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Crum M, Miller C, Micallef C, Delaney R, Hope E. Bilateral Singapore fasciocutaneous flap after anterior vulvectomy and distal urethrectomy for localized recurrent vulvar carcinoma. Gynecol Oncol Rep 2024; 53:101373. [PMID: 38699463 PMCID: PMC11063377 DOI: 10.1016/j.gore.2024.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Vulvar cancer has an overall low incidence, accounting for approximately 3-5% of all gynecological malignancies.Case: We present a case of locally recurrent Stage IIIA squamous cell carcinoma of the vulva in a 51-year-old healthy African American female. She was initially treated with primary chemoradiation with cisplatin sensitization and boost to primary tumor up to 70 Gray. Post-treatment biopsies revealed complete pathologic response. She later presented with local recurrence to the primary site of the clitoris and vulva, with no evidence of metastasis on imaging, with progressive disease despite treatment with immunotherapy. Methods Biopsy-proven disease progression was present on the clitoris, entire left labia minora, and a portion of the right labia minora with no evidence of metastasis on imaging. Surgical resection for localized recurrence was recommended, and she underwent radical anterior vulvectomy, distal urethrectomy, and vulvar reconstruction with bilateral Singapore fasciocutaneous flap as part of a multidisciplinary team. Patient underwent several prophylactic hyperbaric oxygen treatments. There were no issues with postoperative wound healing. Conclusion Treatment with radical excision often requires multidisciplinary teams for complex reconstructions to restore vulvar anatomy in the setting of prior radiation, especially for those patients desiring the ability to have penetrative intercourse in the future. There are few surgical videos that describe these types of vulvar excisions and subsequent reconstructions. This video provides a unique approach to vulvar reconstruction in a previously irradiated field.
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Affiliation(s)
- Madison Crum
- Department of Gynecologic Surgery and Obstetrics, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA
| | - Caela Miller
- Department of Gynecologic Surgery and Obstetrics, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA
| | - Christopher Micallef
- Department of Plastic Surgery, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA
| | - Richard Delaney
- Department of Plastic Surgery, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA
| | - Erica Hope
- Department of Gynecologic Surgery and Obstetrics, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA
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2
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Pomerantz T, Rubin NJ, Karnezis AN, Zhao X, Brooks R. Primary clear cell carcinoma of the vulva: A case report. Gynecol Oncol Rep 2023; 50:101283. [PMID: 37860082 PMCID: PMC10582292 DOI: 10.1016/j.gore.2023.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Clear cell carcinoma (CCC) of the vulva is extremely rare. We report a case of a 54-year-old woman who presented with a 5 cm mass of the mons pubis. She underwent needle biopsy demonstrating CCC. She then underwent radical vulvectomy with bilateral inguinofemoral lymph node dissection. Surgical pathology revealed CCC of the vulva with lymphovascular space invasion (LVSI) and metastatic carcinoma in 1/7 inguinal lymph nodes. The patient has a history of endometriosis, raising suspicion that her CCC could have arisen from endometriosis in the mons. She completed adjuvant treatment with cisplatin and concurrent external beam radiation therapy with radiographic evidence of complete response. However, short-interval imaging demonstrated multi-focal recurrence, which was confirmed with supraclavicular lymph node biopsy. She then completed 8 cycles carboplatin, paclitaxel, and biosimilar bevacizumab-bvzr with favorable response on imaging. She was continued on bevacizumab maintenance. She was later started on pembroluzimab for disease progression based on new mediastinal adenopathy and worsening retroperitoneal lymphadenopathy. She received eight cycles of pembrolizumab with ongoing disease progression before enrolling in hospice and discontinuing cancer-directed treatment. As described in the related literature which we summarize here, the majority of reported cases of vulvar CCC arise from endometriosis implants at the site of prior episiotomy or from the Bartholin's gland. This patient had clinical history of endometriosis; prior tissue sampling was not performed to support the diagnosis. Given the absence of data regarding this rare type of primary vulvar cancer, treatment of this patient's disease was based on existing data specific to squamous cell carcinoma of the vulva and extrapolated from treatment guidelines for CCC of the ovary and endometrium. Continued research is needed on this rare form of vulvar carcinoma to determine the risk factors, prognostic factors, and treatment recommendations specific to this disease.
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Affiliation(s)
- Tali Pomerantz
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, University of California Davis Medical Center, Sacramento, CA, United States
| | - Nicole J. Rubin
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, University of California Davis Medical Center, Sacramento, CA, United States
| | - Anthony N. Karnezis
- Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, United States
| | - Xiao Zhao
- Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA, United States
| | - Rebecca Brooks
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, University of California Davis Medical Center, Sacramento, CA, United States
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3
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Pouwer AW, Te Grootenhuis NC, Hinten F, de Bock GH, van der Zee AGJ, Melchers WJG, Oonk MHM, de Hullu JA, Hollema H, Bulten J. Prognostic value of HPV-PCR, p16 and p53 immunohistochemical status on local recurrence rate and survival in patients with vulvar squamous cell carcinoma. Virchows Arch 2023:10.1007/s00428-023-03690-8. [PMID: 37938322 DOI: 10.1007/s00428-023-03690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
The primary aim of this study was to assess the association between human papilloma virus (HPV) and p53 expression and local recurrence (LR), disease specific survival (DSS), and overall survival (OS) in patients with vulvar squamous cell carcinoma (VSCC). Secondary, the accuracy of p16 immunohistochemistry for HPV status was assessed. The tumor tissue of 255 patients, surgically treated for primary unifocal VSCC between 2000 and 2010, was analyzed. HPV-PCR and P16 and p53 immunohistochemical stainings were performed. All histologic slides were independently reviewed by two expert gyneco-pathologists. Time to first LR, DSS, and OS for the variables p16, p53, and HPV-PCR were compared using univariable and multivariable Cox-regression analyses. In 211/255 (83.5%) patients, HPV-PCR was negative. The local recurrence rate was significantly lower in patients positive with HPV-PCR (10-year LR rate 24.6%) versus negative tumors (47.5%), p = 0.004. After multivariable analyses, this difference remained significant (HR 0.23 (95% CI 0.08-0.62) p = 0.004). There was no difference in LR rate correlated to the p53 expression. DSS and OS did not significantly differ after multivariable analyses for all different subgroups. Sensitivity and specificity of p16 staining for presence of HPV detected by HPV-PCR were 86.4% and 93.8%, respectively. In conclusion, patients with HPV-negative VSCCs have significantly more LR compared to patients with HPV-positive VSCCs, and p16 immunohistochemistry is a reliable surrogate marker for HPV status. No relevant subgroup for LR or survival based on HPV/p53 status could be identified. We advise to perform an HPV-PCR or p16 IHC staining in all patients with VSCC.
