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Liu S, Li M, Zhang H. Neoadjuvant chemotherapy combined with surgery for the treatment of a rare primary vaginal adenocarcinoma. Asian J Surg 2024; 47:2039-2040. [PMID: 38220528 DOI: 10.1016/j.asjsur.2024.01.030] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024] Open
Affiliation(s)
- Shujie Liu
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Mingze Li
- Binzhou Medical University, Binzhou, 256600, Shandong Province, China
| | - Haiyan Zhang
- Department of Gynecology, Linyi People's Hospital, Linyi, 276000, Shandong Province, China.
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Coppin R, Martelli H, Chargari C, Sudour-Bonnange H, Orbach D, Vérité C, Pasquet M, Saumet L, Piguet C, Patte C, Guérin F, Faure-Conter C, Fresneau B. Outcome and late effects of patients treated for childhood vaginal malignant germ cell tumors. Pediatr Blood Cancer 2023; 70:e30697. [PMID: 37798818 DOI: 10.1002/pbc.30697] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Vaginal malignant germ cell tumors (MGCT) are rare, occurring in children less than 2 years old and raise the question of the optimal local treatment. METHODS We included children treated for vaginal MGCT according to the French TGM-95/2013 regimen. Patients were classified as standard risk (SR: localized disease and alpha-fetoprotein (AFP) < 10,000 ng/mL) or high risk (HiR: metastatic and/or AFP > 10,000 ng/mL) and were treated, respectively, with three to five VBP (vinblastine-bleomycin-cisplatin) or four to six VIP (etoposide-ifosfamide-cisplatin), followed by conservative surgery and/or brachytherapy in case of post-chemotherapy residuum. RESULTS Fourteen patients were included (median age = 12 months), of which six (43%) were classified as HiR. AFP levels were normalized after first-line chemotherapy in all cases but one. A vaginal post-chemotherapy residuum (median size = 8 mm, range: 1-24 mm) was observed in 13/14 patients, treated by complete resection in seven of 13 (viable cells in three of seven), incomplete resection in four of 13 (viable cells in two of four), with adjuvant brachytherapy in two of 13, and exclusive brachytherapy in two of 13 (viable cells in one of six). Among the six patients with viable disease, four patients received adjuvant chemotherapy. One patient (SR) experienced immediate postoperative relapse despite presenting no viable residual cells and was treated with four VIP cycles and brachytherapy. At last follow-up (median = 4.6 years, range: 0.5-16), all patients were alive in complete remission. Five patients suffered from vaginal sequelae with synechiae and/or stenosis (of whom four had undergone brachytherapy). CONCLUSION Childhood vaginal MGCTs show a highly favorable prognosis with risk-adapted chemotherapy and local treatment of post-chemotherapy residuum (preferably by conservative surgery with partial vaginectomy). Brachytherapy could be an alternative when conservative surgery is not deemed possible or in cases of incomplete resection with residual viable cells.
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Affiliation(s)
- Robin Coppin
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Helene Martelli
- Department of Pediatric Surgery, Bicêtre Hospital - Assistance Publique-Hôpitaux de Paris - Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Cyrus Chargari
- Department of Radiation Therapy, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | | | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Institut Curie, PSL University, Paris, France
| | - Cecile Vérité
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Bordeaux, France
| | - Marlene Pasquet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Toulouse, France
| | - Laure Saumet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Montpellier, France
| | - Christophe Piguet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Limoges, France
| | - Catherine Patte
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital - Assistance Publique-Hôpitaux de Paris - Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Cecile Faure-Conter
- Department of Pediatric Oncology, Institut d'Hemato-Oncologie Pediatrique, Lyon, France
| | - Brice Fresneau
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
- Paris-Saclay University, Paris-Sud University, Epidemiology of Radiation, CESP, INSERM, Villejuif, France
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3
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Leung E, Tremblay C, Liao D, Burnett M, Huang L, Sun SZ, Ko JJ. Treatment patterns and outcomes of patients with locally advanced vulvar or vaginal cancer in British Columbia. Gynecol Oncol 2023; 175:107-113. [PMID: 37348429 DOI: 10.1016/j.ygyno.2023.06.013] [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: 04/20/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE As vulvar and vaginal cancers are rare malignancies, treatment is extrapolated from the cervical cancer field. Further studies are necessary to evaluate whether surgery, radiotherapy (RT), or combined chemoRT is most beneficial. METHODS A retrospective chart review was conducted on patients diagnosed with vulvar or vaginal cancer in 2000-2017. Descriptive statistics was used to summarize demographic factors. Kaplan-Meier curves, log-rank tests, multivariate analysis with hazard ratios (HR) were conducted to compare survival outcomes, including overall survival (OS), disease-free survival, and cancer-specific survival, between surgery, RT, and chemoRT. RESULTS This study included 688 patients with either vulvar (n = 560, 81%) or vaginal cancer (n = 128, 19%). Median age of diagnosis was 68 (27-98) years. In multivariate survival analysis, vulvar cancer was associated with more likelihood of death (HR: 1.50, p = 0.042) compared to vaginal cancer. For patients who received definitive RT, median OS was 63.8 months with concurrent chemotherapy vs. 46.3 months without for vulvar cancer (p = 0.75); for vaginal, median OS 100.4 with chemotherapy vs. 66.6 months without (p = 0.31). For vulvar cancer patients who received RT (n = 224), adding chemotherapy (n = 100) was not associated with statistically significant OS improvement (HR: 0.989, p = 0.957). Similarly, vaginal cancer patients who received chemoRT (n = 51) did not have significant OS benefit (HR: 0.720, p = 0.331) over patients who received RT (n = 49). CONCLUSIONS In this retrospective study, chemoRT was not associated with significant improvements in survival compared to RT in vulvar or vaginal cancer. Future studies investigating novel therapies to treat these cancers are needed to improve patient outcomes.
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Affiliation(s)
- Emily Leung
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Cassia Tremblay
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Donna Liao
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Madalon Burnett
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Longlong Huang
- Department of Mathematics and Statistics, University of the Fraser Valley, Abbotsford, BC V2S 7M8, Canada
| | - Shaun Z Sun
- Department of Mathematics and Statistics, University of the Fraser Valley, Abbotsford, BC V2S 7M8, Canada; Department of Mathematics, Vancouver Island University, Nanaimo, BC V9R 5S5, Canada
| | - Jenny J Ko
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Department of Medical Oncology, BC Cancer - Abbotsford, Abbotsford, BC V2S 0CS, Canada.
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Mu Q, Wang C, Liu H, Xu Y, Luan S, Xia B. Endometrioid adenocarcinoma of the rectovaginal septum: A case report. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:941-946. [PMID: 37587081 PMCID: PMC10930444 DOI: 10.11817/j.issn.1672-7347.2023.220614] [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] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Indexed: 08/18/2023]
Abstract
Primary endometrioid adenocarcinoma of the rectovaginal septum is rare. Its pathogenesis is not clear and there is no standard treatment. One patient with endometrioid adenocarcinoma of the rectovaginal septum arising from deep infiltrative endometriosis was admitted to Qingdao Municipal Hospital. The patient presented with incessant menstruation and abdominal distension. She had bilateral ovarian endometriotic cystectomy 6 years ago. Imaging findings suggested a pelvic mass which might invade the rectovaginal septum. Pathological results of primary surgery confirmed endometrioid carcinoma of the pelvic mass arising from the rectovaginal septum. Then she had a comprehensive staged surgery. Postoperative chemotherapy was given 6 times. No recurrence or metastasis was found during the 2-year follow-up. The possibility of deep infiltrating endometriosis and its malignant transformation should be considered in the differential diagnosis of a new extragonadal pelvic lesion in a patient with a history of endometriosis, which would avoid misdiagnosis and missed diagnosis.
