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Raos D, Vučemilo Paripović N, Ozretić P, Sabol M. Current status of in vitro models for rare gynaecological cancer research. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108549. [PMID: 39048342 DOI: 10.1016/j.ejso.2024.108549] [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: 06/24/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
Gynaecological cancers originate within the female reproductive system and are classified according to the site in the reproductive system where they arise. However, over 50 % of these malignancies are categorized as rare, encompassing 30 distinct histological subtypes, which complicates their diagnosis and treatment. The focus of this review is to give an overview of established in vitro models for the investigation of rare gynaecological cancers, as well as an overview of available online databases that contain detailed descriptions of cell line characteristics. Cell lines represent the main models for the research of carcinogenesis, drug resistance, pharmacodynamics and novel therapy treatment options. Nowadays, classic 2D cell models are increasingly being replaced with 3D cell models, such as spheroids, organoids, and tumoroids because they provide a more accurate representation of numerous tumour characteristics, and their response to therapy differs from the response of adherent cell lines. It is crucial to use the correct cell line model, as rare tumour types can show characteristics that differ from the most common tumour types and can therefore respond unexpectedly to classic treatment. Additionally, some cell lines have been misclassified or misidentified, which could lead to false results. Even though rare gynaecological cancers are rare, this review will demonstrate that there are available options for investigation of such cancers in vitro on biologically relevant models.
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Affiliation(s)
- Dora Raos
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10 000, Zagreb, Croatia.
| | | | - Petar Ozretić
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10 000, Zagreb, Croatia.
| | - Maja Sabol
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10 000, Zagreb, Croatia.
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2
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Hallonet M, Martinez A, Meresse T. Genitocrural Island Perforator Flap (GIP-Flap): An ideal surgical technique for covering uni- or bilateral vulvar loss tissue. ANN CHIR PLAST ESTH 2024; 69:267-270. [PMID: 38143156 DOI: 10.1016/j.anplas.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/11/2023] [Accepted: 11/18/2023] [Indexed: 12/26/2023]
Abstract
Vulvar loss of soft tissue leads to urinary, sexual and morphological dysfunctions. Most patients affected are comorbid making it difficult to perform a flap, which is the most appropriate way to reconstruct. Our multidisciplinary plastic and gynecologic surgery team has developed a new technique using a pedicled internal pudendal island flap. Reconstruction is reliable, quick and applicable to all patients, with a highly satisfactory final appearance.
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Affiliation(s)
- M Hallonet
- Département de chirurgie plastique, reconstructive et esthétique, hôpital universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 80000 Amiens, France.
| | - A Martinez
- Département de chirurgie, IUCT institut de cancérologie de Toulouse, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - T Meresse
- Département de chirurgie, IUCT institut de cancérologie de Toulouse, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
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3
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Moberg L, Sundqvist A, Holmberg E, Dickman PW, Borgfeldt C. Vulvar cancer incidence and net survival in Sweden 1960 to 2019: A population-based national study. Acta Obstet Gynecol Scand 2024; 103:561-571. [PMID: 38071449 PMCID: PMC10867366 DOI: 10.1111/aogs.14747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Vulvar cancer is a rare gynecological cancer affecting mostly older women. The aim of this population-based study was to investigate the incidence and net survival of vulvar cancer in Swedish women from 1960 to 2019. MATERIAL AND METHODS Data were retrieved from the mandatory Swedish Cancer Registry consisting of all women diagnosed with vulvar cancer between 1960 and 2019. Only women with a morphologically verified diagnosis of vulvar cancer were included. The individuals were then further matched with the Swedish Death Registry up until May 31, 2020. RESULTS In total, 8499 women were included with the following morphologies: squamous cell carcinoma 7250 (85.8%), malignant melanoma 539 (6.4%), adenocarcinoma 401 (4.8%) and other: 259 (3.1%). More than 50% of vulvar cancer cases occurred in women aged between 65 and 84 years of age. The 5-year age-standardized net survival increased from 53.0% (95% confidence interval [CI] 48.9-57.5) in 1960 to 72.1% (95% CI 68.8-75.5) in 2019. The proportion of adenocarcinoma among all cases increased from 2.0% to 8.7% between the 1960s and 2010s and an increase in age-standardized 5-year net survival was found for adenocarcinoma. CONCLUSIONS The age-standardized incidence of vulvar cancer cases in Sweden was stable between 1960 and 2019. During the study period, an increase in adenocarcinoma and a decrease in malignant melanoma cases was found. Five-year net survival increased by 20 percent units during the study period. For squamous cell carcinoma, an increased age-specific 5-year net survival was observed for all age groups, apart for women aged ≥85.
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Affiliation(s)
- Louise Moberg
- Department of Obstetrics and GynecologySkåne University Hospital Lund, Lund UniversityLundSweden
| | - Avalon Sundqvist
- Department of Obstetrics and GynecologySkåne University Hospital Lund, Lund UniversityLundSweden
| | - Erik Holmberg
- Department of OncologyUniversity of Gothenburg Institute of Clinical SciencesGothenburgSweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
| | - Christer Borgfeldt
- Department of Obstetrics and GynecologySkåne University Hospital Lund, Lund UniversityLundSweden
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Szablewski L. Insulin Resistance: The Increased Risk of Cancers. Curr Oncol 2024; 31:998-1027. [PMID: 38392069 PMCID: PMC10888119 DOI: 10.3390/curroncol31020075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/15/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Insulin resistance, also known as impaired insulin sensitivity, is the result of a decreased reaction of insulin signaling to blood glucose levels. This state is observed when muscle cells, adipose tissue, and liver cells, improperly respond to a particular concentration of insulin. Insulin resistance and related increased plasma insulin levels (hyperinsulinemia) may cause metabolic impairments, which are pathological states observed in obesity and type 2 diabetes mellitus. Observations of cancer patients confirm that hyperinsulinemia is a major factor influencing obesity, type 2 diabetes, and cancer. Obesity and diabetes have been reported as risks of the initiation, progression, and metastasis of several cancers. However, both of the aforementioned pathologies may independently and additionally increase the cancer risk. The state of metabolic disorders observed in cancer patients is associated with poor outcomes of cancer treatment. For example, patients suffering from metabolic disorders have higher cancer recurrence rates and their overall survival is reduced. In these associations between insulin resistance and cancer risk, an overview of the various pathogenic mechanisms that play a role in the development of cancer is discussed.
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Affiliation(s)
- Leszek Szablewski
- Chair and Department of General Biology and Parasitology, Medical University of Warsaw, Chałubińskiego 5 Str., 02-004 Warsaw, Poland
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5
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Allende SR, Salcedo-Hernandez R, Dominguez Ocadio G, Peña-Nieves A, Isla-Ortiz D, Verástegui EL, Cabrera-Galeana P. Role of palliative care intervention in patients with vulvar cancer: a retrospective study. BMJ Support Palliat Care 2023:spcare-2023-004734. [PMID: 38154924 DOI: 10.1136/spcare-2023-004734] [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: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To describe the experience of a Mexican cancer centre in vulvar cancer and the opportunity to incorporate palliative care (PC) during treatment. PATIENTS AND METHODS A retrospective study of clinical and sociodemographic characteristics of women with vulvar cancer referred to the PC service (PCS) between 2010 and 2021 is reported. Frequencies were estimated, as well as medians and IQRs, accordingly. Referral time and overall survival were estimated using the Kaplan-Meier method. RESULTS 125 women with vulvar cancer were seen between 2010 and 2021, but only 42% were seen at PCS, mostly polysymptomatic, after several visits to the emergency room. 89% of the patients seen at PCS died at home. CONCLUSIONS Vulvar cancer is a rare type of cancer, while squamous cell carcinoma is the most frequent type. At the time of referral, almost half of the patients had severe pain, bleeding, malodor, infection and urinary incontinence. Most of these patients lived in poverty, were poorly educated and had multiple surgeries. PC may play an important role in the care of patients with advanced vulvar cancer, relieving the physical and psychological symptoms, avoiding unnecessary hospitalisation and favouring death at home without pain and other symptoms.
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Affiliation(s)
- Silvia Rosa Allende
- Palliative Care Service, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Rosa Salcedo-Hernandez
- Department of Gynecological Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Adriana Peña-Nieves
- Palliative Care Service, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - David Isla-Ortiz
- Department of Gynecological Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Emma L Verástegui
- Palliative Care Service, Instituto Nacional de Cancerología, Mexico City, Mexico
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Huang J, Chan SC, Fung YC, Pang WS, Mak FY, Lok V, Zhang L, Lin X, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Global incidence, risk factors and trends of vulvar cancer: A country-based analysis of cancer registries. Int J Cancer 2023; 153:1734-1745. [PMID: 37531169 DOI: 10.1002/ijc.34655] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023]
Abstract
Vulvar cancer is an uncommon malignancy. Vulvar cancer alarmed the public health problem in terms of the cost of diagnostic and medical treatments and psychical health of females. Our study aims to provide a thorough analysis of the global disease burden, related risk factors and temporal incidence trends of vulvar cancer in population subgroups. Data from Global Cancer Observatory and the Cancer Incidence in Five Continents Plus were used for the vulvar cancer incidence. Age-standardized rates (ASR) were used to depict the incidence of vulvar cancer. The 10-year trend of incidence was assessed using joinpoint regression with average annual percentage change and 95% confidence intervals in various age groups, while its correlations with risk factors were investigated using linear regression. Higher ASR were found in Western Europe (2.4), Northern America (1.9), Northern Europe (1.9), Australia and New Zealand (1.8) and Eastern Africa (1.4). The associated risk factors of higher vulvar cancer incidence were gross domestic product per capita, Human Development Index, higher prevalence of smoking, alcohol drinking, unsafe sex and human immunodeficiency virus infection. The overall trend of vulvar cancer incidence was increasing. An increasing trend was found in older females while a mixed trend was observed in younger females. The disease burden of vulvar cancer follows a bimodal pattern according to its two histologic pathways, affecting women in both developed and developing regions. Smoking cessation, sex education and human papillomavirus vaccination programs should be promoted among the general population. Subsequent studies can be done to explore the reasons behind the increasing trend of vulvar cancer.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yat Ching Fung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing Sze Pang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fung Yu Mak
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- Suzhou Industrial Park Monash Research Institute of Science and Technology, China
- The School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Edmar Elcarte
- College of Nursing, University of the Philippines, Manila, Philippines
| | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, California, USA
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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7
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Lee MW, Vallejo A, Mandelbaum RS, Yessaian AA, Pham HQ, Muderspach LI, Roman LD, Klar M, Wright JD, Matsuo K. Temporal trends of failure-to-rescue following perioperative complications in vulvar cancer surgery in the United States. Gynecol Oncol 2023; 177:1-8. [PMID: 37597497 DOI: 10.1016/j.ygyno.2023.08.002] [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: 05/31/2023] [Revised: 07/09/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Failure-to-rescue, defined as mortality following a perioperative complication, is a perioperative quality indicator studied in various surgeries, but not in vulvar cancer surgery. The objective of this study was to assess failure-to-rescue in patients undergoing surgical therapy for vulvar cancer. METHODS This cross-section study queried the National Inpatient Sample. The study population was 31,077 patients who had surgical therapy for vulvar cancer from 1/2001-9/2015. The main outcomes were (i) perioperative morbidity (29 indicators) and (ii) mortality following a perioperative complication during the index admission for vulvar surgery (failure-to-rescue), assessed with a multivariable binary logistic regression model. RESULTS The cohort-level median age was 69 years, and 14,337 (46.1%) had medical comorbidity. Perioperative complications were reported in 4736 (15.2%) patients during the hospital admission for vulvar surgery. In multivariable analysis, patient factors including older age, medical comorbidity, and morbid obesity, and treatment factors with prior radiotherapy and radical vulvectomy were associated with perioperative complications (P < 0.05). The number of patients with morbid obesity, higher comorbidity index, and prior radiotherapy increased over time (P-trends < 0.001). Among 4736 patients who developed perioperative complications, 55 patients died during the hospital admission for vulvar surgery (failure-to-rescue rate, 1.2%). In multivariable analysis, cardiac arrest (adjusted-odds ratio [aOR] 27.25), sepsis or systemic inflammatory response syndrome (aOR 11.54), pneumonia (aOR 6.03), shock (aOR 4.37), and respiratory failure (aOR 3.10) were associated with failure-to-rescue (high-risk morbidities). There was an increasing trend of high-risk morbidities from 2.0% to 3.7% over time, but the failure-to-rescue from high-risk morbidities decreased from 9.1% to 2.8% (P-trend < 0.05). CONCLUSION Vulvar cancer patients undergoing surgical treatment had increased comorbidity over time with an increase in high-risk complications. However, failure-to-rescue rate has decreased significantly.
