489-98. [DOI: 10.1188/12.onf.e489-e498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gutiérrez-Pascual M, Vicente-Martín FJ, López-Estebaranz JL. Lichen sclerosus and squamous cell carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:21-8. [PMID: 22445563 DOI: 10.1016/j.adengl.2011.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/26/2011] [Indexed: 02/08/2023] Open
Abstract
Lichen sclerosus is a chronic inflammatory disease that can progress to malignancy. The literature indicates an association with anogenital squamous cell carcinoma and verrucous carcinoma. Two pathogenic pathways, differentiated vulvar and penile intraepithelial neoplasias, which have recently been described in relation to squamous cell carcinoma, are both highly associated with genital lichen sclerosus independently of human papilloma virus (HPV) infection. Furthermore, tumor-promoting molecular changes unrelated to HPV infection have been demonstrated and may explain the malignant potential of lichen sclerosus. The possible relationship between HPV and genital lichen sclerosus currently remains open to discussion, and the prognostic importance of the overlapping of these 2 diseases is still unclear. This review considers the relationship between lichen sclerosus and squamous cell and verrucous carcinomas, the possible oncogenic mechanisms involved, and their possible association with HPV infection.
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Affiliation(s)
- M Gutiérrez-Pascual
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
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Kaushal S, Merideth M, Kopparthy P, Pulanic TK, Stratton P. Treatment of multifocal Bowen's disease in immunocompromised women with surgery and topical imiquimod. Obstet Gynecol 2012; 119:442-444. [PMID: 22270432 PMCID: PMC3266510 DOI: 10.1097/aog.0b013e318236f1a0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In human immunodeficiency virus (HIV)-infected women, Bowen's disease may be difficult to treat successfully with surgery alone. Imiquimod cream, effective in treating Bowen's disease in healthy women, may be a useful postsurgical treatment in immunocompromised women. CASES Two HIV-infected women had both Bowen's disease and severe cervical dysplasia. In both cases, Bowen's disease, but not cervical dysplasia, recurred after surgical treatment. When treated with topical 5% imiquimod cream twice weekly for 4 months, 70-80% reduction in lesions were observed in both patients. Follow-up biopsies of remaining lesions were vulvar intraepithelial neoplasia 1. CONCLUSION Imiquimod cream, in combination with surgical treatment, may be an appropriate strategy for treatment of Bowen's disease in HIV-infected and other immunocompromised women.
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Affiliation(s)
| | - Melissa Merideth
- Medical Genetics Branch, National Human Genome Research Institute
- Intramural Office of Rare Diseases, Office of the Director
| | - Pallavi Kopparthy
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Tajana Klepac Pulanic
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Pamela Stratton
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development
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Frega A, Sopracordevole F, Scirpa P, Biamonti A, Lorenzon L, Scarani S, De Sanctis L, Pacchiarotti A, Moscarini M, French D. The re-infection rate of high-risk HPV and the recurrence rate of vulvar intraepithelial neoplasia (VIN) usual type after surgical treatment. Med Sci Monit 2011; 17:CR532-5. [PMID: 21873951 PMCID: PMC3560503 DOI: 10.12659/msm.881941] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND VIN usual type appears to be related to the HPV's oncogenic types. The aim of this prospective multicenter study was to evaluate the re-infection rate of high-risk HPV and the recurrence rate of VIN usual type after surgical treatment. MATERIAL/METHODS The study enrolled 103 women affected by VIN usual type. They underwent wide local excision by CO2 laser. The patients were investigated by clinical evaluation and HPV DNA test 6 months after surgical treatment, and then were followed-up at 12, 18, 24, and 36 months. The recurrences were treated with re-excision. RESULTS The rate of HPV infection after surgical treatment was 34% at 6 months, 36.9% at 12 months, 40% at 18 months, 41.7% at 24 months and 44.7% at 36 months. The mean time from HPV infection to the development of VIN was 18.8 months. CONCLUSIONS HPV testing in the follow-up of VIN usual type patients might be useful for identifying those patients with a higher risk of recurrence after surgical treatment, although more studies are needed. These preliminary data suggest that the test, in addition to clinical examination, can improve the efficacy of the follow-up.
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Affiliation(s)
- Antonio Frega
- Department of Woman's Health and Territorial Medicine, Faculty of Medicine and Psychology Sapienza University of Rome, Rome, Italy.
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Gutiérrez-Pascual M, Vicente-Martín FJ, López-Estebaranz JL. [Lichen sclerosus and squamous cell carcinoma]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 103:21-8. [PMID: 22078768 DOI: 10.1016/j.ad.2011.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/27/2011] [Accepted: 05/26/2011] [Indexed: 12/14/2022] Open
Abstract
Lichen sclerosus is a chronic inflammatory disease that can progress to malignancy. The literature indicates an association with anogenital squamous cell carcinoma and verrucous carcinoma. Two pathogenic pathways, differentiated vulvar and penile intraepithelial neoplasias, which have recently been described in relation to squamous cell carcinoma, are both highly associated with genital lichen sclerosus independently of human papilloma virus (HPV) infection. Furthermore, tumor-promoting molecular changes unrelated to HPV infection have been demonstrated and may explain the malignant potential of lichen sclerosus. The possible relationship between HPV and genital lichen sclerosus currently remains open to discussion, and the prognostic importance of the overlapping of these 2 diseases is still unclear. This review considers the relationship between lichen sclerosus and squamous cell and verrucous carcinomas, the possible oncogenic mechanisms involved, and their possible association with HPV infection.
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Affiliation(s)
- M Gutiérrez-Pascual
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, España.
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Senn B, Gafner D, Happ MB, Eicher M, Mueller MD, Engberg S, Spirig R. The unspoken disease: symptom experience in women with vulval neoplasia and surgical treatment: a qualitative study. Eur J Cancer Care (Engl) 2011; 20:747-58. [PMID: 21771133 DOI: 10.1111/j.1365-2354.2011.01267.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Women with vulval neoplasia often experience severe post-surgical complications. This study focuses on symptom experience of women during the first 6 months following surgical treatment for vulval neoplasia considering their socio-cultural context. In this qualitative study using a critical hermeneutic approach, narrative interviews were conducted. A purposeful sample of 20 patients was recruited from one Swiss and two German university hospitals. Content analysis was employed to analyse the transcribed interviews considering women's experiences and social perceptions. Narratives showed eight interrelated themes: delayed diagnosis, disclosed disease, disturbed self-image, changed vulva care, experienced wound-related symptoms, evoked emotions, affected interpersonal interactions and feared illness progression. The women experienced a general lack of information pertaining to above themes and all described strategies used to handle their situation, which affected their distress. The communication, assessment and treatment of symptoms were hampered by the society's and the health system's tendency to overlook these symptoms and leave them in the realm of the unspeakable. Health professionals need new strategies to support these women to recognise, assess and evaluate the seriousness of symptoms, and to communicate their symptom experience so that timely medical treatment is sought. This support may minimise potentially preventable complications and symptom-related distress.
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Affiliation(s)
- B Senn
- Department of Obstetrics and Gynaecology, Inselspital, University Hospital Berne, Berne, Switzerland
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