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Affiliation(s)
- Qingling Mu
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000.
| | - Chun Wang
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000
| | - Hongyun Liu
- Department of Pathology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000, China
| | - Youzheng Xu
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000
| | - Shaohong Luan
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000
| | - Baoguo Xia
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000.
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5
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Meixner E, Arians N, Bougatf N, Hoeltgen L, König L, Lang K, Domschke C, Wallwiener M, Lischalk JW, Kommoss FK, Debus J, Hörner-Rieber J. Vaginal cancer treated with curative radiotherapy with or without concomitant chemotherapy: oncologic outcomes and prognostic factors. Tumori 2023; 109:112-120. [PMID: 34724840 PMCID: PMC9896533 DOI: 10.1177/03008916211056369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vaginal cancer is a rare disease for which prospective randomized trials do not exist. We aimed to assess survival outcomes, patterns of recurrence, prognostic factors, and toxicity in the curative treatment using image-guided radiotherapy (RT). METHODS In this retrospective review, we identified 53 patients who were treated at a single center with external beam radiotherapy and brachytherapy with or without concomitant chemotherapy from 2000 to 2021. RESULTS With a median follow-up of 64.5 months, the Kaplan-Meier 2-, 5-, and 7-year overall survival (OS) was found to be 74.8%, 62.8%, and 58.9%, respectively. Local and distant control were 67.8%, 65.0%, and 65.0% and 74.4%, 62.6%, and 62.6% at 2, 5, and 7 years, respectively. In univariate Cox proportional hazards ratio analysis, OS was significantly correlated to FIGO stage (hazard ratio [HR] 1.78, p = 0.042), postoperative RT (HR 0.41, p = 0.044), and concomitant chemotherapy (HR 0.31, p = 0.009). Local control rates were superior when an equivalent dose in 2-Gy fractions (EQD2) of ⩾65 Gy was delivered (HR 0.216, p = 0.028) and with the use of concurrent chemotherapy (HR 0.248, p = 0.011). Not surprisingly, local control was inferior for patients with a higher TNM stage (HR 3.303, p = 0.027). Minimal toxicity was observed with no patients having documentation of high-grade toxicity (CTCAE grade 3+). CONCLUSION In treatment of vaginal cancer, high-dose RT in combination with brachytherapy is well tolerated and results in effective local control rates, which significantly improve with an EQD2(α/β=10) ⩾65 Gy. Multivariate analyses revealed concomitant chemotherapy was a positive prognostic factor for overall and progression-free survival.
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Affiliation(s)
- Eva Meixner
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
- Eva Meixner, MD, Department of Radiation
Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg,
Baden-Württemberg 69120, Germany.
| | - Nathalie Arians
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and
Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and
Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonathan W. Lischalk
- Department of Radiation Oncology,
Perlmutter Cancer Center, New York University Langone Health, New York, NY,
USA
| | - Felix K.F. Kommoss
- Department of Pathology, Institute of
Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
- Heidelberg Ion Therapy Center (HIT),
Heidelberg, Germany
- Clinical Cooperation Unit Radiation
Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
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Guo N, Zhang J. Primary vaginal malignant melanoma: A rare case report of successful treatment with nivolumab. Medicine (Baltimore) 2021; 100:e25691. [PMID: 33907144 PMCID: PMC8084096 DOI: 10.1097/md.0000000000025691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023] Open
Abstract
RATIONALE Primary vaginal malignant melanoma is a sporadic and very aggressive tumor that is treated through surgery or radiotherapy combined with chemotherapy. Since most cases are diagnosed at an advanced stage, the operation range is extensive, the quality of life is poor, and the prognosis is gloomy. PATIENT CONCERNS A 58-year-old woman presented irregular water-like leukorrhea for 1 month after 6 years of menopause. Positron emission tomography-computed tomography revealed a 3.1 × 2.6 × 3.2 mass on the middle and lower part of the right vaginal wall. A gynecological examination revealed a 2 to 3 cm exophytic black mass in the lower-right part of the vaginal orifice. This mass was 2 cm from the urethral orifice. Furthermore, the mucosa of the anterior inferior vaginal wall had blackened and thickened, and there were some scattered black dots at the medial labia minora. DIAGNOSIS Due to the patient's symptoms with radiographic findings, the postmenopausal woman was diagnosed with primary vaginal malignant melanoma. INTERVENTIONS Surgery was done to remove the mass. The patient also underwent inguinal lymph node dissection, received immunotherapy, and was treated with nivolumab. OUTCOMES After a 6-month follow-up period, the patient underwent a routine gynecological examination with negative radiological results. Moreover, no local recurrence or distant metastases were found. LESSONS This patient showed a good response to immunotherapy. With this treatment method, the prognosis is better for advanced-stage women, especially those who cannot endure the surgery. Local lesion resection and inguinal lymph node dissection combined with immunotherapy are recommended. The case reported here may help treat similar clinical cases.
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Affiliation(s)
- Na Guo
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Jiawen Zhang
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
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Wohlmuth C, Wohlmuth-Wieser I, Laframboise S. Clinical Characteristics and Treatment Response With Checkpoint Inhibitors in Malignant Melanoma of the Vulva and Vagina. J Low Genit Tract Dis 2021; 25:146-151. [PMID: 33252450 PMCID: PMC7984764 DOI: 10.1097/lgt.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aims of the study were to assess the clinical and histopathological characteristics of a comprehensive cohort of women with vulvovaginal melanoma (VVM) treated at our institution and to study the treatment response of checkpoint inhibitors in this patient cohort. MATERIALS AND METHODS This is a retrospective study of women with invasive VVM treated at the Princess Margaret Cancer Centre in Toronto, Ontario, Canada, over a period of 15 years. Clinical and histopathological characteristics, treatment, as well as treatment-related outcome were analyzed in 32 women. Treatment response was evaluated retrospectively using the "response criteria for use in trials testing immunotherapeutics" (iRECIST). The objective response rate was defined as the proportion of patients with complete or partial response based on the best overall response. RESULTS At a median follow-up of 37.8 months (5.8-110.4), 26 women (81.3%) had disease progression and 16 (50%) died. Thirteen patients with locally unresectable or metastatic melanoma were treated with immune checkpoint inhibitors. Ten additional cases were identified from previously published reports. The best objective response rate for immune checkpoint inhibitors was 30.4% (95% CI = 11.6%-49.2%) and the clinical benefit rate was 52.2% (95% CI = 31.8%-72.6%). The clinical benefit rate was significantly better for programmed cell death protein 1 inhibitors (or a combination) compared with ipilimumab alone (Fisher exact, p = .023). Grade 3/4 adverse events were observed in 3 (13.0%) of the 23 patients. CONCLUSIONS Women with VVM constitute a high-risk group with poor overall prognosis. Immune checkpoint inhibitors are effective in the treatment of metastatic melanoma in this patient cohort.