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Affiliation(s)
- Matthew W Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Huyen Q Pham
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Moss C, Sugai N, Persons R, Ciepluch B, Lahmers K, Cecere J. Case report: Clitoral adenocarcinoma in a mixed-breed female dog. Front Vet Sci 2023; 10:1264538. [PMID: 37841455 PMCID: PMC10570542 DOI: 10.3389/fvets.2023.1264538] [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: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
A 9-year-old, spayed female, mixed-breed dog was initially presented for evaluation of chronic dermatitis on the nasal planum, where a clitoral mass was discovered as an incidental finding during the exam. No further investigation of the clitoral mass was undertaken due to other significant dermal lesions and the lack of clinical significance of the mass at the time. However, ~1 month later, the dog was presented to the Emergency Service for bleeding from the vulva. The clitoral mass was found to have prolapsed; the mass was manually reduced back into a position within the vulvar folds and maintained with a purse-string suture. The dog was referred to the Theriogenology Service for further investigation and removal. On follow-up evaluation, the mass was noted to be multi-lobulated, ulcerated, cystic, and involving the clitoris but not the urethra. The urethra was easily catheterized, and no urinary abnormalities were found. No evidence of lymph node metastasis or hypercalcemia was noted prior to surgery. Ultrasonographic evaluation of the anal sacs was normal. The mass was removed, and histopathologic evaluation revealed a primary clitoral adenocarcinoma. On recheck evaluation, after 1 month, no evidence of metastasis or local recurrence was observed. Clitoral adenocarcinoma is a rarely reported neoplasm of the canine genital tract that shares many clinical, histopathological, and immunohistochemical features with canine apocrine gland anal sac adenocarcinoma. This case adds to the available knowledge on the condition, specifically regarding the frequency of complications such as hypercalcemia and metastasis, as previous reports suggest that these are present at least 50% of the time.
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Affiliation(s)
| | - Nicole Sugai
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - Rebecca Persons
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - Brittany Ciepluch
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - Kevin Lahmers
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - Julie Cecere
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
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Darré T, Sama B, Djiwa T, Afantodji-Agbeti WED, Bombone M, Kambote Y, Simgban P, M'Bortche BK, Douaguibe B, Amégbor K, Tchaou M, Aboubakari AS, Saka B, Napo-Koura G. Factors associated with vulvar cancer from 2005 to 2021 in Togo, sub-Saharan Africa. BMC Womens Health 2023; 23:514. [PMID: 37752494 PMCID: PMC10521553 DOI: 10.1186/s12905-023-02669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND vulvar cancer, once predominantly diagnosed in older women, is increasingly being diagnosed in younger individuals, due to Human Papillomavirus (HPV) infection. Our study aimed to describe the epidemiological and histopathological aspects of vulvar cancer in Togo and its associated factors. METHODS This was a cross-sectional study, conducted on vulvar cancer cases histologically diagnosed at the Pathological Laboratory of Lomé over a period of 17-years (2005-2021). Parameters investigated included age, occupation, risk factors, sample nature, macroscopic tumor aspects, histological types, therapeutic intervenions, and prognostic outcomes. RESULTS A total of 32 cases of vulvar cancer were collected, yieding an annual frequency of 1.88 cases. The average age of the patients was 48±14.12 years with extremes of 27 years and 82 years. Housewives accounted for the largest proportion of cases (37.5%). Among the 32 cases, 27 had identifiable risk factors, with HPV infection being the most prevalentr (33.3%). The ulcero-budding aspect was most frequently observed, and squamous cell carcinoma was the most common histological type, with the majority being well differentiated (89.3%). Statistically significant associations were found between risk factors and histological types, risk factors and degrees of differentiation, as well as between histological types and good differentiation of vulvar cancers. The 3-year survival was estimated at 78.13%. CONCLUSION The incidence of vulvar cancer is increasing in Togo, particularly among young, primarily due to HPV infection.
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Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo.
| | - Bagassam Sama
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | | | - Mayi Bombone
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Yendoubé Kambote
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Panakinao Simgban
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bingo K M'Bortche
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Baguilane Douaguibe
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Koffi Amégbor
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Mazamaesso Tchaou
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Lomé, Togo
| | | | - Bayaki Saka
- Department of Dermatology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Gado Napo-Koura
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
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Achdiat PA, Maharani RH, Hamada N, Dwiyana RF, Tsaqilah L, Usman HA, Zulfan. Vulvar squamous cell carcinoma due to human papillomavirus type 11. Skin Res Technol 2023; 29:e13436. [PMID: 37632178 PMCID: PMC10422023 DOI: 10.1111/srt.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran, Dr. Hasan Sadikin HospitalBandungWest JavaIndonesia
| | - Retno Hesty Maharani
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran, Dr. Hasan Sadikin HospitalBandungWest JavaIndonesia
| | - Nizami Hamada
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran, Dr. Hasan Sadikin HospitalBandungWest JavaIndonesia
| | - Reiva Farah Dwiyana
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran, Dr. Hasan Sadikin HospitalBandungWest JavaIndonesia
| | - Laila Tsaqilah
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran, Dr. Hasan Sadikin HospitalBandungWest JavaIndonesia
| | - Hermin Aminah Usman
- Department of Anatomical Pathology, Faculty of MedicineUniversitas Padjadjaran, Dr. Hasan Sadikin HospitalBandungWest JavaIndonesia
| | - Zulfan
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran, Dr. Hasan Sadikin HospitalBandungWest JavaIndonesia
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11
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Caretto AA, Servillo M, Tagliaferri L, Lancellotta V, Fragomeni SM, Garganese G, Scambia G, Gentileschi S. Secondary post-oncologic vulvar reconstruction - a simplified algorithm. Front Oncol 2023; 13:1195580. [PMID: 37409264 PMCID: PMC10318400 DOI: 10.3389/fonc.2023.1195580] [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: 03/28/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Surgical treatment is the gold standard of care for vulvar cancer and is burdened by a high risk of wound complications due to the poor healing typical of the female genital area. Moreover, this malignancy has a high risk of local relapse even after wide excision. For these reasons, secondary reconstruction of the vulvoperineal area is a relevant and challenging scenario for gynecologists and plastic surgeons. The presence of tissue already operated on and undermined, scars, incisions, the possibility of previous radiation therapy, contamination of urinary and fecal pathogens in the dehiscent wound or ulcerated tumor, and the unavailability of some flaps employed during the primary procedure are typical complexities of this surgery. Due to the rarity of this tumor, a rational approach to secondary reconstruction has never been proposed in the literature. Methods In this observational retrospective study, we reviewed the clinical data of patients affected by vulvar cancer who underwent secondary reconstruction of the vulvoperineal area in our hospital between 2013 and 2023. Oncological, reconstructive, demographic, and complication data were recorded. The primary outcome measure was the incidence of wound complications. The secondary outcome measure was the indication of the different flaps, according to the defect, to establish an algorithm for decision-making. Results Sixty-six patients were included; mean age was 71.3 ± 9.4 years, and the mean BMI was 25.1 ± 4.9. The mean size of the defect repaired by secondary vulvar reconstruction was 178 cm2 ± 163 cm2. Vertical rectus abdominis myocutaneous (VRAM), anterolateral thigh (ALT), fasciocutaneous V-Y (VY), and deep inferior epigastric perforator (DIEP) were the flaps more frequently employed. We observed five cases of wound breakdown, one case of marginal necrosis of an ALT flap, and three cases of wound infection. The algorithm we developed considered the geometry and size of the defect and the flaps still available after previous surgery. Discussion A systematic approach to secondary vulvar reconstruction can provide good surgical results with a low rate of complications. The geometry of the defect and the use of both traditional and perforator flaps should guide the choice of the reconstructive technique.
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Affiliation(s)
- Anna Amelia Caretto
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
| | | | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Valentina Lancellotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Simona Maria Fragomeni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Rome, Italy
| | - Giorgia Garganese
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Ginecologia Oncologica, Rome, Italy
| | - Stefano Gentileschi
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Rome, Italy
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Di Fiore R, Suleiman S, Drago-Ferrante R, Subbannayya Y, Suleiman S, Vasileva-Slaveva M, Yordanov A, Pentimalli F, Giordano A, Calleja-Agius J. The Role of FBXW7 in Gynecologic Malignancies. Cells 2023; 12:1415. [PMID: 37408248 DOI: 10.3390/cells12101415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
The F-Box and WD Repeat Domain Containing 7 (FBXW7) protein has been shown to regulate cellular growth and act as a tumor suppressor. This protein, also known as FBW7, hCDC4, SEL10 or hAGO, is encoded by the gene FBXW7. It is a crucial component of the Skp1-Cullin1-F-box (SCF) complex, which is a ubiquitin ligase. This complex aids in the degradation of many oncoproteins, such as cyclin E, c-JUN, c-MYC, NOTCH, and MCL1, via the ubiquitin-proteasome system (UPS). The FBXW7 gene is commonly mutated or deleted in numerous types of cancer, including gynecologic cancers (GCs). Such FBXW7 mutations are linked to a poor prognosis due to increased treatment resistance. Hence, detection of the FBXW7 mutation may possibly be an appropriate diagnostic and prognostic biomarker that plays a central role in determining suitable individualized management. Recent studies also suggest that, under specific circumstances, FBXW7 may act as an oncogene. There is mounting evidence indicating that the aberrant expression of FBXW7 is involved in the development of GCs. The aim of this review is to give an update on the role of FBXW7 as a potential biomarker and also as a therapeutic target for novel treatments, particularly in the management of GCs.