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Affiliation(s)
- A W Pouwer
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N C Te Grootenhuis
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - F Hinten
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A G J van der Zee
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M H M Oonk
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Hollema
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
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4
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Kansal Y, Kundargi RS, R PV, Krishnappa S, Shanbhag E, Punyashree, Jain N, R VC, Bafna UD. Lymph Node Metastasis and Patterns of Recurrence in Vulvar Carcinoma: 10 Years' Single Center Experience. Indian J Surg Oncol 2023; 14:619-627. [PMID: 37900631 PMCID: PMC10611681 DOI: 10.1007/s13193-023-01704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/07/2023] [Indexed: 03/02/2023] Open
Abstract
Vulvar carcinoma is a relatively rare malignancy and there is a paucity of data, especially from India and other developing countries regarding the prognostic factors impacting recurrence and survival. A retrospective observational study was conducted in the Department of Gynecologic Oncology at a tertiary care, regional cancer institute, including all patients with carcinoma vulva who underwent surgery between 2009 and 2018. Demographic profile, surgical-pathological information, details of neo-adjuvant chemotherapy, adjuvant radiation and chemotherapy, and peri-operative complications were analyzed. Long-term follow-up data was gathered, with an evaluation of various prognostic factors impacting recurrence and overall survival outcome. Forty-five cases with mean age of 56.2 years (range 29-82) were treated during the study period. Surgery was the initial treatment modality in 41 (91.1%) cases. Neo-adjuvant chemotherapy prior to surgery was given to four cases. After complete surgico-pathological staging, most patients had stage I disease (26 cases, 57.8%) and 22.2% had stage II disease. Owing to microscopic lymph node involvement, seven cases (15.6%) belonged to FIGO stage III disease. Two cases had stage IVA disease with fixed groin nodes. Adjuvant chemotherapy in the form of 5-fluoro uracil and cisplatin was administered to four out of the nine patients with nodal involvement. The remaining five were advised adjuvant groin radiation. At a median follow-up of 34 months (range 2-114 months), 12 cases (26.7%) experienced a recurrence and one case with stage IVA disease progressed during adjuvant chemotherapy. The 5-year overall survival was 76.6% and the 5-year disease-free survival was 69.6%. There were a total number of 10 deaths, of which seven were due to disease recurrence or progression and the remaining 30% of deaths were due to medical co-morbid conditions. Overall survival was negatively impacted by increasing age (age > 60 years), number of positive nodes, presence of perinodal spread, and stage of the disease. Recurrence-free survival was significantly reduced in those with the presence of peri-nodal spread and lympho-vascular space invasion. The incidence of lymph node metastasis was found to be higher in patients with age > 60 years, increasing tumor size, presence of lympho-vascular space invasion and the number of lymph nodes removed. In carcinoma vulva, treatment should be individualized with multidisciplinary cooperation. In our series, we found that the stage of disease, nodal positivity, and nodal positivity with extra-capsular spread were significant prognostic factors impacting survival on analysis. Lymph nodal positivity was associated with increasing tumour size, presence of lympho-vascular invasion, and patient age.
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Affiliation(s)
- Yamini Kansal
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Rajshekar S. Kundargi
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Pallavi V. R
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Shobha Krishnappa
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Esha Shanbhag
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Punyashree
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Neha Jain
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Vijay C. R
- Department of Biostatistics, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - U. D. Bafna
- Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
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5
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Rustetska N, Szczepaniak M, Goryca K, Bakuła-Zalewska E, Figat M, Kowalik A, Góźdź S, Kowalewska M. The intratumour microbiota and neutrophilic inflammation in squamous cell vulvar carcinoma microenvironment. J Transl Med 2023; 21:285. [PMID: 37118737 PMCID: PMC10141905 DOI: 10.1186/s12967-023-04113-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/09/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND A causal link between microbiota composition (dysbiosis) and oncogenesis has been demonstrated for several types of cancer. Neutrophils play a role in both immune protection against bacterial threats and carcinogenesis. This study aimed to characterise intratumoral bacteria in vulvar squamous cell carcinoma (VSCC) and their putative effect on neutrophil recruitment and cancer progression. METHODS Clinical material was obtained from 89 patients with VSCC. Next-generation sequencing (NGS) of 16S rRNA and quantitative polymerase chain reaction (qPCR) were used to detect bacterial species in VSCC. To verify neutrophil activation, CD66b expression in tumour specimens was analysed by immunohistochemistry (IHC). Subsequently, IHC was applied to detect the main neutrophil serine proteases (NSPs), cathepsin G (CTSG), neutrophil elastase (ELANE), and proteinase 3 (PRTN3) in VSCC. RESULTS Fusobacterium nucleatum and Pseudomonas aeruginosa were identified as tumour-promoting bacteria, and their presence was found to be associated with a shorter time to progression in VSCC patients. Furthermore, high abundance of CD66b, the neutrophil activation marker, in VSCC samples, was found to relate to poor survival of patients with VSCC. The selected NSPs were shown to be expressed in vulvar tumours, also within microabscess. The increased numbers of microabscesess were correlated with poor survival in VSCC patients. CONCLUSIONS Our results show that neutrophilic inflammation seem to be permissive for tumour-promoting bacteria growth in VSCC. The findings provide new therapeutic opportunities, such as based on shifting the balance of neutrophil populations to those with antitumorigenic activity and on targeting NSPs produced by activated neutrophils at the inflammation sites.
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Affiliation(s)
- Natalia Rustetska
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Magdalena Szczepaniak
- Department of Molecular Diagnostics, Holycross Cancer Centre, 25-734, Kielce, Poland
| | - Krzysztof Goryca
- Genomics Core Facility, Centre of New Technologies, University of Warsaw, 02-097, Warsaw, Poland
| | - Elwira Bakuła-Zalewska
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Małgorzata Figat
- Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-097, Warsaw, Poland
| | - 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
| | - 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.
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6
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McKean R, Wolf J, Wong TT, Yin YM, Kanis MJ. Recurrent herpes simplex virus mimicking vulvar carcinoma in patient with Human Immunodeficiency Virus: A case report. Gynecol Oncol Rep 2023; 45:101142. [PMID: 36747898 PMCID: PMC9898014 DOI: 10.1016/j.gore.2023.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Patients with human immunodeficiency virus (HIV) are at increased risk for developing other gynecologic conditions, including herpes simplex virus (HSV) and vulvar intraepithelial neoplasia (VIN)/carcinoma. We describe the case of a woman with a history of microinvasive vulvar squamous cell carcinoma who presented with hypertrophic ulcerated vulvar and peri-anal masses concerning for malignancy. This case highlights the need to maintain a high index of suspicion for malignancy and herpes simplex virus, even with negative polymerase chain reaction (PCR) test, as well as the difficulty of treating this often-resistant lesion.
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Affiliation(s)
- Rachel McKean
- Division of Gynecologic Oncology, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, United States
| | - Jennifer Wolf
- Division of Gynecologic Oncology, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States,Corresponding author at: Work Address: 515 6th Street, Brooklyn, NY 11215, United States. Permanent address: 215 11th St #1, Brooklyn, NY 11215, United States.
| | - Ting Ting Wong
- Division of Infectious Disease, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, United States
| | - Yong Mei Yin
- Division of Pathology, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, United States
| | - Margaux J. Kanis
- Division of Gynecologic Oncology, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, United States
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7
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Wanka G, Jueckstock J, Wild CM, Vattai A, Fürst S, Heidegger HH, Kuhn C, Schmoeckel E, Jeschke U, Dannecker C. MTA1 as negative prognostic marker in vulvar carcinoma. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04579-4. [PMID: 36689059 PMCID: PMC10356867 DOI: 10.1007/s00432-023-04579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
PURPOSE Vulvar cancer is the fourth most common malignancy of the female genital tract after endometrial, ovarian, and cervical carcinoma and affects mainly elderly women. In 2020 there were registered more than 17,000 deaths worldwide related to vulvar carcinoma. Data about target-based therapies and predictive biomarkers for vulva carcinomas are rare so far. The metastasis-associated gene MTA1 is a transcriptional repressor with a potential effect on cancer. Expression of MTA1 was found to be significantly enhanced in gynecological malignancies as breast or ovarian cancer tissues with advanced cancer stages and higher FIGO grading, indicating an important role of MTA1 in the progression of those tumor entities. Due to the lack of information around MTA1 and its significance regarding vulvar carcinoma, this study focuses on the expression of MTA1 in vulvar carcinoma and its correlation to clinicopathological characteristics and prognosis. METHODS A total of 157 paraffin-embedded vulvar cancer tissues were immunohistochemically stained and examined for MTA1 expression by using the immunoreactive score. Subsequently, the values were correlated with clinicopathological parameters. RESULTS MTA1 was found to be expressed in 94% of the patients in the cytoplasm and 91% in the nucleus. Cytoplasmatic expression of MTA1 was significantly increased in non-keratinizing squamous cell carcinoma and in vulvar carcinoma of the condylomatous type, compared to keratinizing squamous cell carcinoma and vulvar carcinoma of the verrucous type. High MTA1 expression in the nucleus was associated with advanced tumor size as well as higher FIGO grading. In addition, p16 negative vulvar carcinomas showed a higher nuclear expression of MTA1 compared to p16 positive vulvar carcinomas. Suprisingly, Kaplan-Meier analysis showed a significantly lower disease-free survival in tumor samples without a nuclear expression of MTA1. CONCLUSIONS MTA1 was identified as a negative prognostic marker for vulvar carcinoma associated with advanced tumor stage and FIGO grading. A possible explanation could be that the antibody used for this study does not bind to a possible mutation in the C terminal region of MTA leading to negative immunohistochemical staining and this can be correlated with early recurrence in patients with vulvar carcinoma.