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Affiliation(s)
- Christoph Wohlmuth
- Division of Gynecologic Oncology, Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Iris Wohlmuth-Wieser
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Stéphane Laframboise
- Division of Gynecologic Oncology, Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
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8
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Naumann RW, Hollebecque A, Meyer T, Devlin MJ, Oaknin A, Kerger J, López-Picazo JM, Machiels JP, Delord JP, Evans TR, Boni V, Calvo E, Topalian SL, Chen T, Soumaoro I, Li B, Gu J, Zwirtes R, Moore KN. Safety and Efficacy of Nivolumab Monotherapy in Recurrent or Metastatic Cervical, Vaginal, or Vulvar Carcinoma: Results From the Phase I/II CheckMate 358 Trial. J Clin Oncol 2019; 37:2825-2834. [PMID: 31487218 PMCID: PMC6823884 DOI: 10.1200/jco.19.00739] [Citation(s) in RCA: 234] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Nivolumab was assessed in patients with virus-associated tumors in the phase I/II CheckMate 358 trial (ClinicalTrials.gov identifier: NCT02488759). We report on patients with recurrent/metastatic cervical, vaginal, or vulvar cancers. PATIENTS AND METHODS Patients received nivolumab 240 mg every 2 weeks. Although patients with unknown human papillomavirus status were enrolled, patients known to have human papillomavirus-negative tumors were ineligible. The primary end point was objective response rate. Duration of response (DOR), progression-free survival, and overall survival were secondary end points. Safety and patient-reported outcomes were exploratory end points. RESULTS Twenty-four patients (cervical, n = 19; vaginal/vulvar, n = 5) were enrolled. Most patients had received prior systemic therapy for metastatic disease (cervical, 78.9%; vaginal/vulvar, 80.0%). Objective response rates were 26.3% (95% CI, 9.1 to 51.2) for cervical cancer and 20.0% (95% CI, 0.5 to 71.6) for vaginal/vulvar cancers. At a median follow-up of 19.2 months, median DOR was not reached (range, 23.3 to 29.5+ months; + indicates a censored observation) in the five responding patients in the cervical cohort; the DOR was 5.0 months in the single responding patient in the vaginal/vulvar cohort. Median overall survival was 21.9 months (95% CI, 15.1 months to not reached) among patients with cervical cancer. Any-grade treatment-related adverse events were reported in 12 of 19 patients (63.2%) in the cervical cohort and all five patients in the vaginal/vulvar cohort; there were no treatment-related deaths. In the cervical cohort, nivolumab treatment generally resulted in stabilization of patient-reported outcomes associated with health status and health-related quality of life. CONCLUSION The efficacy of nivolumab in patients with recurrent/metastatic cervical and vaginal or vulvar cancers is promising and warrants additional investigation. No new safety signals were identified with nivolumab treatment in this population.
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Affiliation(s)
| | | | - Tim Meyer
- UCL Cancer Institute, London, United Kingdom
| | | | - Ana Oaknin
- Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Joseph Kerger
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jean-Pascal Machiels
- Institut Roi Albert II, Service d’Oncologie Médicale, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (IREC, Pole MIRO), UCLouvain, Brussels, Belgium
| | | | | | - Valentina Boni
- START Madrid Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Emiliano Calvo
- START Madrid Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Suzanne L. Topalian
- Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy and Kimmel Cancer Center, Baltimore, MD
| | | | | | - Bin Li
- Bristol-Myers Squibb, Princeton, NJ
| | | | | | - Kathleen N. Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, and Sarah Cannon Research Institute, Nashville, TN
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9
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Abstract
RATIONALE Squamous carcinoma is the most common malignancy of vagina. Adenoid cystic carcinoma (ACC) in the vagina is very rare. PATIENT CONCERNS In the present study, we present a 45-year-old woman with a palpable swelling in the vagina. The patient reported body paresthesia, chest congestion, expiratory dyspnea, and itching in the thigh root. DIAGNOSIS The ultrasound results revealed inhomogeneous echoes of the muscular layer in the middle and distal of the vagina, and probed a slightly richer blood flow signal. Then biopsy was performed. On microscopic examination, it was observed that tumor cells were arranged in a tubular or cribriform pattern, and exhibited a consistent size, small nuclei, and nuclear fission. The myoepithelium was lined around the glandular cavity, but the myoepithelium was tumorous. Immunohistochemistry was performed for further verification. Vimentin was positive in mesenchyme and CK-P was positive in epithelial cells. P63 and calponin were spotted, which were focal positive around the glandular cavity. Finally, the patient was diagnosed as ACC. INTERVENTIONS At last, the patient chose chemoradiotherapy, not surgical excision. OUTCOMES The patient is alive and well 13 months after the initial diagnosis. LESSONS ACC in the vagina is extremely rare. To our knowledge, this report is the first case of ACC arising from the vagina in English-language literature. Extensive surgical section of the tumour and chemoradiotherapy are recommended for therapy. Because of rarity, the prognosis of ACC in vagina is not known.
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Affiliation(s)
- Lan-Zhi Zhang
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Li-Yan Huang
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - An-Liang Huang
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jin-Xing Liu
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Fan Yang
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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10
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Abstract
The clinical efficacy and outcomes of pazopanib treatment for metastatic extraosseous Ewing sarcoma remain unclear. We herein report a case of heavily pre-treated metastatic extraosseous Ewing sarcoma in which pazopanib treatment achieved a significant improvement. A 17-year-old girl was referred to our hospital due to metastatic extraosseous Ewing sarcoma. The initial cytotoxic chemotherapy was temporarily effective, however, her disease eventually progressed, and she was subsequently treated with pazopanib. The recurrent tumor showed a marked response to pazopanib therapy; the therapeutic effect has lasted for more than 26 months. The present case suggests that pazopanib may be a therapeutic option for extraosseous Ewing sarcoma.
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Affiliation(s)
- Yoshinori Mori
- Division of Chemotherapy, Nagoya City University Hospital, Japan
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
- Division of Chemotherapy, Nagoya City West Medical Center, Japan
| | - Shiori Kinoshita
- Division of Chemotherapy, Nagoya City University Hospital, Japan
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Takashi Kanamori
- Division of Chemotherapy, Nagoya City University Hospital, Japan
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Japan
| | | | - Masahiro Kondo
- Department of Pharmacy, Nagoya City University Hospital, Japan
| | - Junko Kuroda
- Department of Pharmacy, Nagoya City University Hospital, Japan
| | - Hirokazu Komatsu
- Division of Chemotherapy, Nagoya City University Hospital, Japan
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Japan
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11
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Daix M, Dillies P, Gueuning A, Watkins-Masters L, Gielen F. [Primary malignant melanoma of vagina]. Rev Med Liege 2018; 73:413-418. [PMID: 30113785] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The primary vaginal melanoma is a rare aggressive tumour with a poor prognosis. The average age at diagnosis is 60, and there are no known risk factors. The establishment of a classification system and treatment protocols are made difficult because there are so few cases. The 5-year survival rate is estimated at no more than ten per cent. We report a case of an inoperable primary vaginal melanoma in a 58-year old woman. There were metastatic lymph nodes in the lumbo-aortic region, but no extension to bone or viscera. She was treated with nivolumab as monotherapy. Clinical and radiological evolution were both favourable, and the treatment was well tolerated.