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Affiliation(s)
- Riccardo Di Fiore
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
| | - Sherif Suleiman
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | | | - Yashwanth Subbannayya
- School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Sarah Suleiman
- Whipps Cross Hospital, Barts Health NHS Trust, Leytonstone, London E11 1NR, UK
| | - Mariela Vasileva-Slaveva
- Department of Breast Surgery, "Dr. Shterev" Hospital, 1330 Sofia, Bulgaria
- Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria
- Bulgarian Breast and Gynecological Cancer Association, 1784 Sofia, Bulgaria
| | - Angel Yordanov
- Department of Gynecological Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
| | - Francesca Pentimalli
- Department of Medicine and Surgery, LUM University "Giuseppe DeGennaro", 70010 Casamassima, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
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Linz VC, Schwanbeck C, Krajnak S, Anic K, Jäkel J, Schwab R, Schmidt M, Schmidberger H, Hasenburg A, Battista MJ. Comparison of cisplatin and mitomycin C/5-FU as radiosensitisers in the treatment of locally advanced vulvar cancer: results of a retrospective, observational, single-institutional cohort study. J Cancer Res Clin Oncol 2023; 149:1391-1399. [PMID: 35451700 PMCID: PMC10020277 DOI: 10.1007/s00432-022-04006-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We retrospectively investigated the widely used radiosensitisers cisplatin and mitomycin C/5-fluorouracil (5-FU) in patients with locally advanced vulvar cancer for outcome and toxicity. METHODS We screened the archive for patients treated with chemoradiation for vulvar cancer diagnosed between 01/2010 and 08/2021 at our institution. The impact of both radiosensitisers on prognosis was compared using Kaplan-Meier method and Cox-regression analysis. RESULTS One hundred and forty-three patients with vulvar cancer were screened. Twenty-nine patients received chemoradiation (mitomycin C/5-FU n = 14; cisplatin n = 12; others n = 3) as a primary, neoadjuvant or adjuvant treatment. Median follow-up was 15.5 months. Patients in the cisplatin group were older (mean age 54.4 vs. 70.7; p = 0.004). However, the mitomycin C/5-FU group had more advanced tumour stages. The 2-year recurrence-free survival (RFS) was comparable (44.5% vs. 33.3%; p = 0.932). The 2-year overall survival (OS) showed a numerical but not statistically significant difference in favour of the mitomycin C/5-FU group (59.7% vs. 31.7%; p = 0.37). 64.3% (9 out of 14) patients, who received mitomycin C/5-FU achieved clinical complete response (cCR) compared to 41.7% (5 out of 12) who received cisplatin (p = 0.505). Radiodermatitis was the most common adverse event in both groups (81%) and more severe in the mitomycin C/5-FU cohort. Myelotoxicity was frequently observed in both groups. Eighteen patients received an additional radiation boost with 10.0 (9-16) Gy and showed a significantly prolonged RFS (p = 0.027) and OS (p = 0.003). CONCLUSION Mitomycin C/5-FU may be considered in the treatment of young and healthy patients with locally advanced vulvar cancer.
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Affiliation(s)
- Valerie Catherine Linz
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Carina Schwanbeck
- Department of Radiooncology and Radiotherapy, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Anic
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jörg Jäkel
- Department of Pathology University Medical Center, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Roxana Schwab
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiooncology and Radiotherapy, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marco Johannes Battista
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Frailty and treatment decisions in older patients with vulvar cancer: A single-center cohort study. J Geriatr Oncol 2023; 14:101442. [PMID: 36739834 DOI: 10.1016/j.jgo.2023.101442] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/19/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Vulvar cancer is a disease that mainly affects older women. Frailty is an important predictor of outcomes and geriatric assessment can help tailor treatment decisions and improve outcomes. This study aims to assess the prevalence of frailty in older women with vulvar cancer, and how it relates to integrated geriatric care and treatment according to the oncological guidelines. MATERIALS AND METHODS A single-center cohort study was performed, among patients 70 years and older, who were diagnosed with vulvar cancer at Leiden University Medical Center, between January 2012 and May 2020. Data on geriatric assessment, treatment decision-making and treatment-related outcomes were collected. RESULTS Our study included 114 patients. Mean age was 79.7 years, and 52 patients (45.6%) were frail. Of the frail patients, 42.0% were referred to a geriatrician. In eight of these cases, the geriatrician was actively involved in weighing the benefit and harm of standard oncological treatment versus de-escalated treatment. Frailty, higher age, impairment in the somatic domain, cognitive impairment, and functional dependency were associated with referral to a geriatrician and with active involvement of a geriatrician in decision making. In 26 of frail patients (50.0%) oncological treatment was de-escalated. Frailty, higher age, impairment in the somatic domain, cognitive impairment, and functional dependency were associated with de-escalation of treatment. De-escalated treatment did not compromise survival. DISCUSSION Frailty is prevalent among older women with vulvar cancer and is associated with referral to a geriatrician and de-escalation of oncological treatment. While this reflects that it is deemed important to tailor treatment decision for frail patients, most frail patients are not routinely evaluated by a geriatrician. Further multidisciplinary collaboration and research is necessary to optimize tailored treatment decisions for this patient group.
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Fenech M. Sonographic localisation and description of inguinofemoral lymph nodes in patients with vulvar squamous cell carcinoma. SONOGRAPHY 2023. [DOI: 10.1002/sono.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Michelle Fenech
- College of Clinical Sciences, Health, Medical and Applied Sciences, CQUniversity, Brisbane Campus Brisbane Australia
- Department of Medical Imaging Royal Brisbane and Women's Hospital Herston Australia
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McGettigan M, Zulfiqar M, Shetty AS. Imaging of Vaginal and Vulvar Malignancy. Radiol Clin North Am 2023; 61:651-670. [PMID: 37169430 DOI: 10.1016/j.rcl.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Vaginal and vulvar malignancies are rare gynecologic malignancies but can be associated with high morbidity and mortality if undiagnosed and untreated. Advanced imaging modalities such as MRI enable assessment of the local extent of disease and evaluation for regional or distant spread. Accurate identification and description of the primary lesion and sites of involvement as well as detection and localization of suspicious lymph nodes are critical in guiding appropriate management. Additionally, radiologists should be aware of potential mimickers on imaging and the differential diagnoses for vaginal and vulvar lesions.
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Winarto H, Habiburrahman M, Anggraeni TD, Nuryanto KH, Julianti RA, Purwoto G, Andrijono A. The Utility of Pre-Treatment Inflammation Markers as Associative Factors to the Adverse Outcomes of Vulvar Cancer: A Study on Staging, Nodal Involvement, and Metastasis Models. J Clin Med 2022; 12:jcm12010096. [PMID: 36614896 PMCID: PMC9821387 DOI: 10.3390/jcm12010096] [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: 10/06/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Given the role of inflammation in carcinogenesis, this study investigated the utility of pre-treatment inflammatory markers as associative indicators for advanced-stage disease, lymph node metastasis (LNM), and distant metastasis (DM) in vulvar cancer (VC). METHODS A cross-sectional study was conducted on 86 women with VC in a single centre in Jakarta, Indonesia. The laboratory data was based on C-reactive protein (CRP), procalcitonin, the erythrocyte sedimentation rate (ESR) and fourteen derived, recorded and calculated ratios: leukocyte-to-platelet (LPR), neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR), neutrophil-to-monocyte (NMR), platelet-to-monocyte (PLR), lymphocyte-to-monocyte (LMR), basophil-to-monocyte (BLR), systemic immune-inflammation index (SII), body mass index, albumin, and NLR (BAN) score, haemoglobin-to-platelet (HPR), prognostic nutritional index (PNI), modified Glasgow Prognostic Score (mGPS), CRP-to-albumin, and CRP-to-procalcitonin. The optimal cut-off for each marker was determined using receiver operating characteristic (ROC) curve analysis, and their diagnostic indicator performances were assessed. The utility of these ratios as associative factors for three endpoints was further evaluated in multivariate regression models. RESULTS Investigated inflammatory markers exhibited specific performances for individual adverse outcomes, proving a fair to excellent ability in case finding and screening. After adjustment, the BAN score ≤ 334.89 (OR 9.20, p = 0.001) and ESR ≥ 104 (OR 4.18, p = 0.048) become two advanced-stage associative factors with AUC: 0.769. LNM was solely determined by higher NLR ≥ 2.83 (OR 4.15, p = 0.014) with AUC: 0.615. Meanwhile, BLR ≥ 0.035 (OR 5.67, p = 0.001) and ESR ≥ 84 (OR 6.01, p = 0.003) were contributing factors for DM, with AUC: 0.765. CONCLUSIONS Inflammatory markers are crucial for identifying the deleterious outcomes of VC. Accordingly, yielded models require external validation.
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Affiliation(s)
- Hariyono Winarto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Correspondence: (H.W.); (M.H.); Tel.: +62-21-3914806 (H.W.); +62-21-31930373 (M.H.)
| | - Muhammad Habiburrahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Correspondence: (H.W.); (M.H.); Tel.: +62-21-3914806 (H.W.); +62-21-31930373 (M.H.)
| | - Tricia Dewi Anggraeni
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Kartiwa Hadi Nuryanto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Renny Anggia Julianti
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Gatot Purwoto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Andrijono Andrijono
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
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de Mattia E, Angioletti C, Perilli A, Guajardo Rios LS, Garganese G, Tagliaferri L, Scambia G, Fragomeni SM, de Belvis AG. Gov➔Value: How to combine reported quality experiences and patient-reported outcome measures. First results on vulvar cancer patients in an Italian Research Hospital. Front Public Health 2022; 10:1014651. [PMID: 36605234 PMCID: PMC9807601 DOI: 10.3389/fpubh.2022.1014651] [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: 08/08/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Vulvar cancer (VC) accounts for <1% of cancers affecting the female gender. Clinical Pathways (CP) and Clinical Outcomes Monitoring are useful for providing high-quality care to these patients. However, it is essential to integrate them with the patient's perspective according to Value-Based Healthcare paradigms. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are tools for assessing outcomes and experiences with health care from the patient's perspective. The aim of this paper is to collect and synthesize PROMs and main stakeholders' experience on the VC CP, according to a value-based approach. Materials and methods To select the most appropriate instrument, a review was conducted on the main databases and official websites of specific institutions and organizations. In the second phase, a 2-round Delphi survey was conducted to assess the Reported Experience Measures (REMs) tool. Questions were evaluated according to four criteria (general relevance, evidence-based, measurability, actionability) and included if strong agreement was reached. A Principal Component Analysis (PCA) was executed. Cronbach's alpha and McDonald's omega were computed. Fisher's exact test and Wilcoxon rank sum test were used to compare ratings between groups. Descriptive statistics were performed for both PROMs and REMs instruments. Results For PROMs assessment, EORTC QLQ-C30 questionnaire was selected and administered to 28 patients. Global Health Status/Quality of Life and Functional Scales Scores were high or very high, while symptoms scale reported low or medium scores. The final REMs consists of 22 questions for professionals and 16 for patients and caregivers. It was administered to 22 patients, 11 caregivers, 5 physicians, 2 nurses and 1 clinical senior manager. PCA identified 4 components. Scale reliability was acceptable (α = 0.75 95% CI: 0.61-0.85; ω = 0.69; 95% CI: 0.54, 0.82). A statistically significant difference between the patient/caregiver group and the professionals was found for items 8 (follow-up), 10 (perceived quality), 12 (safety), and 16 (climate) (p = 0.02; p = 0.03; p < 0.001; p < 0.001, respectively). Discussion PROMs could provide new ways of intercepting patients' needs and feedback, thus acting on them. The proposed REMs tool would allow to detect information not available elsewhere, which, through Audit and feedback strategies, could lead to enhancement of healthcare experience, according to a value-based approach.