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Affiliation(s)
- Giulia Wanka
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,Department of Obstetrics and Gynecology, RoMed Clinic, Krankenhausstraße 2, 83512, Wasserburg am Inn, Germany
| | - Carl Mathis Wild
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Aurelia Vattai
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Sophie Fürst
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Helene H Heidegger
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christina Kuhn
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Elisa Schmoeckel
- Department of Pathology, LMU Munich, Thalkirchner Straße 142, 80337, Munich, Germany
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany. .,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Christian Dannecker
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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8
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Bogers SJ, Schim van der Loeff MF, Boyd A, Davidovich U, van der Valk M, Brinkman K, Sigaloff K, Branger J, Bokhizzou N, de Bree GJ, Reiss P, van Bergen JE, Geerlings SE. Improving indicator-condition guided testing for HIV in the hospital setting (PROTEST 2·0): A multicenter, interrupted time-series analysis. Lancet Reg Health Eur 2022; 23:100515. [PMID: 36246146 PMCID: PMC9558045 DOI: 10.1016/j.lanepe.2022.100515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Indicator-condition (IC) guided HIV testing is a feasible and cost-effective strategy to identify undiagnosed people living with HIV (PLHIV), but remains insufficiently implemented. We aimed to promote IC-guided HIV testing in seven ICs. METHODS Relevant departments in five hospitals of the Amsterdam region participated. HIV testing among adult patients without known HIV infection but with an IC was assessed using electronic health records during pre-intervention (January 2015-June 2020) and intervention (July 2020-June 2021) periods. The multifaceted intervention included audit and feedback. The primary endpoint was HIV testing ≤3 months before or after IC diagnosis and the effect of the intervention was evaluated using segmented Poisson regression. FINDINGS Data from 7986 patients were included, of whom 6730 (84·3%) were diagnosed with an IC in the pre-intervention period and 1256 (15·7%) in the intervention period. The proportion HIV tested ≤3 months before or after IC diagnosis increased from 36.8% to 47.0% (adjusted risk ratio [RR]= 1.16, 95% CI=1.03-1.30, p=0.02). For individual ICs, we observed significant increases in HIV testing among patients with cervical cancer or intraepithelial neoplasia grade 3 (adjusted RR=3.62, 95% CI=1.93-6.79) and peripheral neuropathy (adjusted RR=2.27 95% CI=1.48-3.49), but not the other ICs. Eighteen of 3068 tested patients were HIV positive (0.6%). INTERPRETATION Overall IC-guided testing improved after the intervention, but not for all ICs. Variations in effect by IC may have been due to variations in implemented developments, but the effect of separate elements could not be assessed. FUNDING HIV Transmission Elimination Amsterdam (H-TEAM) initiative, Aidsfonds (grant number: P-42702).
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Affiliation(s)
- Saskia J. Bogers
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of
Care, Amsterdam, the Netherlands
| | - Maarten F. Schim van der Loeff
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health
Service of Amsterdam, Amsterdam, the Netherlands
| | - Anders Boyd
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health
Service of Amsterdam, Amsterdam, the Netherlands
- Stichting hiv monitoring, Amsterdam, the
Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health
Service of Amsterdam, Amsterdam, the Netherlands
| | - Marc van der Valk
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Stichting hiv monitoring, Amsterdam, the
Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, Onze Lieve Vrouwe
Gasthuis, Amsterdam, the Netherlands
| | - Kim Sigaloff
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam,
Internal Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Judith Branger
- Department of Internal Medicine, Flevoziekenhuis,
Almere, the Netherlands
| | - Nejma Bokhizzou
- Department of Internal Medicine, BovenIJ ziekenhuis,
Amsterdam, the Netherlands
| | - Godelieve J. de Bree
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Peter Reiss
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam institute for Global Health and Development,
Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Global
Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan E.A.M. van Bergen
- Amsterdam UMC location University of Amsterdam, General
Practice, Meibergdreef 9, Amsterdam, the Netherlands
- STI AIDS Netherlands, Amsterdam, the
Netherlands
| | - Suzanne E. Geerlings
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of
Care, Amsterdam, the Netherlands
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9
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Ni L, Sinha S, Rara M, Phuong C, Chen LM, Hsu ICJ, Yoshida EJ. The role of adjuvant radiation therapy in older patients with node-positive vulvar cancer: A national cancer database analysis. Gynecol Oncol 2022; 167:189-195. [PMID: 36150913 DOI: 10.1016/j.ygyno.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We sought to evaluate whether the survival benefit of adjuvant radiotherapy in patients with node-positive vulvar cancer is maintained in older patients, who comprise a large subgroup of patients with vulvar cancer. METHODS The National Cancer Database (NCDB) was queried for patients aged 65 years or older, who were diagnosed with vulvar squamous cell carcinoma from 2004 to 2017 and underwent surgery with confirmed node-positive disease. Statistical analysis was performed with propensity-score matching, chi-square test, log-rank test, Kaplan-Meier, and multivariable Cox proportional regression. RESULTS A total of 2396 patients were analyzed, and 1517 (63.3%) received adjuvant radiotherapy. Median follow-up was 73 months. Median age at diagnosis was 77 years (range 65-90). In the propensity score-matched cohort, five-year overall survival (OS) was 29%. Five-year OS was 33% in patients who received surgery followed by adjuvant radiotherapy and 26% in patients who received surgery alone (p < 0.0001). Multivariable analysis continued to demonstrate a survival benefit associated with the addition of adjuvant radiotherapy (OR 0.77 [95% CI 0.69-00.87], p < 0.001). Adjuvant radiotherapy was associated with improved OS among patients aged 65-84 (5-year OS 35% vs 29%, p = 0.0004), but not in patients aged 85 years and older (5-year OS 20% vs 19%, p = 0.32). CONCLUSION This NCDB study suggests that in older patients with node-positive vulvar cancer, radiotherapy continues to be a vital component of multimodality therapy. However, a comprehensive and geriatrics-specific approach is crucial for treating older adults with node-positive vulvar cancer, as the benefit of adjuvant radiotherapy may be compromised by treatment-related morbidity/toxicity.
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Affiliation(s)
- Lisa Ni
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
| | - Sumi Sinha
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
| | - Marianne Rara
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
| | - Christina Phuong
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
| | - Lee-May Chen
- University of California San Francisco, Department of Obstetrics and Gynecology and Reproductive Sciences, 1825 Fourth St, Sixth Floor, San Francisco, CA 94158, United States of America
| | - I-Chow J Hsu
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
| | - Emi J Yoshida
- University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America.