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Affiliation(s)
- M Daix
- Service de Gynécologie-Obstétrique, CHC Saint-Vincent, Rocourt (Liège), Belgique
| | | | - A Gueuning
- Service de Gynécologie-Obstétrique, Erasme, Bruxelles, Belgique
| | | | - F Gielen
- Gynécologie, CHR Haute Senne, Soignies, Belgique
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12
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Inoue K, Tsubamoto H, Isono-Nakata R, Sakata K, Nakagomi N. Itraconazole treatment of primary malignant melanoma of the vagina evaluated using positron emission tomography and tissue cDNA microarray: a case report. BMC Cancer 2018; 18:630. [PMID: 29866134 PMCID: PMC5987480 DOI: 10.1186/s12885-018-4520-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/18/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Primary malignant melanoma of the vagina is extremely rare, with a poorer prognosis than cutaneous malignant melanoma. Previous studies have explored the repurposing of itraconazole, a common oral anti-fungal agent, for the treatment of various cancers. Here, we describe a patient with metastatic, unresectable vaginal malignant melanoma treated with 200 mg oral itraconazole twice a day in a clinical window-of-opportunity trial. CASE PRESENTATION A 64-year-old Japanese woman with vaginal and inguinal tumours was referred to our institution. On the basis of an initial diagnosis of vaginal cancer metastatic to the inguinal lymph nodes, we treated her with itraconazole in a clinical trial until the biopsy and imaging study results were obtained. During this period, biopsies were performed three times, and 18F-fluoro-deoxyglucose positron emission tomography (FDG/PET)-computed tomography (CT) was performed twice. Biopsy results confirmed the diagnosis of primary malignant melanoma of the vagina. Imaging studies revealed metastases to multiple sites, including the brain, for which she underwent gamma-knife radiosurgery. During the window period before nivolumab initiation, the patient received itraconazole for 30 days. Within a week of itraconazole initiation, pain in the inguinal nodes was ameliorated. PET-CT on days 6 and 30 showed a reduction in tumour size and FDG uptake, respectively. The biopsied specimens obtained on days 1, 13, and 30 were subjected to cDNA microarray analysis, which revealed a 100-fold downregulation in the transcription of four genes: STATH, EEF1A2, TTR, and CDH2. After 12 weeks of nivolumab administration, she developed progressive disease and grade 3 immune-related hepatitis. Discontinuation of nivolumab resulted in the occurrence of left pelvic and inguinal pain. Following re-challenge with itraconazole, the patient has not reported any pain for 4 months. CONCLUSION The findings of this case suggest that itraconazole is a potential effective treatment option for primary malignant melanoma of the vagina. Moreover, we identified potential itraconazole target genes, which could help elucidate the mechanism underlying this disease and potentially aid in the development of new therapeutic agents.
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Affiliation(s)
- Kayo Inoue
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
- Department of Medical Oncology, Meiwa Hospital, Nishinomiya, Hyogo 663-8186 Japan
| | - Roze Isono-Nakata
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
| | - Kazuko Sakata
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
| | - Nami Nakagomi
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501 Japan
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13
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Kamrava M, Beriwal S, Erickson B, Gaffney D, Jhingran A, Klopp A, Park SJ, Viswanathan A, Yashar C, Lin L. American Brachytherapy Society recurrent carcinoma of the endometrium task force patterns of care and review of the literature. Brachytherapy 2017; 16:1129-1143. [PMID: 28888417 DOI: 10.1016/j.brachy.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 03/26/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this American Brachytherapy Society task force is to present a literature review and patterns of care by a panel of experts for the management of vaginal recurrence of endometrial cancer. METHODS AND MATERIALS In 2016, the American Brachytherapy Society Board selected a panel of experts in gynecologic brachytherapy to update our current state of knowledge for managing vaginal recurrence of endometrial cancer. Practice patterns were evaluated via an online survey and clinical updates occurred through a combination of literature review and clinical experience and/or expertise. RESULTS There are various retrospective series of patients treated with radiation for vaginal recurrence of endometrial cancer, which include a varied group of patients, multiple treatment techniques, and a range of total doses and demonstrate a wide scope of local control and overall survival outcomes. In the era of image-guided brachytherapy, high local control rates with low significant late-term morbidities can be achieved. Lower rates of local control and higher late-term toxicity are reported in the retreatment setting. In patients with no previous history of radiation treatment, external beam radiation therapy followed by brachytherapy boost should be used. There are varying practices with regard to the definition and appropriate doses of both the high-risk clinical target volume and the intermediate-risk clinical target volume in the setting of vaginal recurrence of endometrial cancer. There are limited data to provide appropriate dose constraints for some organs at risk with the majority of guidance taken from the definitive cervical cancer literature. CONCLUSIONS A summary of literature and expert practice patterns for patient selection, dose recommendations, and constraints are provided as guidance for practitioners.
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Affiliation(s)
- Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Anuja Jhingran
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Ann Klopp
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Sang June Park
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Akila Viswanathan
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD
| | - Catheryn Yashar
- Department of Radiation Oncology, University of California San Diego, San Diego, CA
| | - Lilie Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
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14
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Waqas M, Malik SN, Shohab D, Tariq N, Hussain I, Iqbal Y. Vaginal Yolk Sac Tumor in an Infant. J Coll Physicians Surg Pak 2017; 27:S112-S113. [PMID: 28969744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
Yolk sac tumors are most common tumors among the germ cell tumors (GCTs) in children, mostly involving the gonads. But yolk sac tumors involving the vagina are very rare. These usually present with per vaginal bleeding and vaginal mass. Presentation with discharged tumor fragments is very unusual. We present a rare case of yolk sac tumor of vagina in an infant with very unusual presentation of per vaginal tumor tissue discharge, histopathological examination of which was diagnostic.
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Affiliation(s)
- Muhammad Waqas
- Department of Urology, Shifa International Hospital, Sector H-8/4, Islamabad
| | | | - Durre Shohab
- Department of Urology, Shifa International Hospital, Sector H-8/4, Islamabad
| | - Naima Tariq
- Department of Urology, Shifa International Hospital, Sector H-8/4, Islamabad
| | - Ijaz Hussain
- Department of Urology, Shifa International Hospital, Sector H-8/4, Islamabad
| | - Yasir Iqbal
- Department of Urology, Shifa International Hospital, Sector H-8/4, Islamabad
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15
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Gremel G, Lee RJ, Girotti MR, Mandal AK, Valpione S, Garner G, Ayub M, Wood S, Rothwell DG, Fusi A, Wallace A, Brady G, Dive C, Dhomen N, Lorigan P, Marais R. Distinct subclonal tumour responses to therapy revealed by circulating cell-free DNA. Ann Oncol 2016; 27:1959-65. [PMID: 27502704 PMCID: PMC5035787 DOI: 10.1093/annonc/mdw278] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/01/2016] [Accepted: 07/12/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The application of precision medicine in oncology requires in-depth characterisation of a patient's tumours and the dynamics of their responses to treatment. PATIENTS AND METHODS We used next-generation sequencing of circulating cell-free DNA (cfDNA) to monitor the response of a KIT p.L576P-mutant metastatic vaginal mucosal melanoma to sequential targeted, immuno- and chemotherapy. RESULTS Despite a KIT mutation, the response to imatinib was mixed. Unfortunately, tumours were not accessible for molecular analysis. To study the mechanism underlying the mixed clinical response, we carried out whole-exome sequencing and targeted longitudinal analysis of cfDNA. This revealed two tumour subclones; one with a KIT mutation that responded to imatinib and a second KIT-wild-type subclone that did not respond to imatinib. Notably, the subclones also responded differently to immunotherapy. However, both subclones responded to carboplatin/paclitaxel, and although the KIT-wild-type subclone progressed after chemotherapy, it responded to subsequent re-administration of paclitaxel. CONCLUSION We show that cfDNA can reveal tumour evolution and subclonal responses to therapy even when biopsies are not available.
