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Lang SM, Reddy RA, Renz M. Neovaginal Human Papilloma Virus-Related Squamous Cell Carcinoma in a Transgender Woman. JAMA Netw Open 2024; 7:e242537. [PMID: 38488797 PMCID: PMC10943404 DOI: 10.1001/jamanetworkopen.2024.2537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/11/2024] [Indexed: 03/18/2024] Open
Abstract
This case series discusses a human papilloma virus (HPV)–related neovaginal squamous cell carcinoma in a transgender woman and the need for formal gynecologic screening recommendations.
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Affiliation(s)
- Susan M. Lang
- Gynecologic Oncology Division, Stanford University, Palo Alto, California
| | - Ravali A. Reddy
- Gynecologic Oncology Division, Stanford University, Palo Alto, California
| | - Malte Renz
- Gynecologic Oncology Division, Stanford University, Palo Alto, California
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2
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Smart AC, Liu KX, Domogauer JD, Rodriguez-Russo C, Jones B, Dickstein DR, Mancias JD, Shiloh RY, Wintner A, Zietman AL, Marshall DC, Dyer MA, Russo AL. Gender-Affirming Surgery and Cancer: Considerations for Radiation Oncologists for Pelvic Radiation in Transfeminine Patients. Int J Radiat Oncol Biol Phys 2023; 117:301-311. [PMID: 37230432 PMCID: PMC10527783 DOI: 10.1016/j.ijrobp.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
Access to gender-affirming surgery is increasing for many transgender and nonbinary people in the United States, and radiation oncologists must be equipped to care for patients who have undergone such surgery in the region of their planned radiation treatment field. There are no guidelines for radiation treatment planning after gender-affirming surgery, and most oncologists do not receive training in the unique needs of transgender people with cancer. We review common gender-affirming genitopelvic surgeries for transfeminine people, including vaginoplasty, labiaplasty, and orchiectomy, and summarize the existing literature on the treatment of cancers of the neovagina, anus, rectum, prostate, and bladder in these patients. We also describe our systematic treatment approach and rationale for pelvic radiation treatment planning.
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Affiliation(s)
- Alicia C Smart
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Kevin X Liu
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jason D Domogauer
- Department of Radiation Oncology, New York University Langone Health, New York University, New York, New York
| | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brianna Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph D Mancias
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Ron Y Shiloh
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Anton Wintner
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Aiven Dyer
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrea L Russo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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Chelmow D, Cejtin H, Conageski C, Farid H, Gecsi K, Kesterson J, Khan MJ, Long M, O'Hara JS, Burke W. Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference. Obstet Gynecol 2023; 142:708-724. [PMID: 37543740 PMCID: PMC10424818 DOI: 10.1097/aog.0000000000005283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 08/07/2023]
Abstract
The Centers for Disease Control and Prevention sponsored a project conducted by the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. For this final module, focusing on the cancers of the lower anogenital tract (vulva, vagina, and anus), a panel of experts in evidence assessment from the Society for Academic Specialists in General Obstetrics and Gynecology, ASCCP, and the Society of Gynecologic Oncology reviewed relevant literature and current guidelines. Panel members conducted structured literature reviews, which were then reviewed by other panel members. Representatives from stakeholder professional and patient advocacy organizations met virtually in September 2022 to review and provide comment. This article is the executive summary of the review. It covers prevention, early diagnosis, and special considerations of lower anogenital tract cancer. Knowledge gaps are summarized to provide guidance for future research.