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10
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Botter C, Favier A, Aubry G, Canlorbe G, Méningaud JP, Belghiti J, Hersant B. [How I do…to repair posterior perineal tissue loss with a posterior vaginal mucosa flap after vulvectomy]. Gynecol Obstet Fertil Senol 2022; 50:333-337. [PMID: 34871787 DOI: 10.1016/j.gofs.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 06/13/2023]
Affiliation(s)
- C Botter
- Department of maxillofacial and plastic, reconstructive, and aesthetic surgery, Henri-Mondor hospital, Créteil, France
| | - A Favier
- Department of gynecological and breast surgery and oncology, Pitié-Salpêtrière university hospital, Paris, France.
| | - G Aubry
- Department of gynecological and breast surgery and oncology, Pitié-Salpêtrière university hospital, Paris, France
| | - G Canlorbe
- Department of gynecological and breast surgery and oncology, Pitié-Salpêtrière university hospital, Paris, France
| | - J-P Méningaud
- Department of maxillofacial and plastic, reconstructive, and aesthetic surgery, Henri-Mondor hospital, Créteil, France
| | - J Belghiti
- Department of gynecological and breast surgery and oncology, Pitié-Salpêtrière university hospital, Paris, France
| | - B Hersant
- Department of maxillofacial and plastic, reconstructive, and aesthetic surgery, Henri-Mondor hospital, Créteil, France
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11
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Yanarateş A, Budak E, Budak A, Inan AH, Kanmaz AG, Oral A, Yazici B. Clinical value of metabolic PET parameters of primary vulvar carcinoma. Rev Esp Med Nucl Imagen Mol 2021; 40:367-71. [PMID: 34752370 DOI: 10.1016/j.remnie.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/18/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE We aim to establish the prognostic value of metabolic parameters of the primary tumor in patients diagnosed with vulvar squamous cell carcinoma (VSCC) who underwent a pretreatment F-18 FDG PET/CT scan. MATERIALS AND METHODS This retrospective study included 47 patients with a histopathologically confirmed diagnosis of VSCC, and who underwent a F-18 FDG PET/CT scan prior to treatment. The disease stage and age at diagnosis, and the maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values of the primary tumor, based on a baseline PET scan, were recorded. The relationship between these factors, and progression-free survival (PFS) and overall survival (OS) was evaluated. RESULTS The mean age of the 47 study patients was 69.6±1.9 years. Among the patients, 18 were in early stage of the disease and 29 were in the advanced stage. The age, and SUVmax, SUVmean, MTV and TLG values were statistically significantly associated with OS and PFS. Furthermore, it was noted that OS and PFS were significantly longer in the early stage patients than in the advanced stage patients, in patients with a tumor size <4cm than those with a tumor size ≥4cm, and in patients with a negative lymph node metastasis than those with a positive lymph node metastasis. CONCLUSION Our findings suggest that PET parameters are prognostic factors for VSCC. To the best of our knowledge, this study is the first to investigate the prognostic value of the PET parameters of primary tumors in patients with VSCC, and as such, we believe it contributes to literature.
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12
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Yanarateş A, Budak E, Budak A, Hamdi Inan A, Göksel Kanmaz A, Oral A, Yazici B. Clinical value of metabolic PET parameters of primary vulvar carcinoma. Rev Esp Med Nucl Imagen Mol 2021; 40:S2253-654X(20)30141-4. [PMID: 33926850 DOI: 10.1016/j.remn.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We aim to establish the prognostic value of metabolic parameters of the primary tumor in patients diagnosed with vulvar squamous cell carcinoma (VSCC) who underwent a pretreatment 18F FDG PET/CT scan. MATERIALS AND METHODS This retrospective study included 47 patients with a histopathologically confirmed diagnosis of VSCC, and who underwent a 18F FDG PET/CT scan prior to treatment. The disease stage and age at diagnosis, the maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values of the primary tumor, based on a baseline PET scan, were recorded. The relationship between these factors, and progression-free survival (PFS) and overall survival (OS) was evaluated. RESULTS The mean age of the 47 study patients was 69.6±1.9 years. Among the patients, 18 were in early stage of the disease and 29 were in the advanced stage. The age, and SUVmax, SUVmean, MTV and TLG values were statistically significantly associated with OS and PFS. Furthermore, it was noted that OS and PFS were significantly longer in the early stage patients than in the advanced stage patients, in patients with a tumor size <4cm than those with a tumor size ≥4cm, and in patients with a negative lymph node metastasis than those with a positive lymph node metastasis. CONCLUSION Our findings suggest that PET parameters are prognostic factors for VSCC. To the best of our knowledge, this study is the first to investigate the prognostic value of the PET parameters of primary tumors in patients with VSCC, and as such, we believe it contributes to literature.
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Affiliation(s)
- A Yanarateş
- University of Health Sciences, Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Nuclear Medicine, Izmir, Turquía.
| | - E Budak
- University of Health Sciences, Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Nuclear Medicine, Izmir, Turquía
| | - A Budak
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Izmir, Turquía
| | - A Hamdi Inan
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Izmir, Turquía
| | - A Göksel Kanmaz
- Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, Izmir, Turquía
| | - A Oral
- Ege University Medical Faculty, Department of Nuclear Medicine, Izmir, Turquía
| | - B Yazici
- Ege University Medical Faculty, Department of Nuclear Medicine, Izmir, Turquía
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13
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Kostov S, Dzhenkov D, Metodiev D, Kornovski Y, Slavchev S, Ivanova Y, Yordanov A. A case of human papillomavirus infection and vulvar cancer in a young patient - "hit and run" theory. Gynecol Oncol Rep 2021; 36:100760. [PMID: 33869714 PMCID: PMC8047159 DOI: 10.1016/j.gore.2021.100760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
Squamous vulvar cancer is often associated with human papillomavirus infection. Vulvar cancer located in the Bartholini gland area should be distinguished from Bartholini gland carcinoma. The “hit and run” theory states that the viral genome may disappear after the host cell accumulates numerous mutations. The “hit and run” theory suggests that viruses might cause more cancers than previously thought.
Vulvar cancer (VC) is a rare disease, of which the squamous vulvar carcinomas (SVCs) are the most common histological subtype. SVC is often associated with human papillomavirus (HPV) infection. HPV- positive SVCs are multifocal, typically have non-keratinizing morphology, presence of koilocytes and tend to arise in younger women (<50 years), which are often smokers. The “hit and run” theory has been a subject of longstanding curiosity in tumor virology. The “hit and run” scenario suggests that viruses have an activating role in the cancer development and the viral genome may disappear after the host cell accumulates numerous mutations. Herein, a case of HPV- positive SVC in a 22-year-old patient with a possible “hit and run” scenario, is presented. Gynecological examination revealed a vulvar mass (3 cm) with ulcerated surface, located at the left Bartholini gland area. Punch biopsies of the lesion were performed. The histopathological examination revealed non-keratinizing squamous cell carcinoma (Grade 2) of the vulva and presence of koilocytes. P16 immunostaining was block-positive. HPV-testing of the specimen was negative. In the majority of cases, VC arising in young patients is associated with HPV. VC located in the BG area should be distinguished from BG carcinoma. Future studies should reconsider the third diagnostic (histological areas of apparent transition from normal elements to malignant ones) criteria for defining BG carcinoma. The “hit and run” theory is rarely mentioned in oncology, but should be considered in cancer- associated viruses. The “hit and run” affair suggests that viruses may cause more cancers than previously thought.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, MHAT "Saint Anna'' Varna, 9002 Varna, Bulgaria.,Medical University Pleven, Pleven, Bulgaria
| | - Deyan Dzhenkov
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Division of General and Clinical Pathology, Faculty of Medicine,Medical University - Varna "Prof. Dr. Paraskev Stoyanov",9002 Varna, Bulgaria
| | - Dimitar Metodiev
- Clinical Pathology Laboratory, MHAT "Nadezda" Women's Health Hospital, Sofia, Bulgaria; Neuropathological Laboratory, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
| | - Yavor Kornovski
- Department of Gynecology, MHAT "Saint Anna'' Varna,Medical University Varna " Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Stanislav Slavchev
- Department of Gynecology, MHAT "Saint Anna'' Varna,Medical University Varna " Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Yonka Ivanova
- Department of Gynecology, MHAT "Saint Anna'' Varna,Medical University Varna " Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
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14
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Mukai Y, Koike I, Matsunaga T, Yokota NR, Kaizu H, Takano S, Sugiura M, Ito E, Miyagi E, Hata M. Outcome of Radiation Therapy for Locally Advanced Vulvar Carcinoma: Analysis of Inguinal Lymph Node. In Vivo 2020; 34:307-313. [PMID: 31882493 DOI: 10.21873/invivo.11775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM The aim of this study was to define the outcome of radiation therapy for vulvar carcinoma, and to investigate the effectiveness of therapeutic and prophylactic inguinal lymph node (ILN) irradiation. Because reports about the treatment of ILN were limited. PATIENTS AND METHODS Thirty consecutive vulvar carcinoma patients were treated using external beam radiation therapy (EBRT) for definitive disease (n=25) or postoperatively (n=5). Twenty-four (80%) had squamous cell carcinoma (SCC). Tumor stages (2002 UICC) ranged from 0 to IVB, with no distant metastases. RESULTS The median total prescribed dose for primary tumor was 64.8 Gy. The 2-year overall survival rate was 25.3%. The outcome was significantly better in patients with ILNs<30 mm (p=0.005) and patients receiving prescribed doses >60 Gy (p=0.002). CONCLUSIONS ILN diameters ≤30 mm and prescribed doses over 60 Gy were associated with ILN control in patients with vulvar carcinoma.