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Affiliation(s)
- G Gremel
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - R J Lee
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - M R Girotti
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - A K Mandal
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - S Valpione
- The University of Manchester, The Christie NHS Foundation Trust, Manchester
| | - G Garner
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - M Ayub
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester
| | - S Wood
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester
| | - D G Rothwell
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester
| | - A Fusi
- The University of Manchester, The Christie NHS Foundation Trust, Manchester
| | - A Wallace
- Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Central Manchester NHS Foundation Trust, Manchester, UK
| | - G Brady
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester
| | - C Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester
| | - N Dhomen
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - P Lorigan
- The University of Manchester, The Christie NHS Foundation Trust, Manchester
| | - R Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
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16
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Alhumidi A, Al Shaikh S, Alhammadi A. Yolk sac tumor of vagina: a case report. Int J Clin Exp Pathol 2015; 8:2183-2185. [PMID: 25973124 PMCID: PMC4396344] [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] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
Malignant germ-cell tumors (MGCT) are rare tumors of childhood accounting for less than 3% of pediatric malignancies. Yolk sac (endodermal sinus) tumor is one of the malignant germ cell tumor that usually involves the gonads (ovaries and testes). Its occurrence in the vagina is extremely rare. We report a 6-months old girl presented with a vaginal mass diagnosed as a yolk sac tumor. This diagnosis is confirmed by histopathologic examination, immunehistochemical studies as well as elevated serum alpha fetoprotein (AFP).
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Affiliation(s)
- Ahmed Alhumidi
- Department of Pathology, King Khalid University Hospital, King Saud University Riyadh, Saudi Arabia
| | - Safa Al Shaikh
- Department of Pathology, King Khalid University Hospital, King Saud University Riyadh, Saudi Arabia
| | - Abdullah Alhammadi
- Department of Pathology, King Khalid University Hospital, King Saud University Riyadh, Saudi Arabia
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17
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Jordanov A, Hinkova N, Ivanov I, Popovska S. [PRIMARY VAGINAL NON-HODGKIN LYMPHOMA--A CASE REPORT AND REVIEW FROM THE LITERATURE]. Akush Ginekol (Sofiia) 2015; 54:47-48. [PMID: 26411197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary vaginal non-Hodgkin lymphoma is really uncommon disease. We describe a 71 year old woman with primary vaginal non-Hodgkin lymphoma to whom was made a standart chimiotherapy after diagnosis. Tumor recurrence was not detected for the last 2 years.
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18
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Tsai HJ, Ruan CW, Kok VC, Li MC. A large primary vaginal leiomyosarcoma diagnosed postoperatively and uterine leiomyomas treated with surgery and chemotherapy. J OBSTET GYNAECOL 2013; 33:643-4. [PMID: 23919878 DOI: 10.3109/01443615.2013.795136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- H J Tsai
- Department of Obstetrics and Gynecology, Kuang Tien General Hospital, Shalu Taichung, Taiwan.
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19
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Kunos CA, Radivoyevitch T, Waggoner S, Debernardo R, Zanotti K, Resnick K, Fusco N, Adams R, Redline R, Faulhaber P, Dowlati A. Radiochemotherapy plus 3-aminopyridine-2-carboxaldehyde thiosemicarbazone (3-AP, NSC #663249) in advanced-stage cervical and vaginal cancers. Gynecol Oncol 2013; 130:75-80. [PMID: 23603372 PMCID: PMC4260802 DOI: 10.1016/j.ygyno.2013.04.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 04/09/2013] [Accepted: 04/12/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cervical and vaginal cancers have virally-mediated or mutated defects in DNA damage repair responses, making these cancers sensible targets for ribonucleotide reductase inhibition during radiochemotherapy. METHODS We conducted a phase II study evaluating 3× weekly 2-hour intravenous 3-aminopyridine-2-carboxaldehyde thiosemicarbazone (3-AP, 25 mg/m(2)) co-administered with 1× weekly intravenous cisplatin (40 mg/m(2)) and daily pelvic radiation (45 Gy) in women with stage I(B2)-IV(B) cervical (n=22) or stage II-IV vaginal (n=3) cancers. Brachytherapy followed (40 Gy). Toxicity was monitored by common terminology criteria for adverse events (version 3.0). The primary end point of response was assessed by 3-month posttherapy 2-[(18)F] fluoro-2-deoxy-d-glucose positron emission tomography (PET/CT) and clinical examination. RESULTS 3-AP radiochemotherapy achieved clinical responses in 24 (96% [95% confidence interval: 80-99%]) of 25 patients (median follow-up 20 months, range 2-35 months). 23 (96% [95% confidence interval: 80-99%]) of 24 patients had 3-month posttherapy PET/CT scans that recorded metabolic activity in the cervix or vagina equal or less than that of the cardiac blood pool, suggesting complete metabolic responses. The most frequent 3-AP radiochemotherapy-related adverse events included fatigue, nausea, diarrhea, and reversible hematological and electrolyte abnormalities. CONCLUSIONS The addition of 3-AP to cisplatin radiochemotherapy was tolerable and produced high rates of clinical and metabolic responses in women with cervical and vaginal cancers. Future randomized phase II and III clinical trials of 3-AP radiochemotherapy are warranted.
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Affiliation(s)
- Charles A Kunos
- Department of Radiation Oncology, CASE Comprehensive Cancer Center, University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States.
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20
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Jiménez-Vieyra CR, Quintana-Romero V, Aguilera-Maldonado LV, Solís-Moreno TK. [Case report. Aggressive angiomyxoma of vagina. A rare tumor diagnosed]. Ginecol Obstet Mex 2013; 81:403-408. [PMID: 23971387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The case of a female patient of 35 years of age, with a pedunculated tumor dependent of the vagina, of approximately 25 x 12 x 8 cm, who had a wide resection. The report was consistent with myxoid aggressive angiomyxoma. This is a myxoid mesenchymal neoplasm of slow growth, which mainly appears in deep soft tissues of the pelvic, genital or perineal areas of adult women. It is usually diagnosed after surgical resection by histopathologic examination. Routine evaluation includes: complete physical examination, imaging and pathology report of diagnostic confirmation.
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Affiliation(s)
- Carlos Ramón Jiménez-Vieyra
- Hospital Victor Manuel Espinosa de los Reyes Sánchez, Institute Mexicano del Seguro Social (IMSS), México DF
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21
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Abstract
Background It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT) or concurrent chemoradiation therapy (CRT). Methods Seventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS) and disease-free survival (DFS) rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed. Results The median age at diagnosis was 61 years (range, 18–92 years) and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011). Twenty-three patients (45%) in the RT group had a relapse at any site compared to 3 (15%) in the CRT group (p = 0.027). With regard to the sites of first relapse, 10 patients (14%) had local only, 4 (6%) had local and regional, 9 (13%) had regional only, 1 (1%) had regional and distant, and 2 (3%) had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10–0.97; p = 0.04)). Conclusions Vaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients.