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Affiliation(s)
- Egidio de Mattia
- Clinical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Carmen Angioletti
- Clinical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Alessio Perilli
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy,*Correspondence: Alessio Perilli, ✉
| | - Linda Stella Guajardo Rios
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy,Section of Gynecology and Obstetrics, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- Unit of Oncological Radiotherapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Giovanni Scambia
- Section of Gynecology and Obstetrics, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy,Unit of Cancer Gynecology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Simona Maria Fragomeni
- Unit of Cancer Gynecology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy
| | - Antonio Giulio de Belvis
- Clinical Pathways and Outcomes Evaluation Unit, Fondazione Policlinico Universitario ‘A. Gemelli’—IRCCS, Rome, Italy,Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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Mix JM, Gopalani SV, Simko S, Saraiya M. Trends in HPV- and non-HPV-associated vulvar cancer incidence, United States, 2001-2017. Prev Med 2022; 164:107302. [PMID: 36240909 PMCID: PMC10999169 DOI: 10.1016/j.ypmed.2022.107302] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/18/2022] [Accepted: 10/07/2022] [Indexed: 11/20/2022]
Abstract
Vulvar cancer incidence has been rising in recent years, possibly due to increasing exposure to human papillomavirus (HPV). We assessed incidence rates of HPV-associated and non-HPV-associated vulvar cancers diagnosed from 2001 to 2017 in the United States (US). Using population-based cancer registry data covering 99% of the US population, incidence rates were calculated and stratified by age, race/ethnicity, stage, geographic region, and histology. The average annual percent change in incidence per year were calculated using joinpoint regression. From 2001 to 2017, the incidence of HPV-associated vulvar cancers increased by 1.2% per year, most notably among women who were aged 50-59 years (2.6%), 60-69 years (2.4%), and ≥ 70 years (0.9%); of White (1.5%) and Black (1.1%) race; diagnosed at an early (1.3%) and late (1.8%) stage; and living in the Midwest (1.9%), Northeast (1.4%), and South (1.2%). Incidence increased each year for HPV-associated histologic subtypes including keratinizing (4.7%), non-keratinizing (6.0%), and basaloid (3.1%) squamous cell carcinomas (SCCs), while decreases were found in warty (2.7%) and microinvasive (5.5%) SCCs. HPV-associated vulvar cancer incidence increased overall and among women aged over 50 years while remaining stable among women younger than 50 years. The overall incidence for non-HPV-associated cancers was stable. Continued surveillance of HPV-associated cancers will allow us to monitor future trends as HPV vaccination coverage increases in the US.
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Affiliation(s)
- Jacqueline M Mix
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States of America; Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, United States of America
| | - Sameer V Gopalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States of America; Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, United States of America
| | - Sarah Simko
- Adventist Health White Memorial Medical Center, Los Angeles, CA 90033, United States of America
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States of America.
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Robinson KE, Tahbouh Amawi AD, Venkatesh SK, Torres-Mora J, West E, Kumar A. Vulvar glomangioma: A case report and literature review. Gynecol Oncol Rep 2022; 42:101034. [PMID: 35800986 PMCID: PMC9253594 DOI: 10.1016/j.gore.2022.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/15/2022] Open
Abstract
Vulvar glomangioma is a rare cause of pelvic pain and can be confused with angiomyxoma or Bartholin gland cyst. Vulvar glomangioma are best treated with resection. Glomangiomas are associated with GLMN gene mutations.
GLMN is a gene that encodes a critical protein necessary for normal vascular development. Mutations of GLMN predispose individuals to development of glomangiomas, with nearly 100% penetrance by age 30. Glomangiomas are tumors of the glomus body, a thermoregulatory arterial-venous shunt composed of modified smooth muscle cells. Vulvar glomangioma is an exceedingly rare cause of chronic pelvic pain, that may be easily confused for other conditions such as Bartholin’s gland abscess or deep angiomxyomas, thereby delaying diagnosis and treatment. Glomangiomas have characteristic pathologic and imaging findings which may aid diagnosis. We herein describe the case of a 24-year-old female who developed chronic pelvic pain in the setting of a vulvar glomangioma. We further delineate the magnetic resonance imaging and biopsy findings critical to her diagnosis, and the appropriate steps taken for surgical management. She was found to harbor a heterozygous GLMN mutation. To the best of our knowledge, this is the first description of such a case in the medical literature.
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Affiliation(s)
- Kyle E. Robinson
- Mayo Clinic Alix School of Medicine; Mayo Clinic Florida, Jacksonville, FL, USA
| | | | | | | | - Ellen West
- Department of Obstetrics and Gynecology, Department of Oncology; Mayo Clinic, Rochester, MN, USA
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Department of Oncology; Mayo Clinic, Rochester, MN, USA
- Corresponding author at: Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
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21
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Barwal TS, Singh N, Sharma U, Bazala S, Rani M, Behera A, Kumawat RK, Kumar P, Uttam V, Khandelwal A, Barwal J, Jain M, Jain A. miR-590-5p: A double-edged sword in the oncogenesis process. Cancer Treat Res Commun 2022; 32:100593. [PMID: 35752082 DOI: 10.1016/j.ctarc.2022.100593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/22/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
Accumulating evidence suggests the critical role of miR-590-5p in various aspects of cellular homeostasis, including cancer. Furthermore, we and others have recently demonstrated that miRNA-590-5p acts as an oncogene in some cancers while it acts as a tumor-suppressor in others. However, the role of miR-590-5p in oncogenesis is more complex, like a double-edged sword. Thus, this systematic review introduces the concept, mechanism, and biological function of miR-590-5p to resolve this apparent paradox. We have also described the involvement of miR-590-5p in crucial cancer-hallmarks processes like proliferation, invasion, metastasis, and chemo radioresistance. Finally, we have presented the possible genes/pathways targets of miR-590-5p through bioinformatics analysis. This review may help in designing better biomarkers and therapeutic targets for cancers.
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Affiliation(s)
- Tushar Singh Barwal
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India; GreyB consultancy services, Mohali, Punjab 160062, India
| | - Neha Singh
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India
| | - Uttam Sharma
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India
| | - Sonali Bazala
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India
| | - Medha Rani
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India
| | - Alisha Behera
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India
| | - Ram Kumar Kumawat
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India
| | - Pawan Kumar
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India
| | - Vivek Uttam
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India
| | - Akanksha Khandelwal
- Department of Biochemistry, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Jyoti Barwal
- Department of Zoology, Government Post Graduate College, Bilaspur, Himachal Pradesh, India
| | - Manju Jain
- Department of Biochemistry, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Aklank Jain
- Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India.
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22
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Garganese G, Fragomeni SM, Della Corte L, Conte C, Marinucci B, Tagliaferri L, Gentileschi S, Corrado G, Vizzielli G, Scambia G. Trans-inguinal pelvic lymphadenectomy in vulvar cancer patients: TRIPLE pilot study. Int J Gynecol Cancer 2022; 32:846-852. [PMID: 35618308 DOI: 10.1136/ijgc-2022-003347] [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: 11/03/2022] Open
Abstract
OBJECTIVE The goal of this study was to assess the feasibility and safety of a retrograde extraperitoneal trans-inguinal novel approach to pelvic lymphadenectomy in vulvar cancer patients. The secondary objectives were to assess complications (early and late) and oncological outcomes. METHODS In this pilot study, all patients referred to our institution from November 2019 to May 2021 were evaluated. The inclusion criteria were patients diagnosed with primary/recurrent vulvar cancer and who were candidates for concomitant groin and pelvic lymph node dissection. A consecutive sampling was planned during the study period. After conventional inguino-femoral lymph nodal dissection, ipsilateral extraperitoneal trans-inguinal pelvic lymphadenectomy (TRIPLE) was performed through a groin incision. Clinical data, type of treatment, perioperative complications, and follow-up were evaluated. RESULTS 13 patients (8 primary, 5 recurrent vulvar cancer) underwent 16 TRIPLE procedures (10 unilateral, 3 bilateral). The median age was 69 years (range 58-93 years); 8 patients had comorbidities (61.5%). Up front locoregional radiotherapy was previously performed in two cases (15.4%). The pathology report showed metastatic lymph nodes in 20 (87%) groins and 11 (68.8%) pelvic sites; the mean number of removed and metastatic pelvic lymph nodes was 12.1 (range 5-33) and 2.9 (range 0-18), respectively. No intra-operative site-specific complications occurred. One (5.9%) post-operative site-specific complication was reported (pelvic abscess, grade 2), which was treated with antibiotics. One patient died due to concomitant pneumonia. No unilateral pelvic lymph node recurrence occurred during follow-up (median 13 months, range 2-43 months); 3 patients (23.1%) had distant site recurrence (median disease-free survival 9 months). CONCLUSIONS TRIPLE seems to be a feasible and safe technique, providing adequate lymph node dissection. Despite being a high-risk and fragile population, morbidity was similar to previously reported data for conventional mini-invasive approaches. Prospective larger comparative series are necessary.
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Affiliation(s)
- Giorgia Garganese
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica - Sezione di Ginecologia ed Ostetricia - Università Cattolica del Sacro Cuore, Rome, Italy.,Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Simona Maria Fragomeni
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Della Corte
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Universita degli Studi di Napoli Federico II, Naples, Italy
| | - Carmine Conte
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Benito Marinucci
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica - Sezione di Ginecologia ed Ostetricia - 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, Lazio, Italy
| | - Stefano Gentileschi
- Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Rome, Lazio, Italy.,Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Corrado
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vizzielli
- Division of Obstetrics and Gynecology, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Scambia
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica - Sezione di Ginecologia ed Ostetricia - Università Cattolica del Sacro Cuore, Rome, Italy.,Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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23
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Maate F, Julius P, Siyumbwa S, Pinder L, Kaile T, Mwanahamuntu M, Parham G. High-risk human papillomavirus-associated vulvar neoplasia among women living with human immunodeficiency virus in Zambia. Afr J Lab Med 2022; 11:1563. [PMID: 35747556 PMCID: PMC9210187 DOI: 10.4102/ajlm.v11i1.1563] [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: 02/21/2021] [Accepted: 02/24/2022] [Indexed: 01/27/2023] Open
Abstract
Background Globally, women living with HIV have a higher risk of vulvar neoplasia than HIV-negative women. Vulvar neoplasia among women living with HIV has not previously been characterised in Zambia. Objective This study determined the clinical and pathologic features of vulvar neoplasia among women living with HIV at the University Teaching Hospital, Lusaka, Zambia. Methods We conducted a cross-sectional study of vulvar lesions among 53 women living with HIV who presented with vulvar lesions between July 2017 and February 2018. The study assessed clinical and histological characteristics and prevalence of high-risk human papillomavirus (HRHPV). Results Twenty-one patients were diagnosed with vulvar squamous cell carcinoma (VSCC), 20 with usual vulvar intraepithelial neoplasm (uVIN), and the rest with either benign lesions or non-neoplastic lesions (NNL). Participants' mean age was 40 years. Patients with VSCC were significantly older than those with NNL (mean (s.d.): 43 (21) vs 33 (10), p = 0.004). The prevalence of HRHPV was 88.9% in VSCC patients and 100.0% in high-grade squamous intraepithelial lesion patients. HPV16 was the most common (52.6%) genotype. The clinical features of neoplasia were similar to those of NNL. Conclusion VSCC was significantly more common among women aged ≥ 40 years. HRHPV in VSCC and high-grade squamous intraepithelial lesions was high. Women with vulvar lesions, especially those aged > 40 years, should be evaluated for vulvar cancer. Young girls should be vaccinated to prevent vulvar cancer.