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Affiliation(s)
- Yuki Mukai
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Izumi Koike
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tatsuya Matsunaga
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naho Ruiz Yokota
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hisashi Kaizu
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shoko Takano
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Madoka Sugiura
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Eiko Ito
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaharu Hata
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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15
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Thangarajah F, Morgenstern B, Pahmeyer C, Schiffmann LM, Puppe J, Mallmann P, Hamacher S, Buettner R, Alidousty C, Holz B, Scheel AH, Schultheis AM. Clinical impact of PD-L1 and PD-1 expression in squamous cell cancer of the vulva. J Cancer Res Clin Oncol 2019; 145:1651-1660. [PMID: 30972492 DOI: 10.1007/s00432-019-02915-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/08/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Squamous cell carcinoma of the vulva (SQCV) is the fifth most common cancer in women and accounts for about 5% of all genital cancers in women. The PD-L1 signaling pathway is activated in many malignant neoplasms and its blockade enhances anti-cancer immunity. The aim of our study was to examine the protein expression of PD-L1 and PD-1 in squamous cell cancer of the vulva, its correlations with clinicopathologic features and prognostic value. METHODS Patients with SQCV treated in one institution were used for the analyses. PD-L1 immunohistochemistry was performed on 4 µm-thick section of the respective FFPE tissue blocks using the 28-8 antibody. PD-L1 scoring was performed separately for tumour cells (TC) and tumour associated immune cells. DNA was extracted to determine HPV status. Kaplan-Meier estimates for disease-free-survival and overall-survival were calculated and compared by log-rank test. RESULTS PD-L1 expression in tumour cells could be observed in 32.9% of the patients. The expression of PD-L1 in peritumoural immune cells was confirmed in 91.4% of the patients. A significant correlation between PD-L1 expression in tumour cells and tumour stage was detected (p = 0.007). PD-L1 expression was independent from HPV status. Using the log-rank test we could not prove any significant differences in disease-free survival (p = 0.434) and overall survival (p = 0.858). Regression analysis showed that nodal status is a predictive factor of survival (p < 0.001). CONCLUSION The present study showed that a relevant amount of patients with squamous cell cancer of the vulva express PD-L1 in both, tumour cells and tumour-associated immune cells. Furthermore, the significant correlation of PD-L1 expression in TCs with tumour stage indicated the clinical impact of PD-L1 expression during tumour development. These data indicate that SQCV might be amenable to immune checkpoint-inhibition and constitute a rational for the future clinical trials.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
| | - Bernd Morgenstern
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Caroline Pahmeyer
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Lars Mortimer Schiffmann
- Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Julian Puppe
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Reinhard Buettner
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany
| | - Christina Alidousty
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany
| | - Barbara Holz
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany
| | - Andreas H Scheel
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anne Maria Schultheis
- Department of Pathology, University Hospital of Cologne, Institute of Pathology, Kerpener Str. 62, 50937, Cologne, Germany.
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16
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Kaltenecker B, Manos R, McCall M, Sparzak P. Intestinal-type adenocarcinoma of the vulva: A case study. Gynecol Oncol Rep 2019; 28:133-135. [PMID: 31061870 PMCID: PMC6488529 DOI: 10.1016/j.gore.2019.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/02/2022] Open
Abstract
Approximately 5% of all gynecologic cancers are of the vulva, of which 90% are squamous cell in origin. Adenocarcinomas of the vulva are extremely infrequent with most relating to epithelial glands in the vulvar region. A 53 year old African American female presented to the emergency department complaining of a lesion on her left labia that had been present for the past 6 months. In the operating room, multiple biopsies were taken of the left labial lesion as well as the right, and sufficient tissue was sent to pathology for analysis. The pathology report demonstrated adenocarcinoma of the vulva with intestinal type features, CD20+, CK7-, mCEA+, vimentin -, p53+. These findings were consistent with a colorectal primary; however, no colorectal primary was discovered. The intestinal type of primary adenocarcinoma of the vulva is a rare variant, and only a few cases have been reported to date. It histologically resembles mucinous colonic carcinomas, but immunohistochemical workups with various tumor markers are needed before confirmation. Adenocarcinoma of the vulva is rare. A rare variant of adenocarcinoma of the vulva is intestinal-type that resembles colorectal CK7-, mCEA+, CK20+, p53+ IHC profile favors intestinal primary Treatment for this cancer should be individualized
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Affiliation(s)
- Brian Kaltenecker
- Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, United States of America.,Department of OBGYN, Cape Fear Valley Medical Center Fayetteville, NC, United States of America
| | - Robert Manos
- Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, United States of America.,Department of OBGYN, Cape Fear Valley Medical Center Fayetteville, NC, United States of America
| | - Meagan McCall
- Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, United States of America.,Department of OBGYN, Cape Fear Valley Medical Center Fayetteville, NC, United States of America
| | - Paul Sparzak
- Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, United States of America.,Department of OBGYN, Cape Fear Valley Medical Center Fayetteville, NC, United States of America
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17
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Lillsunde Larsson G, Kaliff M, Sorbe B, Helenius G, Karlsson MG. HPV16 viral characteristics in primary, recurrent and metastatic vulvar carcinoma. Papillomavirus Res 2018; 6:63-69. [PMID: 30391517 PMCID: PMC6249404 DOI: 10.1016/j.pvr.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/06/2018] [Accepted: 10/28/2018] [Indexed: 01/06/2023]
Abstract
Vulvar carcinoma is the fourth most common gynecological malignancy. Two separate carcinogenic pathways are suggested, where one is associated with the human papillomavirus (HPV) and HPV16 the most common genotype. The aim of this study was to evaluate HPV-markers in a set of primary tumors, metastases and recurrent lesions of vulvar squamous cell carcinomas (VSCC). Ten HPV16-positive VSCC with metastatic regional lymph nodes, distant lymphoid/hematogenous metastases or local recurrent lesions were investigated for HPV genotype, HPV16 variant, HPV16 viral load, HPV16 integration and HPV16 E2BS3 and 4 methylation. In all 10 analyzed case series, the same HPV genotype (HPV16), HPV16 variant and level of viral load were detected in all lesions within a patient case. Primary tumors with a high E2/E6 ratio were found to have fewer vulvar recurrences and/or metastases after diagnosis and treatment. Also, a significantly lower viral load was evident in regional lymph nodes compared to primary tumors. The data presented strengthens the evidence for a clonal HPV-induced pathway for vulvar carcinoma.