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Affiliation(s)
- David T. Miyamoto
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Akila N. Viswanathan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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Liu Q, Yang J, Tao T, Cao D, Shen K. The clinical features and treatment of endodermal sinus tumor of vagina. Eur J Obstet Gynecol Reprod Biol 2012; 165:130-1. [PMID: 22819272 DOI: 10.1016/j.ejogrb.2012.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 06/13/2012] [Accepted: 06/30/2012] [Indexed: 11/28/2022]
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Tao T, Yang J, Cao D, Guo L, Chen J, Lang J, Shen K. Conservative treatment and long-term follow up of endodermal sinus tumor of the vagina. Gynecol Oncol 2012; 125:358-61. [PMID: 22178761 DOI: 10.1016/j.ygyno.2011.12.430] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/03/2011] [Accepted: 12/08/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Tao Tao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences & Peking Union Medical College, People's Republic of China
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Yoshida K, Ueda M, Yamazaki H, Takenaka T, Yoshida M, Miyake S, Yoshida S, Koizumi M, Ban C, Tanaka E. Interstitial brachytherapy using virtual planning and Doppler transrectal ultrasonography guidance for internal iliac lymph node metastasis. J Radiat Res 2012; 53:154-158. [PMID: 22240939 DOI: 10.1269/jrr.11142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
To expand the indications for high-dose-rate interstitial brachytherapy (HDR-ISBT) for deep-seated pelvic tumors, we investigated the usefulness of Doppler transrectal ultrasonography (TRUS) guidance and virtual planning. The patient was a 36-year-old female. She had right internal iliac lymph node oligometastasis of vaginal cancer 12 months after radical radiotherapy. The tumor could not be found by gray-scale TRUS and physical examination. Virtual planning was performed using computed tomography with template and vaginal cylinder insertion. We uploaded the images to our treatment planning software and reconstructed the contours of the clinical target volume (CTV) and right internal iliac vessel. Virtual needle applicators were plotted using the template holes for virtual planning. At the time of implantation, Doppler TRUS was used to prevent vessel injury by needle applicators. Applicators were implanted in accordance with virtual planning and Doppler TRUS could detect the right iliac vessel. The percentage of CTV covered by the prescribed dose was 99.8%. The minimum dose received by the maximally irradiated 0.1-cc volume for the right internal iliac vessel was 95% prescribed dose. Complete response was achieved, however, radiological findings showed marginal recurrence at 15 months after HDR-ISBT. Post-radiation neuropathy occurred as a late complication four months after treatment; however, the pain was well controlled by medication. We consider that virtual planning and Doppler TRUS are effective methods in cases where it is difficult to detect the tumor by physical examination and gray-scale TRUS, thereby expanding the indications for ISBT.
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Affiliation(s)
- Ken Yoshida
- Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Japan.
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25
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Affiliation(s)
- Maha Arafah
- Department of Histopathology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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26
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Guastafierro S, Tedeschi A, Criscuolo C, Celentano M, Cobellis L, Rossiello R, Falcone U. Primary extranodal non-Hodgkin's lymphoma of the vagina: a case report and a review of the literature. Acta Haematol 2012; 128:33-8. [PMID: 22584110 DOI: 10.1159/000337336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/12/2012] [Indexed: 11/19/2022]
Abstract
Primary lymphoma of the female genital tract is very rare. We report the case of a 36-year-old woman who was referred to our hospital because of an indeterminate Pap smear test. The colposcopy showed a thickening of the posterior vaginal wall and various irregular ulcerated nodular lesions. Histological examination, immunohistochemistry and the staging procedures were conclusive of diffuse large B-cell lymphoma of the vagina, stage IEA. Complete remission was achieved after 6 cycles of immunopolychemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). No relapse has occurred during a follow-up of 71 months. Moreover, we reviewed the 62 previously reported cases of primary extranodal non-Hodgkin's lymphoma of the vagina, focusing on clinicopathological and therapeutic aspects, to better characterize this unusual disease.
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Abstract
We report on an infant, aged four months, suffering from a severe hemangioma of the left labium majus. We induced systemic treatment with propranolol in off-label-use over a period of 5 1/2 months. A few weeks after onset of the treatment, the size and color of hemangioma was obviously reduced; finally there was an almost complete regression. This result underlines the role of propranolol in treatment of problematic hemangioma.
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Affiliation(s)
- J Baetz
- Hautklinik des Universitätsklinikums Düsseldorf, Düsseldorf
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Cagayan MSFS. Vaginal metastases complicating gestational trophoblastic neoplasia. J Reprod Med 2010; 55:229-235. [PMID: 20626179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the clinical experience and outcomes of patients with gestational trophoblastic neoplasia (GTN) complicated by vaginal metastases. STUDY DESIGN A retrospective descriptive study of patients with vaginal metastases from GTN treated at the University of the Philippines-Philippine General Hospital (UP-PGH) Trophoblastic Disease Section from 1998 to 2008. RESULTS Vaginal metastases were present in 46 (11%) of the 424 patients treated for GTN. The majority of the patients (69.6%) were stage III, 19.6% were stage II and 10.9% were stage IV. Thirty-six patients (78.3%) were high-risk patients with World Health Organization scores of > 7. Eleven patients (24%) had bleeding vaginal lesions on initial consultation, and transfusion of packed red blood cells was necessary in all of these patients. Interventions to control bleeding included vaginal packing with methotrexate solution (5/11 or 46%), ligation of bleeders with bilateral internal iliac artery ligation (4/11 or 36%), over sewing of bleeding vaginal lesions (2/11 or 18%), ligation of vaginal bleeders (3/11 or 27%), vaginal packing only (6/11 or 54%), methotrexate infiltration of vaginal mass (1/11 or 9%) and external beam radiation (1/11 or 9%). Of the 37 patients who were given chemotherapy, 26 (70%) had complete remission. CONCLUSION Prognosis with vaginal metastasis mainly depends on disease extent. Favorable response to chemotherapy was observed in low-risk patients with pretreatment hCG of < 100,000 mIU/mL and metastases confined to the vagina and/or pelvic area only.
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Affiliation(s)
- Ma Stephanie Fay S Cagayan
- Department of Pharmacology and Toxicology, Section of Trophoblastic Diseases, College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila, Philippines 1000.
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Aggarwal S, Goel G, Banerji N, Khullar H. Sustained complete remission with taxane-based chemotherapy in stage IVB primary vaginal squamous cell carcinoma. Hematol Oncol Stem Cell Ther 2010; 2:362-3. [PMID: 20118062 DOI: 10.1016/s1658-3876(09)50027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shyam Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
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Nasu K, Kai K, Matsumoto H, Mori C, Takai N, Narahara H. Primary mucinous adenocarcinoma of the vagina. EUR J GYNAECOL ONCOL 2010; 31:679-681. [PMID: 21319516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Primary mucinous adenocarcinoma of the vagina is a rare disease which is characterized by aggressiveness and poor prognosis because of its rapid growth and recurrence, its frequent distant metastases, and its relative resistance to conventional treatment modalities including surgery, radiotherapy, and chemotherapy. We report a case of advanced stage primary mucinous adenocarcinoma of the vagina that showed a highly aggressive course and resistance to combination chemotherapy with paclitaxel and carboplatin. CASE A 46-year-old multigravid Japanese woman was admitted to our hospital to be treated for Stage IVb primary mucinous adenocarcinoma of the vagina. She had no history of in utero exposure to diethylstilbestrol. She was treated by two courses of neoadjuvant chemotherapy with tri-weekly paclitaxel and carboplatin, which were not effective. Subsequently, total pelvic exenteration with pelvic lymphadenectomy was performed. However, the disease progressed rapidly and the patient died five months after the initial treatment. CONCLUSION Because of its rarity, little is known about the behavior of primary mucinous adenocarcinoma of the vagina. Additional data about patients with this rare tumor should be collected and analyzed in an attempt to elucidate its prognostic factors, characteristics, optimal treatment, and outcome.