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Affiliation(s)
- David Chelmow
- Departments of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, Feinberg School of Medicine Northwestern University, Stroger Hospital, Chicago, Illinois, University of Colorado School of Medicine, Aurora, Colorado, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, Medical College of Wisconsin, Milwaukee, Wisconsin, Stanford University School of Medicine, Palo Alto, California, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, and Stony Brook University Hospital, Stony Brook, New York; the Division of Gynecologic Oncology, UPMC-Central PA, Mechanicsburg, Pennsylvania; and the American College of Obstetricians and Gynecologists, Washington, DC
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Arruza-Frau C, López-García A, Morales-López R. Squamous cell carcinoma of the neovagina 47 years after gender-affirming surgery. Urol Case Rep 2023; 50:102488. [PMID: 37719184 PMCID: PMC10504474 DOI: 10.1016/j.eucr.2023.102488] [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: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 09/19/2023] Open
Abstract
A 74-year-old transgender female presented with urinary difficulty and a painful lesion at her neo-vagina, 47 years after undergoing gender-affirming vaginoplasty. Initial biopsy reported Low-Grade Squamous Intraepithelial Lesion (LGSIL), while MRI revealed no inguinal or pelvic lymphadenopathy. Patient underwent partial neo-vaginectomy with wide local excision and formal urethroplasty. Pathology revealed verrucous carcinoma of the neovagina, a rare neoplasm in transgender female patients. This case highlights the importance of considering squamous cell carcinoma in the differential diagnosis of patients presenting lesions at neo-vagina and the need of screening methods for early detection of such neoplasms.
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Affiliation(s)
- Cristina Arruza-Frau
- Urology Section, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
- School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Ariana López-García
- Urology Section, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Ramphis Morales-López
- Urology Section, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
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Nandwana D, Hawes K, Zuend CF, Pope R. Neovaginal Human Papillomavirus Prevalence in Transfeminine Individuals: A Systematic Review. Obstet Gynecol 2023; 142:296-306. [PMID: 37411025 DOI: 10.1097/aog.0000000000005264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/04/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To assess the prevalence of high-risk human papillomavirus (hrHPV) and human papillomavirus (HPV)-associated abnormalities in the neovaginas of postvaginoplasty transfeminine patients to inform potential HPV-screening guidelines for this patient population. DATA SOURCES MEDLINE, ClinicalTrials.gov , the Cochrane Library, Scopus, and Google Scholar were searched through September 30, 2022. METHODS OF STUDY SELECTION The population included transfeminine individuals who had undergone vaginoplasty with an outcome of subsequent positive HPV diagnosis or HPV-related lesions. Randomized clinical trials, cohort studies, cross-sectional studies, and case reports available in English were included in the analysis. Identified articles were doubly screened, and accepted articles were doubly extracted. TABULATION, INTEGRATION, AND RESULTS Of 59 abstracts identified, 30 were screened for eligibility, of which 15 met the criteria for review. Included studies were assessed for vaginoplasty procedure type, time elapsed between vaginoplasty and HPV testing, HPV type, location and manner of sample collection, method of HPV diagnosis, and classification and location of HPV-associated neovaginal lesions. Studies were assigned a grade of evidence of very low, low, moderate, or high based on study design, precision, directness, and risk of bias. Prevalence of neovaginal hrHPV ranged from 8.3% to 20% in identified studies, and per-study prevalence of HPV-related neovaginal abnormalities ranged from 0% to 8.3% in patients. CONCLUSION The current body of research demonstrates that, after vaginoplasty, transfeminine individuals may develop neovaginal HPV infection with associated cytologic abnormalities or grossly apparent lesions. In some included studies, neovaginal HPV-associated lesions were highly advanced before they were identified. A small number of studies assessed neovaginal HPV prevalence in transfeminine individuals, with hrHPV prevalence ranging from 8.3% to 20%. However, broader conclusions about neovaginal HPV prevalence are limited by a lack of high-grade evidence in the existing literature. More rigorous prevalence research is needed to inform preventative care guidelines for transfeminine individuals at risk of developing HPV-related neovaginal complications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022379977.