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Affiliation(s)
- Gabriella Lillsunde Larsson
- School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden; Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden.
| | - Malin Kaliff
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
| | - Bengt Sorbe
- Department of Oncology, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
| | - Gisela Helenius
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
| | - Mats G Karlsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
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18
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Griffiths C, Howell R, Boinpally H, Jimenez E, Chalas E, Musa F, Gorenstein S. Using advanced wound care and hyperbaric oxygen to manage wound complications following treatment of vulvovaginal carcinoma. Gynecol Oncol Rep 2018; 24:90-93. [PMID: 29915804 PMCID: PMC6003433 DOI: 10.1016/j.gore.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 11/21/2022] Open
Abstract
Postoperative management of patients with vulvar cancer is associated with a high incidence of poor wound healing and radiation -induced late tissue necrosis. This case series demonstrates the impact on wound healing with the use of hyperbaric oxygen therapy and advanced wound care following radical vulvectomy and/or radiation therapy. A retrospective case series was performed of all patients from 2016 to 2017 with lower genital cancer who underwent radical surgery with or without chemoradiation treatment, experienced wound dehiscence or late tissue radionecrosis, and were treated with advanced wound care, including hyperbaric oxygen therapy (HBO). Five patients were included with a mean age of 63; four had squamous cell carcinoma and one patient had vaginal adenocarcinoma secondary to prior diethylstilbestrol exposure. Three patients underwent radical vulvectomy. All received pelvic radiation therapy, subsequently experienced wound complications, and were managed with advanced wound care and HBO. The mean reduction in wound area at the final wound follow up visit after completion of HBO therapy was found to be 76%, ranging 42-95%, with an average follow up of five months. The mean number of HBO sessions per patient was 58. Complete tissue granulation or significant improvement in tissue radionecrosis was present in all patients. Advanced wound care and hyperbaric oxygen therapy are beneficial in the management of postoperative wound complications. Prospective studies are needed to identify the optimal use of perioperative hyperbaric oxygen and appropriate wound care for patients with gynecologic malignancies.
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Affiliation(s)
- C. Griffiths
- Department of Gynecologic Oncology, NYU Winthrop Hospital, Mineola, NY, USA
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA
| | - R.S. Howell
- Department of Gynecologic Oncology, NYU Winthrop Hospital, Mineola, NY, USA
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA
| | - H. Boinpally
- Department of Gynecologic Oncology, NYU Winthrop Hospital, Mineola, NY, USA
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA
| | - E. Jimenez
- Department of Gynecologic Oncology, NYU Winthrop Hospital, Mineola, NY, USA
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA
| | - E. Chalas
- Department of Gynecologic Oncology, NYU Winthrop Hospital, Mineola, NY, USA
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA
| | - F. Musa
- Department of Gynecologic Oncology, NYU Winthrop Hospital, Mineola, NY, USA
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA
| | - S. Gorenstein
- Department of Gynecologic Oncology, NYU Winthrop Hospital, Mineola, NY, USA
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY, USA
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Laliscia C, Fabrini MG, Cafaro I, Barcellini A, Baldaccini D, Miniati M, Parietti E, Morganti R, Paiar F, Gadducci A. Adjuvant Radiotherapy in High-Risk Squamous Cell Carcinoma of the Vulva: A Two-Institutional Italian Experience. Oncol Res Treat 2017; 40:778-783. [PMID: 29183034 DOI: 10.1159/000479876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the treatment benefit and patterns of recurrence for patients with high-risk vulvar squamous cell carcinoma treated with surgery followed by adjuvant radiotherapy (RT). PATIENTS AND METHODS From January 1999 to June 2016, 51 patients underwent total or partial deep vulvectomy with inguinofemoral lymphadenectomy followed by adjuvant RT with 45-50 Gy in 25 fractions +/- a 4-10 Gy boost. 17 (33.3%) women received concomitant chemotherapy. RESULTS Median overall survival was 81 months. The 5-year disease-free survival and overall survival rates were 52 and 63%, respectively. In univariate and multivariate analysis, patients aged ≤ 76 years and those receiving an RT total dose of > 54 Gy had a significantly lower risk of progression (p = 0.044 and 0.045; p = 0.012 and 0.018, respectively) and death (p = 0.015 and 0.011; p = 0.015 and 0.026, respectively). There was a trend towards a lower risk of progression for patients with tumor size ≤ 4 (p = 0.098) and negative lymphovascular space involvement (p = 0.080). Also, there was a trend towards a higher risk of death (p = 0.075) for grade 3 tumors. Concomitant chemotherapy provided no significant benefit. CONCLUSION Only age and RT total dose are significant prognostic variables for squamous cell carcinoma of the vulva treated with primary surgery and adjuvant RT to improve local and locoregional control.
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Affiliation(s)
- Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
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Llueca A, Herraiz JL, Del Moral R, Piquer D, Maazouzi Y, Segarra B, Barres J, Serra A. Use of negative pressure wound therapy after infection and flap dehiscence in radical vulvectomy: A case report. Int J Surg Case Rep 2017; 41:370-372. [PMID: 29156232 PMCID: PMC5709344 DOI: 10.1016/j.ijscr.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/26/2022] Open
Abstract
Radical vulvectomy is a very agressive surgery. Deshiscence of vulvar wound is one of the most feared complications. Negative wound pressure therapy could be incorporate in the management of this complications.
Introduction Vulvar cancer has a lower incidence in high income countries, but is rising, in part, due to the high life expectancy in these societies. Radical vulvectomy is still the standard treatment in initial stages. Wound dehiscence contitututes one of the most common postoperative complications. Presentation of case A 76 year old patient with a squamous cell carcinoma of the vulva, FIGO staged, IIIb is presented. Radical vulvectomy and bilateral inguinal lymph node dissection with lotus petal flaps reconstruction are performed as the first treatment. Wound infection and dehiscence of lotus petal flaps was seen postoperatively. Initial management consisted in antibiotics administration and removing necrotic tissue from surgical wound. After this initial treatment, negative wound pressure therapy was applied for 37 days with good results. Discussion Wound dehiscence in radical vulvectomy remains the most frequent complication in the treatment of vulvar cancer. The treatment of this complications is still challenging for most gynecologic oncologist surgeons. Conclusion The utilization of the negative wound pressure therapy could contribute to reduce hospitalization and the direct and indirect costs of these complications.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain.
| | - Jose Luis Herraiz
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Raquel Del Moral
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Dolors Piquer
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Yasmine Maazouzi
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Blanca Segarra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Jordan Barres
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Anna Serra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain, Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
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Lopes A, St Louis J, Balancin ML, Nogueira-Rodrigues A, Silva LCFF, Paulino E, Sá BS, Bukowski A, Barbosa EM, Costa RLR, Goss PE. A Rare Presentation of Primary Breast Carcinoma in the Vulva: A Case Report and Literature Review. Clin Breast Cancer 2017; 18:e291-e294. [PMID: 28709748 DOI: 10.1016/j.clbc.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/30/2017] [Accepted: 06/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Andre Lopes
- Gynecology Department, Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | - Jessica St Louis
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA
| | | | - Angelica Nogueira-Rodrigues
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA; Federal University of Minas Gerais, Belo Horizonte, Brazil; Brazilian Group of Gynecologic Oncology, EVA, Belo Horizonte, Brazil
| | - Luana C F F Silva
- Medical Oncology Department, Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | - Eduardo Paulino
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA; Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Bianca Silveira Sá
- Mastology Department, Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA
| | | | | | - Paul E Goss
- The Global Cancer Institute, Boston, MA; MGH-Avon Global Breast Cancer Program, Boston, MA; Harvard Medical School, Boston, MA.