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Affiliation(s)
- K Nasu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.
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Giordano G, Bersiga A, Marchetti G, Melpignano M. Primary adenocarcinoma of the rectovaginal septum arising in pregnancy in the absence of endometriosis. EUR J GYNAECOL ONCOL 2010; 31:211-213. [PMID: 20527244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A case of primary adenocarcinoma of the rectovaginal septum (PARVS) is reported with clinical and pathological findings. A 37-year-old Caucasian woman with a history of sterility and small posterior leiomyoma, a few months after a cesarean section, was admitted because of vaginal spotting, abdominal pain and constipation. Her previous history did not reveal exposure to diethylstil bestrol (DES). Pelvic computed tomography showed a heterogeneous pelvic mass in the Douglas pouch, measuring 9 cm in diameter, located in the rectovaginal septum, involving the rectal and vaginal wall. Histological examination of neoplastic tissue revealed solid sheet structures, occasional tubular lumen, extensive necrotic areas and clear cells. The neoplastic elements showed immunoreactivity for Mullerian markers (cytokeratin 7, CA-125 and vimentin). Because, the present case of PARVS cannot be due to DES exposure, the clear appearance of the neoplastic elements could represent only one differentiation of Mullerian rests. Moreover, because no foci of endometriosis were identified in several sections of the neoplasm, uterine and cervical wall, and tissues nearby the neoplasm could represent a rare subtype of PARVS arising in the absence of endometriosis.
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Affiliation(s)
- G Giordano
- Department of Pathology and Medicine of Laboratory, Section of Pathology, Parma University, Italy.
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Ferrari S, Persico P, Di Puppo F, Giardina P, Ferrari A. Laparoscopic lateral ovarian transposition: a fertility sparing procedure. Minerva Ginecol 2009; 61:465-468. [PMID: 19749679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article reports the case of a 30-year-old woman who, in 2003, had diffuse large B-cell lymphoma of the left vaginal fornix, associated with sclerosis. After six chemoimmunotherapy cycles the patient underwent a laparoscopic procedure for lateral ovarian transposition to spare ovarian function before radiotherapy. Six months after the transposition the evaluation of ovarian function was performed. The hypothalamic-pituitary-ovary axis was normal. Three years after radiation therapy (2006) the patient spontaneously conceived. Her pregnancy proceeded regularly. She had an uneventful vaginal delivery. Lateral ovarian transposition with tubal anatomy preservation, which is an underused technique, can be successfully used to spare ovarian function in women who undergo pelvic radiotherapy and to let them achieve spontaneous pregnancy.
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MESH Headings
- Adult
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Female
- Humans
- Hypothalamo-Hypophyseal System/physiology
- Infant, Newborn
- Infertility, Female/etiology
- Infertility, Female/prevention & control
- Laparoscopy/methods
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Ovary/transplantation
- Pregnancy
- Radiotherapy/adverse effects
- Rituximab
- Transplantation, Heterotopic
- Vaginal Neoplasms/drug therapy
- Vaginal Neoplasms/radiotherapy
- Vincristine/administration & dosage
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Affiliation(s)
- S Ferrari
- Obstetrics and Gynecology Department, Vita-Salute University, San Raffaele Hospital, Milan, Italy. stefano.ferrari@ fastwebnet.it
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Buzdar SA, Gadhi MA, Rao MA, Laghari NA, Anees M. Verification of computerized treatment planning for HDR 192Ir brachytherapy for gynaecological cancer. J PAK MED ASSOC 2009; 59:113-115. [PMID: 19260579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Treatment planning in both teletherapy and brachytherapy is time consuming practice but accurate determination of planning parameters is more important. This paper aims to verify the dose delivery time for the treatment of vaginal cancer, which is a vital parameter of High Dose Rate (HDR) brachytherapy treatment planning. Treatment time has been calculated by the computerized treatment planning system (ABACUS 3.1), and then it has been compared with the manually calculated time. The results obtained are in good agreement. Independent verification of nominal time by two different protocols assures the quality of treatment. This should always be practiced to increase the accuracy of treatment.
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Batashki I, Amaliev I, Markova D, Amaliev G, Milchev N. [Ovarian cancer with metastatic lesion in the vagina (foetus papiraceus)]. Akush Ginekol (Sofiia) 2009; 48:49-51. [PMID: 20198766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ovarian cancer spreads primarily by intraperitoneal implantation of exfoliated cancer cells, by lymphatic dissemination, and by haematogenous spread. Very rarely it metastasizes to cervix, vulva and vagina; this type of metastases present a diagnostic challenge to the gynecologist and pathologist. We present a case of ovarian cancer with initial clinical manifestation-lesion of the vagina.
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Thoms J, Berendt R, Pearcey R. A young woman with distant recurrent metastatic primary vaginal carcinoma salvaged with radical radiotherapy. Oncology (Williston Park) 2008; 22:1143-1146. [PMID: 18935926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The incidence of distant recurrent metastatic primary vaginal carcinoma is rare. The prognosis in such cases is poor, with cure being extremely rare. We report the case of a young woman, with distant recurrent metastatic primary vaginal carcinoma in which the patient remains disease-free 5 years after completing salvage radical radiotherapy. The clinical management of recurrent metastatic primary vaginal carcinoma must be tailored to the site of recurrence and the patient's performance status. Complete clinical remission and long-term survival without evidence of disease may be achieved in rare cases with radical radiotherapy.
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Affiliation(s)
- John Thoms
- Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.
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Samant R, Lau B, E C, Le T, Tam T. Primary Vaginal Cancer Treated With Concurrent Chemoradiation Using Cis-Platinum. Int J Radiat Oncol Biol Phys 2007; 69:746-50. [PMID: 17512130 DOI: 10.1016/j.ijrobp.2007.04.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 03/30/2007] [Accepted: 04/11/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the feasibility of concurrent weekly Cis-platinum chemoradiation (CRT) in the curative treatment of primary vaginal cancer. METHODS A retrospective review was performed of all primary vaginal cancer patients treated with curative intent at the Ottawa Hospital Regional Cancer Centre between 1999 and 2004 using concurrent Cis-platinum CRT. RESULTS Twelve patients were treated with concurrent weekly CRT. The median age at diagnosis was 56 years (range, 34-69 years), and the median follow-up was 50 months (range, 11-75 months). Ten patients (83%) were diagnosed with squamous cell carcinoma and 2 patients (17%) with adenocarcinoma. The distribution according to stage was as follows: 6 (50%) Stage II, 4 (33%) Stage III, and 2 (17%) Stage IVA. All patients received pelvic external beam radiotherapy (EBRT) concurrently with weekly intravenous Cis-platinum chemotherapy (40 mg/m(2)) followed by brachytherapy (BT). The median dose of EBRT was 4500 cGy given in 25 fractions over 5 weeks. Ten patients received interstitial BT, and 2 patients received intracavitary BT, with the median dose being 3000 cGy. The 5-year overall survival, progression-free survival, and locoregional progression-free survival rates were 66%, 75%, and 92%, respectively. Late toxicity requiring surgery occurred in 2 patients (17%). CONCLUSIONS For the treatment of primary vaginal cancer, it is feasible to deliver concurrent weekly Cis-platinum chemotherapy with high-dose radiation, leading to excellent local control and an acceptable toxicity profile.