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Affiliation(s)
- Fred Maate
- Department of Pathology and Microbiology, Adult and Emergency Hospital, University Teaching Hospitals, Lusaka, Zambia,Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Peter Julius
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Stepfanie Siyumbwa
- Department of Pathology and Microbiology, Adult and Emergency Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Leeya Pinder
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States
| | - Trevor Kaile
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Groesbeck Parham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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24
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Cells to Surgery Quiz: May 2022. J Invest Dermatol 2022; 142:e59-e63. [DOI: 10.1016/j.jid.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/19/2022]
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25
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Virarkar M, Vulasala SS, Daoud T, Javadi S, Lall C, Bhosale P. Vulvar Cancer: 2021 Revised FIGO Staging System and the Role of Imaging. Cancers (Basel) 2022; 14:2264. [PMID: 35565394 PMCID: PMC9102312 DOI: 10.3390/cancers14092264] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 01/27/2023] Open
Abstract
Vulvar cancer is a rare gynecological malignancy. It constitutes 5-8% of all gynecologic neoplasms, and squamous cell carcinoma is the most common variant. This article aims to review the etiopathogenesis revised 2021 International Federation of Gynecology and Obstetrics (FIGO) classification and emphasize imaging in the staging of vulvar cancer. The staging has been regulated by FIGO since 1969 and is subjected to multiple revisions. Previous 2009 FIGO classification is limited by the prognostic capability, which prompted the 2021 revisions and issue of a new FIGO classification. Although vulvar cancer can be visualized clinically, imaging plays a crucial role in the staging of the tumor, assessing the tumor extent, and planning the management. In addition, sentinel lymph node biopsy facilitates the histopathological staging of the draining lymph node, thus enabling early detection of tumor metastases and better survival rates.
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Affiliation(s)
- Mayur Virarkar
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Sai Swarupa Vulasala
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Taher Daoud
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
| | - Sanaz Javadi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
| | - Chandana Lall
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
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26
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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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27
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Cebeci D, Yaşar Ş, Eker T, Bayraktaroğlu G. Necrotizing fasciitis arising from squamous cell carcinoma of the vulva: Case report. Dermatol Reports 2022; 14:9082. [PMID: 36199909 PMCID: PMC9527690 DOI: 10.4081/dr.2022.9082] [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: 01/23/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
Necrotizing fasciitis (NF) is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. While it is associated with several risk factors, including malignancy, alcoholism, liver disease, drug use, malnutrition, diabetes, male gender and old age, few case reports in the literature describe its rare connection with genital malignancy. Vulvar squamous cell carcinoma (SCC) is the fourth most common malignancy, representing 5% of all gynaecological tumours among women. NF due to vulvar SCC is a rare complication. In this article, we present the 1991 case of a 58-year-old diabetic female patient with NF due to vulvar SCC. While surgical intervention was successful, the prognosis for vulvar SCC was poor because of late detection.
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28
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Khullar K, Patrich T, Jabbour SK, Hathout L. Adjuvant Radiation in Early Stage Vulvar Cancer: A Review of Indications and Optimal Dose. APPLIED RADIATION ONCOLOGY 2022; 11:14-20. [PMID: 35445143 PMCID: PMC9017798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vulvar cancer is a relatively rare gynecologic malignancy for which surgery remains the cornerstone of treatment. A wide local excision is the goal for treatment with curative intent in patients with early stage vulvar cancer, given that there are adverse pathologic features shown to increase risk of local recurrence. Specifically, the presence of positive or close margins of < 8 mm or 2 or more positive nodes have been shown to significantly increase the risk of recurrence and have informed guidelines for risk-adapted adjuvant radiation, although the optimal dose for adjuvant radiation is yet to be established. Given the rarity of vulvar cancer, guidelines regarding the indications and dose for adjuvant radiation are based largely on retrospective studies. The purpose of this review is to summarize the evidence underlying the current indications for adjuvant radiation in early stage vulvar cancer as well as to determine the optimal dose for adjuvant radiation.
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Affiliation(s)
- Karishma Khullar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Tomas Patrich
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
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29
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Cocks MM, Mills AM. The Immune Checkpoint Inhibitor LAG-3 and Its Ligand GAL-3 in Vulvar Squamous Neoplasia. Int J Gynecol Pathol 2022; 41:113-121. [PMID: 33782343 DOI: 10.1097/pgp.0000000000000782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vulvar squamous cell carcinoma (vSCC), although rare, carries significant morbidity and a high rate of recurrence. Treatment options beyond surgical excision remain limited. Lymphocyte activation gene-3 (LAG-3) and its binding partner galectin-3 (GAL-3) are an immuno-inhibitory checkpoint pair that represent potential immunotherapy targets for the treatment of vSCC. This study examined the expression of LAG-3 and GAL-3 alongside programmed cell death ligand-1 expression in invasive SCC and vulvar intraepithelial neoplasia (VIN) by immunohistochemical analysis of formalin-fixed paraffin-embedded tissue. A total of 35 cases were selected for evaluation: 13 VIN3 [human papillomavirus (HPV)-associated VIN/usual-type VIN], 2 differentiated VIN (dVIN), 16 HPV-associated vSCC, and 4 dVIN-associated vSCC. LAG-3+ tumor-infiltrating lymphocytes were identified in 91% (32/35) of cases of vulvar squamous neoplasia. Tumor cells were positive for GAL-3 in 71% of the vulvar neoplasia cases. HPV-associated vSCC was more likely to demonstrate GAL-3 tumoral positivity when compared with dVIN-associated vSCC (24/29 vs. 1/6, P=0.004). We observed co-expression of all 3 immunomarkers in 40% (14/35) of cases evaluated. In light of these findings, use of immunomodulatory drugs that target the LAG-3/GAL-3 pathway may be potentially beneficial in vSCC and efficacy may be increased when combined with anti-programmed cell death ligand-1 therapy.
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30
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Parpex G, Bucau M, Estevez JP, Raimond E, Ouldamer L, Carcopino X, Touboul C, Bendifallah S, Graesslin O, Lavoue V, Bolze PA, Koskas M. Impact of vulvar reconstruction on the accuracy of a nomogram for predicting local recurrence after surgery for vulvar cancer. Gynecol Oncol 2022; 165:143-148. [PMID: 35177278 DOI: 10.1016/j.ygyno.2022.02.008] [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: 10/18/2021] [Revised: 01/17/2022] [Accepted: 02/06/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND DATA Vulvar carcinoma is a rare disease accounting for 3%-5% of all gynaecological cancers. Although surgery is the standard treatment at an early stage, the outcomes are highly correlated with clear resection margins. Therefore, surgical defects can be important and require reconstruction. The aim of this study was to evaluate vulvar reconstructions using a previously validated nomogram predicting the risk of local recurrence at 2 years. METHODS Patients who underwent surgery for vulvar cancer between 1998 and 2017 were extracted from eight FRANCOGYN centres. We estimated the probability of local recurrence at 2 years using a previously validated nomogram and compared it with actual relapse in patients with or without vulvar reconstruction. Patients were clustered into tiertiles according to their nomogram score: low-, intermediate-, and high-risk for local relapse probability. RESULTS We reviewed 254 patients, of whom 49 underwent immediate vulvar reconstruction. The predicted and actual probability of two-year local relapse were 20.1% and 15.7%, respectively, with a concordance index of 0.75. In the low- and intermediate-risk groups, the difference between predicted and observed recurrence was less than 10% in patients with or without vulvar reconstruction. For the high-risk group, the difference reached 25% and observed recurrence probability was lower in patients who underwent vulvar plasty compared with those who did not (20.0% vs. 36.2%, respectively). Local recurrence-free survival rates following vulvar reconstruction were comparable at two years (82.1% vs. 84.8%, respectively, p = 0.26). CONCLUSION Vulvar reconstruction after surgical resection for vulvar cancer is safe. Vulvar reconstruction should be considered in aggressive cases to decrease local recurrence.
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Affiliation(s)
- Guillaume Parpex
- Department of Gynaecology and Obstetrics, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Paris University, Paris, France.
| | - Margot Bucau
- Department of Pathology, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Juan Pablo Estevez
- Department of Gynaecology and Obstetrics, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne, Universitary Hospital of Reims, University of Reims Champagne Ardenne (URCA), 51092 Reims Cedex, France
| | - Lobna Ouldamer
- Department of Obstetrics and Gynaecology, Centre, Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France
| | - Xavier Carcopino
- Hôpital Nord (APHM), Department of Obstetrics and Gynecology, Aix-Marseille Université (AMU), CNRS, IRD, IMBE, Marseille, France
| | - Cyril Touboul
- Paris University, Paris, France; Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne, Universitary Hospital of Reims, University of Reims Champagne Ardenne (URCA), 51092 Reims Cedex, France
| | - Vincent Lavoue
- Department de Gynaecology, Obstetrics and Reproductive Medicine, University Hospital of Rennes, Rennes, France; Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Pierre-Adrien Bolze
- Université Lyon 1, Faculté de Médecine Lyon Sud, Hospices Civils de Lyon, Department of Gynaecologic Surgery and Oncology, Obstetrics, Hôpital Lyon Sud, Pierre Bénite, France
| | - Martin Koskas
- Department of Gynaecology and Obstetrics, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France; Paris University, Paris, France
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31
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Dryden SM, Reshko LB, Gaskins JT, Silva SR. Verrucous carcinoma of the vulva: Patterns of care and treatment outcomes. Cancer Rep (Hoboken) 2022; 5:e21591. [PMID: 35075817 PMCID: PMC9575509 DOI: 10.1002/cnr2.1591] [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: 08/24/2021] [Revised: 09/30/2021] [Accepted: 11/10/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Verrucous vulvar carcinoma (VC) is an uncommon and distinct histologic subtype of squamous cell carcinoma (SCC). The available literature on VC is currently limited to case reports and small single institution studies. AIMS The goals of this study were to analyze data from the National Cancer Database (NCDB) to quantitate the incidence of VC and to investigate the effects of patient demographics, tumor characteristics, and treatment regimens on overall survival (OS) in women with verrucous vulvar carcinoma. METHODS AND RESULTS Patients diagnosed with vulvar SCC or VC between the years of 2004 and 2016 were identified in the NCDB. OS was assessed with Kaplan-Meier curves and the log-rank test. Construction of a Cox model compared survival after controlling for confounding variables. The reported incidence of SCC of the vulva has significantly increased since 2004 (p < .0001). In contrast, the incidence of VC has remained stable (p = .344) since 2004. Compared to SCC, VC was significantly more likely to be diagnosed in older women (p < .0001) and treated with surgery alone (p < .0001). However, on propensity score weighted analysis there was a trend toward improved 5-year OS in women with VC compared to those with SCC (63.4% vs. 57.7%, p = .0794). Multivariable Cox survival analysis showed an improvement in OS in VC patients treated with both primary site and regional lymph node surgery compared to primary site surgery alone (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI] 0.46-0.97, p = .0357). CONCLUSION Verrucous carcinoma is more likely to present in older women. Regional lymph node surgery in addition to primary site surgery significantly improves OS in VC patients.