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Castelnau-Marchand P, Escande A, Mazeron R, Bentivegna E, Cavalcanti A, Gouy S, Baratiny C, Maroun P, Morice P, Haie-Meder C, Chargari C. Brachytherapy as part of the conservative treatment for primary and recurrent vulvar carcinoma. Brachytherapy 2017; 16:518-525. [PMID: 28262516 DOI: 10.1016/j.brachy.2017.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/22/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE There are only scarce data on the place of brachytherapy (BT) for treatment of vulvar carcinoma. Our institutional experience of interstitial BT for vulvar carcinoma patients is reported. METHODS AND MATERIALS Clinical records of patients receiving low-dose-rate or pulsed-dose-rate BT as part of the primary treatment for primary/recurrent vulvar squamous cell carcinoma or as part of postoperative treatment between 2000 and 2015 were included. Patients, tumors, and treatment characteristics as well as clinical outcome were examined. RESULTS A total of 26 patients treated with BT were identified. BT was delivered as part of primary intent treatment for locally advanced/recurrent cancer in 11 patients and as part of postoperative treatment in 15 patients. Median age at time of BT was 63 years (range, 41-88 years). Pulsed-dose-rate and low-dose-rate were used in 15 patients and 11 patients, respectively. BT was performed as a boost to the tumor bed following external beam radiotherapy (n = 13) or as the sole irradiation modality (n = 13). Total median dose at the level of primary tumor was 60 GyEQD2 (range, 55-60 GyEQD2). With mean followup of 41 months (range, 5 months-11.3 years), 11 patients experienced tumor relapse, and in two of them, site of relapse was only local. Three-year estimated disease-free survival and overall survival rates were 57% (95% confidence interval: 45-69%) and 81% (95% confidence interval: 72-90%), respectively. All toxicities were Grade 2 or less. CONCLUSIONS Interstitial BT used as part of the primary or postoperative treatment of vulvar carcinoma is feasible with a satisfactory toxicity profile. Prognosis remains, however, dismal, with a high frequency of failures in patients with locally advanced tumors.
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Affiliation(s)
- P Castelnau-Marchand
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Escande
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - R Mazeron
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - E Bentivegna
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Cavalcanti
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - S Gouy
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Baratiny
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Maroun
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Morice
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Haie-Meder
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Chargari
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; French Military Health Services Academy, Paris, France; Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.
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23
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Klapdor R, Länger F, Gratz KF, Hillemanns P, Hertel H. SPECT/CT for SLN dissection in vulvar cancer: Improved SLN detection and dissection by preoperative three-dimensional anatomical localisation. Gynecol Oncol 2015; 138:590-6. [PMID: 26067332 DOI: 10.1016/j.ygyno.2015.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/01/2015] [Accepted: 06/06/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In this study, we assessed the feasibility and clinical advantages of single photon emission computed tomography with CT (SPECT/CT) for sentinel lymph node (SLN) detection in vulvar cancer. METHODS This is a unicentric prospective trial. Vulvar cancer patients underwent preoperative SLN marking (10MBq Technetium (TC)-99m-nanocolloid) and subsequent planar lymphoscintigraphy (LSG) and SPECT/CT for SLN visualization. Directly before surgery, a patent blue dye was injected. We assessed detection rates of SPECT/CT and those of planar LSG and intraoperative detection. We analyzed the sensitivity, negative predictive value and false negative rate. RESULTS At Hannover Medical School, 40 vulvar cancer patients underwent SLN dissection after preoperative LSG and SPECT/CT. The mean diameter of all tumors in final histology was 2.23 (0.1-10.5) cm with a mean tissue infiltration of 3.93 (0.25-11) mm. In preoperative imaging, SPECT/CT identified significantly more SLNs (mean 8.7 (1-35) LNs per patient) compared to LSG (mean 5.9 (0-22) LNs, p<0.01). In addition, SPECT/CT led to a high spatial resolution and anatomical localization of SLNs. Thus, SPECT/CT identified aberrant lymphatic drainage in 7/40 (17.5%) patients. There were no significant differences, but significant correlation was found between SPECT/CT and intraoperative SLN identification. Regarding inguino-femoral LNs, for all patients who underwent complete groin dissection, sensitivity was 100%, NPV was 100% and false negative rate was 0%. CONCLUSION SPECT/CT leads to higher SLN identification compared to LSG in vulvar cancer. Due to its higher spatial resolution and three-dimensional anatomical localisation of SLNs, SPECT/CT provides the surgeon with important additional information, facilitates intraoperative SLN detection and predicts aberrant lymphatic drainage.
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Affiliation(s)
- R Klapdor
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany
| | - F Länger
- Institute of Pathology, Hannover Medical School, Germany
| | - K F Gratz
- Department of Nuclear Medicine, Hannover Medical School, Germany
| | - P Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany
| | - H Hertel
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany.
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24
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Abstract
Bartholin gland carcinoma is a rare tumor. Treatment is not consensual due to the absence of prospective and randomized controlled trials. Bartholin gland carcinoma is actually treated similarly to primary median squamous cell carcinoma of the vulva. Here we report two cases of 42- and 67-year-old females who developed respectively an adenoid cystic carcinoma, and a squamous carcinoma of Bartholin gland.
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Affiliation(s)
- Z Chraibi
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - T Hebert
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnelé, 37044 Tours, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - F Arbion
- Département d'anatomie pathologique, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnelé, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France; Unité Inserm 1069, 37044 Tours, France.
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25
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Wu Q, Shi H, Holm R, Li X, Trope C, Nesland JM, Suo Z. Aldehyde dehydrogenase-1 predicts favorable prognosis in patients with vulvar squamous cell carcinoma. Anticancer Res 2014; 34:859-865. [PMID: 24511023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUNDS Aldehyde dehydrogenase-1 (ALDH1) has been considered as a potential cancer stem cell marker in different types of cancer. In the present study, we investigated the expression of ALDH1 in vulvar squamous cell carcinoma, and evaluated its correlation with clinicopathological factors in patients suffering from this disease. MATERIALS AND METHODS One hundred and fifty-four patients with vulvar squamous cell carcinoma, together with their verified histopathological and complete clinical data in Norway were included in the study. All paraffin-embedded samples of the primary vulvar carcinoma were recruited. The presence of ALDH1 was detected by immunohistochemistry and compared against commonly recognized prognostic factors. RESULTS By immunohistochemical staining, the expression of ALDH1 was observed in 10/154 (6.5%) vulvar squamous cell carcinomas, while being extensively expressed in the suprabasal cells in normal vulvar epithelia from patients with benign gynecological disease and non-malignant epithelia adjacent to the tumor cells. In addition, ALDH1 was highly expressed in stromal fibroblasts, blood vessels and keratinized pearl of the carcinoma in all the samples. Patients with ALDH1-positive tumors had a significantly longer disease-specific survival (p=0.042). CONCLUSION Contrary to the characteristics of cancer stem cells shown in other types of cancer with positive expression of ALDH1, the positive expression of ALDH1 in patients with vulvar squamous cell carcinoma indicates a significantly better prognosis. Furthermore, there is a trend that the expression of ALDH1 is associated with better histological differentiation.
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Affiliation(s)
- Qinghua Wu
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China, or Department of Pathology, Oslo University Hospital, Ullernchausseen 70, N-0310, Oslo, Norway.