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Affiliation(s)
- Devika Nandwana
- School of Medicine and the Center for Global Health and Diseases, Department of Pathology, School of Medicine, Case Western Reserve University, and University Hospitals Urology Institute, Cleveland, Ohio
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Domínguez-Riscart J, Ariza-Jimenez AB, Baez-Castillo C, Mateo-Gavira I. Factors associated with knowledge and vaccination intention for human papillomavirus on trans girls by their main caregiver: A cross-sectional study. Front Immunol 2023; 14:1097449. [PMID: 37063882 PMCID: PMC10098167 DOI: 10.3389/fimmu.2023.1097449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Trans women are highly affected by the human papillomavirus (HPV) and are at risk of suffering from HPV-related diseases such as oropharyngeal, anal, penile, or neovaginal neoplasia. HPV vaccination seems to be a good strategy to reduce HPV-related diseases, mainly during the early age before the first sexual intercourse, but only cisgender girls are covered by the National Health Services, while some high-risk groups such as trans girls are not included. Achieving a high vaccination rate is important in the adolescent population, but there are many factors that could affect it, such as lack of knowledge about HPV or fear of side effects by patients and main caregivers. The aim of our study is to analyze the knowledge of trans girls' main caregivers about HPV-related diseases in the general population and, in particular, in trans women, as well as factors associated with HPV vaccination intention. Methods A cross-sectional study was performed with the collaboration of main caregivers of adolescent trans girls, between 9 and 16 years old, assisted in two reference centers' multidisciplinary Gender Diversity Units. Information was requested through a self-completed questionnaire: HPV-related diseases Knowledge Transwomen questionnaire (HPV-TQ) was elaborated based on a 19-item self-administered questionnaire and score was standardized from 0 to 19 points. Percentage of correct answers was calculated and defined by the group of high scores that showed over 70% correct answers. Results A total of 65 main caregivers were included. Almost all main caregivers were mothers with a Caucasian ethnicity. The HPV-TQ average score was 11 (3.7) with an average correct answer of 58.1% (19.6). Only 17/65 (26.1%) of main caregivers were highly knowledgeable in HPV. Of 65 trans girls, 14 were already vaccinated (29.8% of trans girls over 12 years old); 78.5% were not vaccinated and only 21.5% had intentions to be vaccinated. The group with a high score in HPV-TQ had a longer follow-up at the transgender unit, a higher maternal vaccination rate, and a positive family history of HPV-related disease, especially in mothers. Conclusion Adolescent trans girls attended to in our units had a low rate and a low intention of vaccination against HPV. Education on and promotion and prevention of transgender HPV-related diseases should probably be implemented to achieve a higher knowledge and vaccination coverage in adolescent trans girls.
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Affiliation(s)
- Jesus Domínguez-Riscart
- Pediatric Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
- *Correspondence: Jesus Domínguez-Riscart,
| | - Ana-Belen Ariza-Jimenez
- Pediatric Department, Hospital Universitario Reina Sofia, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Celia Baez-Castillo
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Isabel Mateo-Gavira
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Awe AM, Burkbauer L, Pascarella L. Surgical Implications of LGBTQ+ Health Disparities: A Review. Am Surg 2022; 88:2786-2795. [PMID: 35466711 DOI: 10.1177/00031348221096577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) patients face challenging health care disparities. However, due to restrictions in reporting and collection of sexual orientation and gender identity (SOGI) demographic data, comprehensive studies of surgical disparities in the LGBTQ+ population are limited. This review aims to summarize the existing literature describing surgical disparities in LGBTQ+ patients and to identify areas of surgical care in which further studies are warranted. This review addresses the literature in infectious diseases, substance use disorders, bariatrics, cardiovascular medicine, oncology, and laryngology as relevant to surgical practice. Understanding the current landscape of knowledge in LGBTQ+ surgical disparities and the areas where gaps in research exist will help the surgeon to create a framework of practice to provide more equitable care to LGBTQ+ patients.
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Affiliation(s)
- Adam M Awe
- Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
| | - Laura Burkbauer
- Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
| | - Luigi Pascarella
- Division of Vascular Surgery, Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
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Van Gerwen OT, Aryanpour Z, Selph JP, Muzny CA. Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: A review. Int J STD AIDS 2022; 33:106-113. [PMID: 34615399 PMCID: PMC9713597 DOI: 10.1177/09564624211046997] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As acceptance of transgender and gender diverse individuals continues to increase, gender-affirming surgery, a cornerstone in the management of gender dysphoria, is becoming more readily available. HIV and sexually transmitted infections (STIs) disproportionately affect these populations, but there are limited epidemiologic and management data on STIs in people who have undergone gender-affirming genital surgery such as vaginoplasty. This review will provide clinicians with anatomical details about the various vaginoplasty procedures currently being performed, complications associated with these procedures, and an overview of the current literature describing HIV/STI epidemiology among transfeminine individuals who have undergone vaginoplasty.