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Affiliation(s)
- Sara M Dryden
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, USA
| | - Leonid B Reshko
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, USA
| | - Jeremy T Gaskins
- Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, Kentucky, USA
| | - Scott R Silva
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, USA
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Anorectal and Genital Mucosal Melanoma: Diagnostic Challenges, Current Knowledge and Therapeutic Opportunities of Rare Melanomas. Biomedicines 2022; 10:biomedicines10010150. [PMID: 35052829 PMCID: PMC8773579 DOI: 10.3390/biomedicines10010150] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/05/2023] Open
Abstract
Mucosal melanomas (MM) are rare tumors, being less than 2% of all diagnosed melanomas, comprising a variegated group of malignancies arising from melanocytes in virtually all mucosal epithelia, even if more frequently found in oral and sino-nasal cavities, ano-rectum and female genitalia (vulva and vagina). To date, there is no consensus about the optimal management strategy of MM. Furthermore, the clinical rationale of molecular tumor characterization regarding BRAF, KIT or NRAS, as well as the therapeutic value of immunotherapy, chemotherapy and targeted therapy, has not yet been deeply explored and clearly established in MM. In this overview, focused on anorectal and genital MM as models of rare melanomas deserving of a multidisciplinary approach, we highlight the need of referring these patients to centers with experts in melanoma, anorectal and uro-genital cancers treatments. Taking into account the rarity, the poor outcomes and the lack of effective treatment options for MM, tailored research needs to be promptly promoted.
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The Current and Future States of Screening in Gynecologic Cancers. Obstet Gynecol Clin North Am 2021; 48:705-722. [PMID: 34756291 DOI: 10.1016/j.ogc.2021.06.001] [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: 11/23/2022]
Abstract
Gynecologic cancers contribute to a significant portion of cancer morbidity and mortality among women in the United States and across the globe. This article provides a comprehensive review of current screening guidelines and novel techniques that have promise in the prevention and early detection of gynecologic cancers in the future. The authors anticipate a move toward less invasive testing modalities, use of cancer biomarkers, and the prevention and treatment of high-risk factors such as human papilloma virus infection and obesity.
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HPV-Positive and HPV-Negative Vulvar Squamous Cell Carcinoma Are Biologically, but Not Clinically, Distinct. J Invest Dermatol 2021; 142:1280-1290.e7. [PMID: 34756880 PMCID: PMC9038635 DOI: 10.1016/j.jid.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/05/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022]
Abstract
Vulvar squamous cell carcinoma (VSCC) pathogenesis is traditionally defined by the presence or absence of human papillomavirus (HPV), but the definition of these groups and their molecular characteristics remains ambiguous across studies. Here, we present a retrospective cohort analysis of 36 patients with invasive VSCC where HPV status was determined using RNA in situ hybridization (ISH) and polymerase chain reaction (PCR). Clinical annotation, p16 immunohistochemistry (IHC), programmed death ligand-1 (PD-L1) IHC, HPV16 circular E7 RNA (circE7) detection, and RNA-sequencing (RNA-seq) of the cases was performed. A combination of ISH and PCR identified 20 cases (55.6%) as HPV-positive. HPV-status did not impact overall survival (HR: 1.36, 95% CI: 0.307 to 6.037, p=0.6857) or progression-free survival (HR: 1.12, 95% CI: 0.388 to 3.22, p=0.8367), and no significant clinical differences were found between the groups. PD-L1 expression did not correlate with HPV status, but increased expression of PD-L1 correlated with worse overall survival. Transcriptomic analyses (n=23) revealed distinct groups, defined by HPV status, with multiple differentially expressed genes previously implicated in HPV-induced cancers. HPV-positive tumors showed higher global expression of endogenous circular RNAs (circRNAs), including several circRNAs that have previously been implicated in the pathogenesis of other cancers.
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Hlapane RS, Khumalo TL, Makhathini BS, Moodley J. Impact of a delayed diagnosis of vulvar cancer and its association with HIV infection: A 4-year review at a tertiary hospital in KwaZulu-Natal, South Africa. South Afr J HIV Med 2021; 22:1272. [PMID: 34691768 PMCID: PMC8517792 DOI: 10.4102/sajhivmed.v22i1.1272] [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: 05/27/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022] Open
Abstract
Background Vulvar cancer is becoming more common in young women owing to the increased prevalence of co-infection with human papillomavirus and HIV. Objectives The aim of this study was to determine the impact of the time interval from the diagnosis of vulvar cancer at the referring institution to the tertiary hospital and to evaluate the impact of HIV infection in the study population. Method This was a retrospective descriptive chart review. Results A total of 86 cases of vulvar cancer were analysed. The mean age was 48.2 ± 12.5. Sixty (69.8%) patients were under 50 years of age and eight (9.3%) under 30 years. The interval from the onset of symptoms to the diagnosis of cancer was > 12 months in 63 (73.3%) patients. Eighty-one (94.8%) had had symptoms treated multiple times prior to diagnosis. Seventy (81.4%) were referred to the tertiary institution within 3 months of the diagnosis of cancer. Seventy (81.4%) had concomitant HIV infection. Of those with CD4 counts of > 200 cells/mm3, 61.7% had early-stage vulvar cancer, while 38.3% had late-stage disease (P = 0.048). There was no association between the viral load and the Federation of Gynaecology and Obstetrics stage (P = 0.401). The primary treatment was surgery in 50%. Conclusion Although the study was retrospective, we found that vulvar cancer was prevalent in younger patients with HIV infection. Higher CD4 counts were associated with early-stage disease. Early sampling of suspicious lesions can ensure early diagnosis of vulvar cancer and the initiation of therapeutic interventions, particularly in HIV-infected patients.
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Affiliation(s)
- Ramakhosana S Hlapane
- Department of Obstetrics and Gynaecology, Edendale Regional Hospital, Pietermaritzburg, South Africa.,Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thandekile L Khumalo
- Department of Obstetrics and Gynaecology, Edendale Regional Hospital, Pietermaritzburg, South Africa.,Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bongumusa S Makhathini
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Obstetrics and Gynaecology, Grey's Hospital, Pietermaritzburg, South Africa
| | - Jagidesa Moodley
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Women's Health and HIV Research Group, Faculty of Health Sciences, Nelson R Mandela School of Medicine, Durban, South Africa
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36
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Krishnatry R, Mangaj A, Bhajbhuje R, Murthy V. Indigenous Groin Board Immobilization Reduces Planning Target Volume Margins in Groin Radiotherapy. J Med Phys 2021; 46:88-93. [PMID: 34566288 PMCID: PMC8415245 DOI: 10.4103/jmp.jmp_120_20] [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: 12/09/2020] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: To quantify the relative motion of pelvic and groin lymph nodes (PLN and GLN) and define indicative margins for image-guided radiotherapy based on bony anatomy for the frog-leg position (FLP) and groin immobilization board (GIB). Materials and Methods: Twenty patients with planning computed tomography (CT) scan and on treatment cone beam CTs (median = 8) for groin and pelvic radiotherapy were included in the study. Of these nine were treated with FLP and eleven with GIB. The PLN and GLN regions on the left and right were outlined in each scan. Systematic and random uncertainties were determined along with correlations between the motions of these regions. The clinical target volume to planning target volume (PTV) margins required to take motion into account was calculated for each immobilization. Results: The mean shifts for PLN and GLN were lesser but not statistically lower using GIB over FLP. There was significant concordance in the vertical, longitudinal and lateral motion of the pelvis and right groin (P = 0.015, 0.09 and 0.049, respectively), pelvis and left groin (P = 0.001, 0.048, and 0.006, respectively) and between left and right groin (P = 0.013, 0.01 and 0.07, respectively) for FLP and not GIB. The PTV margins required by Van Herk and Stroom's formula were reduced from 11 mm and 9 mm to 6 mm and 5 mm for pelvis; 12 mm and 11 mm to 7 mm and 6 mm for groin, respectively, using FLP over GIB. Conclusions: GIB brings concordance in shifts between pelvis and groin and between bilateral groins, thereby reducing the required PTV margins.
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Affiliation(s)
- Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akshay Mangaj
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajesh Bhajbhuje
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Bujko M, Zalewski K, Szczyrek M, Kowalik A, Boresowicz J, Długosz A, Goryca K, Góźdź S, Kowalewska M. Circulating Hsa-miR-431-5p as Potential Biomarker for Squamous Cell Vulvar Carcinoma and Its Premalignant Lesions. Diagnostics (Basel) 2021; 11:diagnostics11091706. [PMID: 34574047 PMCID: PMC8465739 DOI: 10.3390/diagnostics11091706] [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: 06/30/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 11/20/2022] Open
Abstract
Vulvar squamous cell carcinoma (VSCC) develops from high-grade squamous intraepithelial lesions (HSIL) and differentiated vulvar intraepithelial neoplasia (dVIN). This study aimed to assess the diagnostic value of circulating hsa-miR-431-5p in vulvar precancers and VSCC. Expression levels of hsa-miR-431-5p were analyzed by quantitative RT-PCR in plasma samples of 29 patients with vulvar precancers (HSIL or dVIN), 107 with VSCC as well as 15 healthy blood donors. We used hsa-miR-93-5p and hsa-miR-425-5p as normalizers. The levels of miR-431-5p were increased in the blood of patients with VSCC compared to those with vulvar precancers. Statistically significant differences in the survival rates (time to progression) were revealed for VSCC patients categorized by miR-431-5p levels. Low levels of circulating miR-431-5p were found to be indicative of unfavorable survival rates. In summary, our data reveal the diagnostic potential of circulating miR-431-5p in patients with vulvar precancers and VSCC.
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Affiliation(s)
- Mateusz Bujko
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.B.); (K.Z.); (M.S.); (J.B.)
| | - Kamil Zalewski
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.B.); (K.Z.); (M.S.); (J.B.)
- Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland
- Chair and Department of Obstetrics, Gynecology and Oncology, 2nd Faculty of Medicine, Medical University of Warsaw, 00-315 Warsaw, Poland
| | - Martyna Szczyrek
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.B.); (K.Z.); (M.S.); (J.B.)
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Centre, 25-734 Kielce, Poland;
- Division of Medical Biology, Institute of Biology Jan Kochanowski University, 25-406 Kielce, Poland
| | - Joanna Boresowicz
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.B.); (K.Z.); (M.S.); (J.B.)
| | - Angelika Długosz
- Department of Immunology, Biochemistry and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Krzysztof Goryca
- Genomics Core Facility, Centre of New Technologies, University of Warsaw, 02-097 Warsaw, Poland;
| | - Stanisław Góźdź
- Department of Clinical Oncology, Holycross Cancer Centre, 25-734 Kielce, Poland;
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| | - Magdalena Kowalewska
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.B.); (K.Z.); (M.S.); (J.B.)