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26
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de Melo Maia B, Fontes AM, Lavorato-Rocha AM, Rodrigues IS, de Brot L, Baiocchi G, Stiepcich MM, Soares FA, Rocha RM. EGFR expression in vulvar cancer: clinical implications and tumor heterogeneity. Hum Pathol. 2014;45:917-925. [PMID: 24746196 DOI: 10.1016/j.humpath.2014.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 11/23/2022]
Abstract
Epidermal growth factor receptor (EGFR) protein expression was assessed by immunohistochemistry (IHC) in 150 cases of invasive vulvar squamous cell carcinoma. In addition, gene copy number status by fluorescence in situ hybridization was performed in a smaller set of samples. Results were correlated with patient's clinical data and prognostic factors. EGFR overexpression (2+ and 3+) was observed on the membrane in 24.66% and 21.33% of all cases, respectively. Higher EGFR expression was associated with depth of invasion (P = .0409) and disease recurrence (P = .0401). Cytoplasm staining was found in 21.33% of the cases and was associated with absence of nodal metastasis (P = .0061) and better survival (P = .0199). Intratumor heterogeneity of EGFR IHC staining was frequently observed (55.33%) and was associated with the presence of nodal metastasis (P = .0207) and tumor invasion (P = .0161). Worse survival outcomes have been demonstrated in tumors with EGFR heterogeneity (P = .0434). EGFR gene status evaluated by fluorescence in situ hybridization did not correlate with protein expression evaluated by IHC. In conclusion, EGFR cytoplasm staining has no link with poorer outcome; still, this pattern of staining is even more related to better prognosis. EGFR heterogeneity of staining correlated with more aggressive tumors, and presented to be an important marker of poor prognosis in vulvar squamous cell carcinoma. The usage of small biopsies or even tissue microarrays for vulvar cancer evaluation should be carefully reconsidered for the assessment of EGFR as the results may be misleading. Protein overexpression may be independent on gene amplification, showing that other molecular mechanisms than copy number variation may regulate protein expression of EGFR in vulvar cancer.
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Iacoponi S, Zapardiel I, Diestro MD, Hernandez A, De Santiago J. Prognostic factors associated with local recurrence in squamous cell carcinoma of the vulva. J Gynecol Oncol 2013; 24:242-8. [PMID: 23875074 PMCID: PMC3714462 DOI: 10.3802/jgo.2013.24.3.242] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 12/27/2012] [Accepted: 01/09/2013] [Indexed: 11/30/2022] Open
Abstract
Objective To analyze the prognostic factors related to the recurrence rate of vulvar cancer. Methods Retrospective study of 87 patients diagnosed of vulvar squamous cell carcinoma diagnosed at a tertiary hospital in Madrid between January 2000 and December 2010. Results The pathological mean tumor size was 35.1±22.8 mm, with stromal invasion of 7.7±6.6 mm. The mean free margin after surgery was 16.8±10.5 mm. Among all patients, 31 (35.6%) presented local recurrence (mean time 10 months; range, 1 to 114 months) and 7 (8%) had distant metastases (mean time, 5 months; range, 1 to 114 months). We found significant differences in the mean tumor size between patients who presented a relapse and those who did not (37.6±21.3 mm vs. 28.9±12.1 mm; p=0.05). Patients with free margins equal or less than 8 mm presented a relapse rate of 52.6% vs. 43.5% of those with free margin greater than 8 mm (p=0.50). However, with a cut-off of 15 mm, we observed a local recurrence rate of 55.6% vs. 34.5%, respectively (p=0.09). When the stromal invasion cut-off was >4 mm, local recurrence rate increased up to 52.9% compared to 37.5% when the stromal invasion was ≤4 mm (p=0.20). Conclusion Tumor size, pathologic margin distance and stromal invasion seem to be the most important predictors of local vulvar recurrence. We consider the cut-off of 35 mm of tumor size, 15 mm tumor-free surgical margin and stromal invasion >4 mm, high risk predictors of local recurrence rate.
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Affiliation(s)
- Sara Iacoponi
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
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28
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Abstract
Acquired perineovulvar defects are usually the result of excision of vulvar intraepithelial neoplasia (VIN) or invasive squamous cell carcinoma. Because both VIN and vulvar carcinoma have a tendency toward local recurrence, future reconstructive options should be reckoned with during treatment of the primary and all subsequent (pre-) malignant perineovulvar lesions. Hence, a proposal of sequence of reconstructive options for these defects is called for. In cases where local skin flaps suffice, these are preferably designed in such a fashion as not to sever the branches of the internal pudendal vascular system. In cases where either a pudendal thigh flap or an infragluteal flap may be used to close the perineovulvar defect, the pudendal thigh flap is to be preferred to preserve the infragluteal flap for future use. Only when these flaps no longer are available or sufficient to cover the defect should the gluteal thigh flap be applied. The use of myocutaneous flaps is rarely indicated to close isolated superficial perineovulvar defects.
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Inrhaoun H, Elghissassi I, Gutierrez M, Brain E, Errihani H. Long term response to erlotinib in a patient with recurrent vulvar carcinoma: Case report and review of literature. Gynecol Oncol Case Rep 2012; 2:119-20. [PMID: 24371640 DOI: 10.1016/j.gynor.2012.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
Abstract
► We report a case of recurrent vulvar carcinoma with a good response to erlotinib. ► Treatment was well tolerated with no serious side effects. ► Further evaluation of this new therapeutic approach may be warranted.
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Affiliation(s)
- Hanane Inrhaoun
- Department of Medical Oncology, Hôpital René Huguenin (Institut Curie), 35 rue Dailly 92210 Saint-Cloud, France
| | - Ibrahim Elghissassi
- Department of Medical Oncology, National Institute of Oncology, Allal Elfassi Street, Rabat, Morocco
| | - Maya Gutierrez
- Department of Medical Oncology, Hôpital René Huguenin (Institut Curie), 35 rue Dailly 92210 Saint-Cloud, France
| | - Etienne Brain
- Department of Medical Oncology, Hôpital René Huguenin (Institut Curie), 35 rue Dailly 92210 Saint-Cloud, France
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, Allal Elfassi Street, Rabat, Morocco
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Tapisiz OL, Topcu O, Gungor T, Ozdal B, Sirvan L, Yesilyurt A. Squamous cell carcinoma of the vulva in a virgin patient with Turner syndrome. J Gynecol Oncol 2011; 22:211-3. [PMID: 21998766 PMCID: PMC3188722 DOI: 10.3802/jgo.2011.22.3.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 10/06/2010] [Indexed: 11/30/2022] Open
Abstract
Two types of gynecologic tumors are commonly described in the Turner syndrome, the first one is gonadoblastoma, which occurs in patients with Y chromosome abnormalities, and the second one is endometrial carcinoma which is mostly related with exogenous estrogen usage. Here, we describe an extremely rare case of squamous cell carcinoma of the vulva in a virgin woman with Turner syndrome. A 35-years old single, virgin woman referred to our Oncology Department with warty, necrotized, exophytic 6-7 cm vulvar mass. She had a history of primary amenorrhea and mosaic Turner syndrome was determined in her karyotype analysis. Biopsy specimen of the vulvar mass revealed squamous cell carcinoma of the vulva, and total vulvectomy with inguinal femoral lymphadenectomy was performed. The postoperative course was uneventful and there has been no recurrence of the disease up to date. Women with Turner syndrome have streak ovaries that produce very low estrogen and the squamous cell carcinoma of the vulva may have developed at an early age with Turner syndrome because of this low estrogen value similar to postmenopausal women. The current case is a special case due to its age of occurrence, virgin and Turner syndrome status.
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Affiliation(s)
- Omer Lutfi Tapisiz
- Department of Gynecologic Oncology, Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Abstract
Carcinoma of the vulva is an uncommon malignant neoplasm (approximately one-fifth as frequent as cervical cancer) and represents 4% of all genital cancers in women. Approximately two-thirds of cases occur in women older than 60 years, and squamous cell carcinoma is the most common histologic type. Several different subtypes of squamous cell carcinoma have been described in the vulva; however, in terms of etiology, pathogenesis, and histologic features, most carcinomas belong to one of two categories: keratinizing squamous cell carcinomas associated with chronic inflammatory skin disorders, and basaloid or warty carcinomas related to infection with high oncogenic risk human papillomaviruses. Glandular neoplasms of the vulva arise from the vulvar apocrine sweat glands (papillary hidradenoma and Paget disease) or the Bartholin gland and their cause is not known.
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Affiliation(s)
- Edyta C Pirog
- Department of Pathology, Weill Medical College of Cornell University, 525 East 68th Street, ST-1041, New York, NY 10065, USA.
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