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Affiliation(s)
- Olivia T Van Gerwen
- Department of Medicine, Division of Infectious Diseases, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zain Aryanpour
- Department of Medicine, 9967University of Alabama School of Medicine, Birmingham, AL, USA
| | - John P Selph
- Department of Urology, 9968University of Alabama at Birmingham, Birmingham, AL, USA.Increase
| | - Christina A Muzny
- Department of Medicine, 9967University of Alabama School of Medicine, Birmingham, AL, USA
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Christophe M, Heinemann M, Thomassin J, Lelong B, Houvenaeghel G, Lambaudie E. Development of a mucinous adenocarcinoma on a sigmoid colpoplasty for vaginal agenesis: About a case report and review of the literature. Gynecol Oncol Rep 2021; 36:100712. [PMID: 33786358 PMCID: PMC7988275 DOI: 10.1016/j.gore.2021.100712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/28/2022] Open
Abstract
Our article lists all cases in the neovaginal cancer literature since 1929. We propose an explanation of the pathophysiology of the development of neovaginal cancer. We propose a classification of neovaginal cancers.
We report a case of mucinous adenocarcinoma developed on sigmoid colpoplasty, performed for a congenital agenesis vaginal. The cancer development of neovagina remains exceptional. Its management consists, in the majority of cases, in surgery for a complete excision. Adjuvant treatments are associated according to the pathological results and the neovagina reconstruction technique performed.
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Affiliation(s)
- Marie Christophe
- Université Aix Marseille, Institut Paoli Calmettes, Chirurgie Oncologique 2, Marseille, France
| | | | - Jeanne Thomassin
- Institut Paoli Calmettes, Laboratoire anatomopathologie, Marseille, France
| | - Bernard Lelong
- Institut Paoli Calmettes, Chirurgie Oncologique 1, Marseille, France
| | - Gilles Houvenaeghel
- Université Aix Marseille, Inserm, CNRS, Institut Paoli Calmettes, Service de chirurgie oncologique 2, Marseille, France
| | - Eric Lambaudie
- Université Aix Marseille, Inserm, CNRS, Institut Paoli Calmettes, Service de chirurgie oncologique 2, Marseille, France
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Sterling J, Garcia MM. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Transl Androl Urol 2021; 9:2771-2785. [PMID: 33457249 PMCID: PMC7807311 DOI: 10.21037/tau-20-954] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Over the last 50 years cancer mortality has decreased, the biggest contributor to this decrease has been the widespread adoption of cancer screening protocols. These guidelines are based on large population studies, which often do not capture the non-gender conforming portion of the population. The aim of this review is to cover current guidelines and practice patterns of cancer screening in transgender patients, and, where evidence-based data is lacking, to draw from cis-gender screening guidelines to suggest best-practice screening approaches for transgender patients. We performed a systematic search of PubMed, Google Scholar and Medline, using all iterations of the follow search terms: transgender, gender non-conforming, gender non-binary, cancer screening, breast cancer, ovarian cancer, uterine cancer, cervical cancer, prostate cancer, colorectal cancer, anal cancer, and all acceptable abbreviations. Given the limited amount of existing literature inclusion was broad. After eliminating duplicates and abstract, all queries yielded 85 unique publications. There are currently very few transgender specific cancer screening recommendations. All the guidelines discussed in this manuscript were designed for cis-gender patients and applied to the transgender community based on small case series. Currently, there is not sufficient to evidence to determine the long-term effects of gender-affirming hormone therapy on an individual’s cancer risk. Established guidelines for cisgender individuals and can reasonably followed for transgender patients based on what organs remain in situ. In the future comprehensive cancer screening and prevention initiatives centered on relevant anatomy and high-risk behaviors specific for transgender men and women are needed.