- Correspondence: ; Tel.: +48-22-546-26-50
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Lancellotta V, Macchia G, Garganese G, Fionda B, Fragomeni SM, D'Aviero A, Casà C, Gui B, Gentileschi S, Corrado G, Inzani F, Rovirosa A, Morganti AG, Gambacorta MA, Tagliaferri L. The role of brachytherapy (interventional radiotherapy) for primary and/or recurrent vulvar cancer: a Gemelli Vul.Can multidisciplinary team systematic review. Clin Transl Oncol 2021; 23:1611-1619. [PMID: 33650029 DOI: 10.1007/s12094-021-02557-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of our systematic review was to assess the role of interventional radiotherapy (IRT, brachytherapy) in the management of primary and/or recurrent vulvar carcinoma. EVIDENCE ACQUISITION A systematic research using PubMed, Scopus and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Only full-text English-language articles related to IRT for treatment of primary or recurrent VC were identified and reviewed. Conference paper, survey, letter, editorial, book chapter and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered. EVIDENCE SYNTHESIS Primary disease: the median 5-year LC was 43.5% (range 19-68%); the median 5-year DFS was 44.5% (range 44-81%); the median 5-year OS was 50.5% (range 27-85%). Recurrent disease: the median 5-year DFS was 64% (range 56-72%) and the median 5-year OS was 45% (range 33%-57%). Acute ≥ grade 2 toxicity was reported in three patients (1.6%). The severe late toxicity rates (grade 3-4) ranged from 0% to 14.3% (median 7.7%). CONCLUSION IRT as part of primary treatment for primary and/or recurrent vulvar cancer is associated with promising clinical outcomes.
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Affiliation(s)
- V Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - G Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - G Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B Fionda
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - S M Fragomeni
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A D'Aviero
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - C Casà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - B Gui
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Gentileschi
- UOC Chirurgia Plastica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Corrado
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Inzani
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Rovirosa
- Department of Radiation Oncology, Hospital Clinic I Universitari, Fonaments Clinics Department, University of Barcelona, Barcelona, Spain
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M A Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
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Vulvar cancer in a patient with long-lasting premalignant lesions in the genital area: easily overlooked and difficult to diagnose - a case report and literature review. Postepy Dermatol Alergol 2021; 38:366-370. [PMID: 34377114 PMCID: PMC8330851 DOI: 10.5114/ada.2021.107924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/15/2020] [Indexed: 11/21/2022] Open
Abstract
Vulvar intraepithelial lesions are a heterogenic group of diseases, which can be easily misdiagnosed. The case of a 61-year-old woman with a history of genital intraepithelial lesions and infection with HPV is presented. Her main complaint was vulvar pruritus. Vulvoscopy revealed the presence of two skin lesions: the first one had the morphology of lichen sclerosus, and the second of a Bowenoid lesion. The biopsy of the first lesion revealed vulvar intraepithelial neoplasia, whereas cells of squamous vulvar cancer were identified in the second lesion. After staging, the patient was advised to undergo hemivulvectomy and lymphadenectomy. The coexistence of morphologically diverse vulvar skin lesions may cause difficulties with diagnosis and the selection of an adequate treatment. Long-term follow-up and regular examination are essential for diagnosis of vulvar malignancies in the early stage.
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40
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Brambullo T, Azzena GP, Masciopinto G, Toninello P, Biffoli B, De Lazzari A. A Misdiagnosed Metastatic Squamous Cell Carcinoma of the Vulva. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Early diagnosis of vulvar squamous cell carcinoma (SCC) is directly related to better prognosis and higher survival rate. Missed gynecologist follow-up, some cultural traditions and refrain from facing with a problem that involves intimacy and sexual sphere can be the cause of delayed diagnosis and treatment. Radical surgery still represents the gold standard, but narrow excision margins can progressively lead to local recurrence, even after years.
CASE REPORT: The case we present is a rare case of misdiagnosed metastatic SCC of the vulva after radical excision and groin dissection 2 years before. After a full-through discussion with patient on treatment options and prognosis, a multidisciplinary surgical approach was planned, consisting in wide surgical resection of groin, part of mons pubis and right pelvic iliac-obturator lymphadenectomy. Femoral artery excision was performed due to absence of a clear margin, and reconstruction was accomplished with interposed great saphenous vein graft. The plastic reconstruction consisted in harvest of transverse rectus abdominal flap (TRAM), that was transposed inferiorly to repair right groin. Pathologist confirmed free margins of excision and pelvic lymph nodes resulted negative (pT1b, N3, M0 – stage IV A).
DISCUSSION: When deep structures of the groin - such as femoral vessels - are involved by relapse, the condition is potentially life-threatening. A multidisciplinary approach consents to perform a radical surgery with free margins and likewise to achieve a satisfying functional reconstruction.
CONCLUSION: This case should emphasize that skin ulceration on a non-weight-bearing surface is always suspicious for skin malignancy, an incisional biopsy is easy to perform and consents a rapid diagnosis. A history of recurrent vulvar SCC should always warn about the risk of late lymph node metastasis even years after a radical excision of the primary tumor and concomitant lymphadenectomy.
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Thangarajah F, Rogeé K, Pahmeyer C, Kuhr K, Schmidt M, Fridrich C, Morgenstern B. Morbidity and quality of life in patients with vulvar cancer after inguinal sentinel lymphadenectomy compared to radical inguinofemoral lymphadenectomy. Nuklearmedizin 2021; 60:368-374. [PMID: 34169496 DOI: 10.1055/a-1491-6405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Probability of survival of patients with vulvar cancer directly depends on the lymph node status. Surgery of lymph nodes can be performed as radical inguinofemoral lymphadenectomy or in cases with certain conditions as sentinel lymph node surgery. The aim of this study is to obtain an overview of the intervention-related morbidity and quality of life in patients with vulvar carcinoma after lymphadenectomy. METHODS Quality of life and morbidity was compared between patients who underwent radical inguinofemoral lymphadenectomy with those who underwent sentinel lymph node surgery. RESULTS All recorded postoperative complications occur more frequently in the non-sentinel group, Significant difference was shown for the occurrence of lymphedema (p-value = 0.024) and sensitivity loss (p-value = 0.024). Recurrence of disease was more frequent in the non-sentinel group (38 % vs. 20 %, p = 0.621, n.s.) and satisfaction with groin surgery is slightly higher in the sentinel group (94 % vs. 89 %, p = 1.000, n.s.). CONCLUSION We could demonstrate a significantly lower morbidity of sentinel lymphadenectomy compared to conventional inguinofemoral lymphadenectomy while maintaining the same oncological safety. The low morbidity of sentinel- lymphadenectomy does not seem to influence the postoperative quality of life significantly. However, recording of the individual burden of lymphadenectomy by questionnaires should be optimized.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany
| | - Kristina Rogeé
- Department of Gynecology and Obstetrics, GFO Clinic Rhein-Berg; Vinzenz-Pallotti-Hospital, Bergisch Gladbach-Bensberg, Germany
| | - Caroline Pahmeyer
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics and Computational Biology, University of Cologne, Germany
| | | | - Claudius Fridrich
- Department of Gynecology and Obstetrics, Heilig-Geist-Krankenhaus, Cologne, Germany
| | - Bernd Morgenstern
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany
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42
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Carvalho FS, Porto NKA, Azevedo PVM, Magalhães PKA, Araújo END, Correia MS, Silva KMD, Pavão JMSJ, Ferreira JRDS, Maior LPS, Cavalcanti MGS, Ferreira-Júnior GC, Matos-Rocha TJ. Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears. BRAZ J BIOL 2021; 82:e238180. [PMID: 34161422 DOI: 10.1590/1519-6984.238180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/28/2020] [Indexed: 11/22/2022] Open
Abstract
Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.
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Affiliation(s)
| | - N K A Porto
- Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brasil
| | | | | | | | - M S Correia
- Centro Universitário Cesmac, Maceió, AL, Brasil
| | - K M da Silva
- Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brasil
| | | | - J R da S Ferreira
- Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brasil
| | - L P S Maior
- Centro Universitário Cesmac, Maceió, AL, Brasil
| | | | - G C Ferreira-Júnior
- Instituto Federal de Educação, Ciência e Tecnologia do Acre - IFAC, Xapuri, AC, Brasil
| | - T J Matos-Rocha
- Centro Universitário Cesmac, Maceió, AL, Brasil.,Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brasil
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Wang Y, Lin R, Zhang B, Zhou H, Lin Z, Yao T. Pembrolizumab in FIGO IVB Verrucous Carcinoma of the Vulva: A Case Report. Front Oncol 2021; 11:598594. [PMID: 34123775 PMCID: PMC8193986 DOI: 10.3389/fonc.2021.598594] [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: 08/25/2020] [Accepted: 04/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Vulvar cancer is the fourth most common gynecologic cancer, and prognosis is poor in advanced vulvar cancer patients. Treatment for advanced vulvar cancer has not been satisfactory. In this report, we firstly report a FIGO IVB vulva verrucous carcinoma patient who obtained good prognosis after systemic treatment. Case Presentation A patient was admitted to hospital due to her vulvar lesion persistent for past 14 years. The vulvar mass has widely invaded urethra, part of anus, the lower third of the vagina, bilateral superior and inferior branches of pubis, and bilateral internal and external muscles of obturator. Multiple metastatic lymph nodes were also found in the pelvic cavity. The histopathological studies confirmed vulvar verrucous carcinoma with a PD-L1 overexpression. After six courses of neoadjuvant chemotherapy and pembrolizumab, the patient underwent radical vulvectomy and achieved optimal cytoreduction. Postoperative pathology found no residual tumor. The patient then received one course of postoperative chemotherapy and pembrolizumab, underwent radiation therapy, and was disease free after 6 months follow-up. Conclusion Our individualized treatment strategy is successful. Pembrolizumab is safe and effective in the treatment of advanced vulvar verrucous carcinoma with PD-L1 overexpression.
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Affiliation(s)
- Yuhan Wang
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rongchun Lin
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bingzhong Zhang
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Zhou
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhongqiu Lin
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingting Yao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China
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Soheili M, Keyvani H, Soheili M, Nasseri S. Human papilloma virus: A review study of epidemiology, carcinogenesis, diagnostic methods, and treatment of all HPV-related cancers. Med J Islam Repub Iran 2021; 35:65. [PMID: 34277502 PMCID: PMC8278030 DOI: 10.47176/mjiri.35.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Human papillomavirus (HPV) infection is considered as the most common viral sexually transmitted infection worldwide. This poses an increasingly interdisciplinary medical challenge. Since there is vast scattered information in databases about HPV and the correlated diseases, we decided to collect useful data so that the experts can get a more comprehensive view of HPV. Methods: In this article, HPV-associated diseases, prevalence, prevention, and new treatments are discussed. The retrieved articles reporting the latest data about the required information for our review were selected through searching in Web of Science, Scopus, Medline (PubMed), EMBASE, Cochrane Library, Ovid, and CINHAL with language limitations of English and German. Results: There are 2 groups of HPVs: (1) low-risk HPV types that can lead to genital warts, and (2) high-risk HPV types that are involved in HPV-associated oncogenesis. About 70% of all sexually active women are infected and most of these infections heal within many weeks or months. In the case of HPV-persistence, a risk of preneoplasia or carcinoma exists. These types of viruses are responsible for the existence of genitoanal, gastrointestinal, urinary tract, and head and neck tumors. There is still no definite successful treatment. The detection of HPV-related condylomata occurs macroscopically in women and men, and the diagnosis of the precursors of cervical carcinoma in women is possible by Pap smear. Conclusion: For extragenital manifestations, there is no structured early detection program. Meanwhile, studies on HPV vaccines confirm that they should be used for the primary prevention of HPV-dependent diseases. However, we need more research to find out the real advantages and disadvantages of vaccines.