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Affiliation(s)
- Joshua Sterling
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA.,Department of Anatomy, University of California San Francisco, San Francisco, CA, USA
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Wang G, Ferguson D, Ionescu DN, Hoang L, Barrett S, van Niekerk D, Rose JN, Kollmannsberger C. HPV-Related Neovaginal Squamous Cell Carcinoma Presenting as Lung Metastasis after Male-to-Female Gender Confirmation Surgery. Case Rep Oncol 2020; 13:17-22. [PMID: 32110215 PMCID: PMC7036568 DOI: 10.1159/000504936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022] Open
Abstract
There have been 4 reported cases of squamous cell carcinoma (SCC) of the neovagina in transgender women. In this report, we present another case of neovaginal SCC in a transgender woman, which was HPV-related, with lung metastasis as the initial presentation, and which was also complicated by her previous history of metastatic renal cell carcinoma. This unique case highlights the diagnostic challenges in these unusual scenarios. Through this report, we hope to address the benefits of multidisciplinary tumor board rounds, provision of detailed clinical information, and familiarization of the transgender anatomy within the pelvis in this group of patients. We also propose that transgender women undergo a continuous annual follow-up after postoperative follow-up is completed.
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Affiliation(s)
- Gang Wang
- Department of Pathology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - David Ferguson
- Department of Radiology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Diana N Ionescu
- Department of Pathology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Lien Hoang
- Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Barrett
- Department of Radiology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- Department of Pathology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - James Neil Rose
- Department of Radiation Oncology, BC Cancer Abbotsford Centre, Abbotsford, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Kollmannsberger
- Department of Medical Oncology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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Fernández-Ruiz M, Pantoja-Garrido M, Frías-Sánchez Z, Rodríguez-Jiménez I, Aguilar-Martín MDV. Epidermoid carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome. Case report and literature review. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2019; 70:266-276. [PMID: 32142241 DOI: 10.18597/rcog.3328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 01/06/2020] [Indexed: 01/09/2023]
Abstract
Objective To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment and prognosis of vaginal neoplasms or HPV infection in transgender women or with MRKH syndrome. Materials and methods A 56-year-old woman consulted to the Hospital Universitario of Sevilla (Spain). During the clinical examination, a exophytic tumor at the bottom of the vagina was found and the biopsy reported squamous carcinoma and positive nucleic acid amplification test for human papilloma (HPV) type 16. A literature search of case reports, case series and observational studies published from 2000 to October 2019 in English and Spanish was performed in Medline via PubMed, with the follow- ing terms: "congenital abnormalities"; "Mullerian aplasia"; "neovagina"; "Vaginal neoplasms"; "Squamous carcinoma"; "HPV infection" was performed. Results 14 studies were finally included; seven corresponded to squamous cell carcinoma, three to adenocarcinoma and four reported HPV infection only. All of the squamous cell carcinomas were at advanced stages due to local or lymphatic compro- mise and received radiotherapy with concomitant chemotherapy or radical surgery. The prognosis was bad in three of the cases. Patients with adenocarcinoma also presented with advanced lesions due to local extensión and received surgical treatment and two cases received concomitant chemotherapy. Only one patient was followed-up for five years or more. HPV infection is common in women who underwent neovagina reconstruction. Conclusions Patients with neovagina are susceptible to develope squamous carcinomas or adenocarcinomas depending if skin or intestinal tissue grafts are used. According to local compromise at the time of diagnosis, radical or combined treatments are required. Which screening strategies for HPV, squamous cell carcinomas and adenocarcinoma is to be investigated.
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Affiliation(s)
- Marta Fernández-Ruiz
- Servicio de Ginecología del Hospital general Santa María del Puerto (Cádiz), España
| | - Manuel Pantoja-Garrido
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen Macarena de Sevilla (España)
| | - Zoraida Frías-Sánchez
- Unidad de Gestión Clínica de Ginecología del Hospital Universitario Virgen del Rocío de Sevilla (España)
| | - Inmaculada Rodríguez-Jiménez
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen Macarena de Sevilla (España)
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