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Affiliation(s)
- Maryam Soheili
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Hossein Keyvani
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Soheili
- Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Human Revivification Society of Congress 60, Tehran, Iran
| | - Sherko Nasseri
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Molecular Medicine and Medical Genetics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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45
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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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Perrone AM, Ravegnini G, Miglietta S, Argnani L, Ferioli M, De Crescenzo E, Tesei M, Di Stanislao M, Girolimetti G, Gasparre G, Porcelli AM, De Terlizzi F, Zamagni C, Morganti AG, De Iaco P. Electrochemotherapy in Vulvar Cancer and Cisplatin Combined with Electroporation. Systematic Review and In Vitro Studies. Cancers (Basel) 2021; 13:cancers13091993. [PMID: 33919139 PMCID: PMC8122585 DOI: 10.3390/cancers13091993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Electrochemotherapy (ECT) is an emerging treatment for solid tumors and an attracting research field due to its clinical results. ECT in association with bleomycin is an effective and safe treatment option in the vulvar cancer palliative setting. With regard to cisplatin (CSP)-based ECT, considering the clear evidence on its efficacy in gynecological tumors, the possibility to improve local control with CSP-based ECT is intriguing and a well-designed randomized clinical trial should be addressed to this issue. Abstract Electrochemotherapy (ECT) is an emerging treatment for solid tumors and an attractive research field due to its clinical results. This therapy represents an alternative local treatment to the standard ones and is based on the tumor-directed delivery of non-ablative electrical pulses to maximize the action of specific cytotoxic drugs such as cisplatin (CSP) and bleomycin (BLM) and to promote cancer cell death. Nowadays, ECT is mainly recommended as palliative treatment. However, it can be applied to a wide range of superficial cancers, having an impact in preventing or delaying tumor progression and therefore in improving quality of life. In addition, during the natural history of the tumor, early ECT may improve patient outcomes. Our group has extensive clinical and research experience on ECT in vulvar tumors in the palliative setting, with 70% overall response rate. So far, in most studies, ECT was based on BLM. However, the potential of CSP in this setting seems interesting due to some theoretical advantages. The purpose of this report is to: (i) compare the efficacy of CSP and BLM-based ECT through a systematic literature review; (ii) report the results of our studies on CSP-resistant squamous cell tumors cell lines and the possibility to overcome chemoresistance using ECT; (iii) discuss the future ECT role in gynecological tumors and in particular in vulvar carcinoma.
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Affiliation(s)
- Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.M.P.); (E.D.C.); (M.T.); (M.D.S.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
- Correspondence:
| | - Stefano Miglietta
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
- Center for Applied Biomedical Research, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
| | - Lisa Argnani
- Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Eugenia De Crescenzo
- Division of Oncologic Gynecology, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.M.P.); (E.D.C.); (M.T.); (M.D.S.); (P.D.I.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Marco Tesei
- Division of Oncologic Gynecology, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.M.P.); (E.D.C.); (M.T.); (M.D.S.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
| | - Marco Di Stanislao
- Division of Oncologic Gynecology, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.M.P.); (E.D.C.); (M.T.); (M.D.S.); (P.D.I.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Giulia Girolimetti
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Center for Applied Biomedical Research, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
| | - Giuseppe Gasparre
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Center for Applied Biomedical Research, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
| | - Anna Maria Porcelli
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
- Center for Applied Biomedical Research, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
- Interdepartmental Center for Industrial Research Life Sciences and Technologies for Health, Alma Mater Studiorum-University of Bologna, 40064 Ozzano dell’Emilia, Italy
| | | | - Claudio Zamagni
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
- Oncologia Medica Addarii, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.M.P.); (E.D.C.); (M.T.); (M.D.S.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy; (S.M.); (G.G.); (G.G.); (A.M.P.); (C.Z.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
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Quality of Life with Vulvar Carcinoma Treated with Palliative Electrochemotherapy: The ELECHTRA (ELEctroCHemoTherapy vulvaR cAncer) Study. Cancers (Basel) 2021; 13:cancers13071622. [PMID: 33915692 PMCID: PMC8036723 DOI: 10.3390/cancers13071622] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary A multicenter prospective observational study was conducted on patients with vulvar cancer (VC) refractory or not amenable to standard therapies undergoing palliative electrochemotherapy (ECT) as per clinical practice. Electrochemotherapy with bleomycin improves quality of life in patients with recurrent vulvar cancer. The assessment was performed with a visual analog pain scale (VAS), EuroQol 5-Dimension 5-Level (EQ-5D-L5) and Functional Assessment of Cancer Therapy—Vulva cancer (FACT—V). To our knowledge, this is the first study reporting the impact of palliative ECT on QoL of VC patients, with a detailed evaluation of potential correlations between tumor characteristics and severity of and response to symptoms. This improvement is higher in patients with clinical response and for smaller and anterior lesions. Based on these results, ECT in VC should be considered as an effective option based on the favorable outcomes both in terms of response and QoL. Abstract The ELECHTRA (ELEctroChemoTherapy vulvaR cAncer) project was conceived to collect data on palliative electrochemotherapy (ECT) in vulvar cancer (VC) assessing patients’ outcomes (response and survival) and impact on quality of life (QoL). After reporting outcome data in 2019, here, we present the results on QoL. A multicenter prospective observational study was conducted on patients with VC refractory or not amenable to standard therapies undergoing palliative ECT as per clinical practice. The following questionnaires were administered before and after ECT (two and four months later, early and late follow-up): visual analog pain scale (VAS), EuroQol 5-Dimension 5-Level (EQ-5D-L5) and Functional Assessment of Cancer Therapy—Vulva cancer (FACT—V). Analyses were conducted on both the whole study population and by subgroups (clinical response after ECT and site, number and size of lesions). Questionnaires from 55 patients were evaluated. Compared to the baseline (6.1 ± 2.1), the VAS was significantly reduced at early (4.3 ± 2.5) and late follow-up (4.6 ± 2.8) (p < 0.0001). The FACT—V score improved significantly at early (9.6 ± 4.0) (p < 0.0001) and late follow-up (8.9 ± 4.1) (p < 0.0054) as compared to the baseline (7.1 ± 3.6). No EQ-5D-5L statistically significant changes were observed. Subgroup analyses showed worse QoL in patients with stable or progressive disease, posterior site and multiple or larger than 3 cm nodules. This is the first study reporting improved QoL in VC patients after palliative ECT. Based on these results, ECT in VC should be considered an effective option based on the favorable outcomes both in terms of response and QoL.
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Ghebre R, Berry-Lawhorn JM, D'Souza G. State of the Science: Screening, Surveillance, and Epidemiology of HPV-Related Malignancies. Am Soc Clin Oncol Educ Book 2021; 41:1-12. [PMID: 33830827 DOI: 10.1200/edbk_325319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Oropharyngeal, cervical, vulvar, and anal cancers share a common risk factor of HPV infection. HPV vaccination is currently recommended at age 11 or 12 to prevent new HPV infections for all genders with catch-up vaccination recommened up to age 26. Despite the known effectiveness of HPV vaccination to prevent HPV-related cancer, there is continued low uptake in the United States; only 40% of eligible persons were vaccinated in 2018, though rates are 70% among teenagers. Current American Cancer Society cancer screening guidelines recommend cervical cancer screening, but do not have specific recommendations for screening for other HPV-related cancers. Oropharyngeal cancer precursors have yet to be identified, and there are currently no routine screening tests for oropharyngeal cancer recommended by the U.S. Preventive Services Task Force. The U.S. Preventive Services Task Force and American Cancer Society recommend cervical cancer screening for women at average risk up to age 65, and screening guidelines do not currently differ by HPV vaccination status. Primary HPV DNA testing was first approved for cervical cancer screening in 2016 and was shown to be superior for cervical cancer prevention. Vulvar and anal cancer precursors have been identified, but optimal screening remains unclear. Examination of the anal canal and perianus is best performed by trained clinicians using high-resolution anoscopy, and effectiveness of using high-resolution anoscopy to detect and treat anal high-grade squamous intraepithelial lesions to prevent cancer is actively being researched. Current multistep approaches to control HPV-related malignancies include HPV vaccination coupled with cervical cancer screening or surveillance for oropharyngeal, vulvar, and anal cancers.
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Affiliation(s)
- Rahel Ghebre
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN.,Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - J Michael Berry-Lawhorn
- Department of Medicine, Division of Hematology Oncology, Anal Neoplasia Clinic, Research, and Education Center, University of California San Francisco, San Francisco, CA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Smith CG, DeSimone CP. Invasive Hidradenocarcinoma of the Vulva: A Case Report and Literature Review. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christopher G. Smith
- Division of Gynecologic Oncology, Department of Gynecology & Obstetrics, Emory University, Atlanta, Georgia, USA
| | - Christopher P. DeSimone
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
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50
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Vilos GA, Reyes-MuÑoz E, Riemma G, Kahramanoglu I, Lin LT, Chiofalo B, Lordelo P, Della Corte L, Vitagliano A, Valenti G. Gynecological cancers and urinary dysfunction: a comparison between endometrial cancer and other gynecological malignancies. Minerva Med 2021; 112:96-110. [PMID: 32700863 DOI: 10.23736/s0026-4806.20.06770-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this paper is to provide a narrative overview of the available literature about voiding dysfunction in women with gynecological cancer before and after surgical, chemo- and radiotherapy treatments. Radical surgery, radiotherapy, and chemotherapy may cause lower urinary tract dysfunction such as stress and urge urinary incontinence, and voiding difficulties. However, nerve-sparing radical hysterectomy may be a valid surgical approach in order to reduce bladder innervation impairment and maintain normal urinary function. Also, newer radiotherapy techniques significantly reduce the number of adverse effects, including bladder dysfunction. Pelvic floor muscle physiotherapy and training with biofeedback and urethral bulking agents represent some additional therapies that can be used in oncologically treated patients with urinary symptoms in order to improve a significant aspect of their quality of life. Considering the important impact on the patients' quality of life, a full urogynecological evaluation should be considered as an important part of oncological treatment and follow-up.
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Affiliation(s)
- George A Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada -
| | - Enrique Reyes-MuÑoz
- Department of Endocrinology, Isidro Espinosa de los Reyes National Institute of Perinatology, Mexico City, Mexico
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
- Division of Gynecologic Oncology, Department of Women's and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, University of Instanbul, Istanbul, Turkey
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Patricia Lordelo
- Centro de Atenção ao Piso Pélvico (CAAP), Division of Physiotherapy, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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