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Affiliation(s)
- Rajiv Samant
- Department of Radiation Oncology, Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada.
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Abstract
A 12-year-old, entire, nulliparous crossbreed female dog was presented with a history of vulval bleeding, bulging of the perineum and faecal tenesmus. A firm, non-painful perineal mass, measuring 9.11x5.4 cm, with erythema was detected. Abdominal radiography showed compression and elevation of the rectal ampulla. A dose of 10 mg/kg aglepristone was administered subcutaneously on days 1, 2, 8, 15, 28 and 35. An incision biopsy was taken on day 15 and immunohistochemical analysis showed that the majority of neoplastic cells expressed progesterone receptors. Both the cutaneous erythema and the faecal tenesmus had resolved by day 28. A 50 per cent reduction in size was observed by day 60 (surgical excision). This study shows that benign tumours of the vagina of the dog that contain progesterone receptors can be reduced in size in a palliative or neoadjuvant setting using the progesterone receptor antagonist aglepristone.
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Affiliation(s)
- E Rollón
- Small Animal Clinic Canymar, c/Granja de San Ildefonso 5, 11007, Cádiz, Spain
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Abstract
BACKGROUND Involvement of the vaginal mucosa in pemphigus vulgaris is a rare occurrence. Here we report an original case that resulted in discovery of intra-epithelial neoplasia at the same site. PATIENTS AND METHODS A 63 year-old woman was followed for 18 years for pemphigus vulgaris treated with prednisone, initially in combination with azathioprine. An erosive lesion was discovered in the pouch of Douglas during routine gynecological examination and demonstrated the histological features of pemphigus, despite remission of the disease at other sites. In spite of resumption of azathioprine and prednisone, the vaginal lesion continued to spread. A further biopsy revealed intra-epithelial vaginal neoplasia together with images of suprabasal cleavage and acantholysis. Surgical removal was carried out. DISCUSSION Intra-epithelial carcinoma associated with pemphigus vulgaris has been described in rare cases in the cervix but never in the vagina.
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Affiliation(s)
- F Hoareau
- Service de Dermatologie, CHU d'Angers
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Zakashansky K, Peiretti M, Mahdavi A, Chun JK, Nezhat F. Combined laparoscopic and radical vaginal treatment of primary vaginal leiomyosarcoma in a patient with unicornuate uterus and pelvic kidney. J Minim Invasive Gynecol 2007; 14:518-20. [PMID: 17630176 DOI: 10.1016/j.jmig.2007.01.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2006] [Revised: 01/21/2007] [Accepted: 01/28/2007] [Indexed: 11/27/2022]
Abstract
We report a case of primary vaginal leiomyosarcoma occurring in a patient with a unicornuate uterus and pelvic kidney. The patient was treated with radical partial vaginectomy, unilateral groin dissection, total laparoscopic hysterectomy, and left pelvic laparoscopic lymphadenectomy, followed by adjuvant chemotherapy. Twenty-five months after her original procedure, the patient is alive and free of disease. The exact association between müllerian anomalies and primary malignancies of the genitourinary tract is unclear. It is nonetheless important to be aware of the close embryonic association between the genital and urinary tracts when evaluating such patients and choosing the appropriate surgical and therapeutic approach.
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Affiliation(s)
- Konstantin Zakashansky
- Division of Gynecologic Oncology and Minimally Invasive Surgery, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York 10029, USA
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Abstract
Malignant germ cell tumors of the vagina represent a critical site for local treatment. We report on our experience with two vaginal endodermal sinus tumors. Treatment with PEB regimen induced both tumor regression and alpha fetoprotein normalization. One patient had a residual lesion that was biopsied twice and no viable tumor cells were ever found. Both patients remained alive and disease-free, without having had surgical procedures except for biopsies. Platinum-based chemotherapy is able to achieve complete remissions and should be considered for vaginal endodermal sinus tumors.
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Abstract
Malignant melanoma of the vagina is a very rare neoplasm and resistant to conventional radiotherapy. We report a case of vaginal malignant melanoma that was locally well controlled by carbon ion radiotherapy. A 55-year-old postmenopausal woman presented with abnormal vaginal bleeding. On pelvic and imaging examinations, an irregular mass of the posterior vaginal wall sized 7.5 x 5 x 5 cm, an enlarged right inguinal lymph node, and two lung metastases were observed. Histologic diagnosis based on positive immunostaining for HMB-45 was malignant melanoma. She received dacarbazine-based chemotherapy and carbon ion radiotherapy for vaginal and inguinal tumor sites with 57.6 Gy equivalent dose per 16 fractions using five ports. Six months later, she was also given carbon ion radiotherapy for regrowing lung metastasis with 52.8 Gy equivalent dose per four fractions using four ports. She died 19 months after initial treatment due to brain metastases. The primary irradiated tumor disappeared completely 12 months after initial treatment. The vaginal tumor, right inguinal lymph node, and lung tumor treated with carbon ion radiotherapy did not show any evidence of recurrence until her death. Carbon ion radiotherapy may be of value for vaginal malignant melanoma as a conservative approach.
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Affiliation(s)
- T Ohno
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
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McBee WC, Brainard J, Sawady J, Rose PG. Yolk sac tumor of the ovary associated with endometrioid carcinoma with metastasis to the vagina: A case report. Gynecol Oncol 2007; 105:244-7. [PMID: 17316775 DOI: 10.1016/j.ygyno.2006.07.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Revised: 07/07/2006] [Accepted: 07/16/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mixed yolk sac tumors of the ovary are biologically aggressive even in early stage disease. CASE A 41-year-old woman presented with a large pelvic mass and anterior vaginal wall tumor. At surgery vaginal biopsies were performed followed by an exploratory laparotomy with resection of the mass. Pathology of the ovary revealed a primary yolk sac tumor associated with poorly differentiated endometrioid and undifferentiated carcinoma with vaginal metastasis only. She was initiated on bleomycin, etoposide, and cisplatin, with three additional cycles of etoposide and cisplatin. Initially the patient experienced a complete response, however her disease recurred and she currently is dead of her disease. CONCLUSION To our knowledge this is the first case of a mixed ovarian germ cell tumor with vaginal metastasis.
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Affiliation(s)
- William C McBee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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Abstract
Endodermal sinus tumor (EST) of the vagina is a rare malignancy usually diagnosed before 3 years of age. Historically, the approach to therapy has included radical surgical resection, with adjuvant irradiation, and chemotherapy. An infant presented with vaginal bleeding, imaging evidence of a vaginal mass and an elevated alpha-fetoprotein level. Examination under anesthesia with vaginal biopsies confirmed the diagnosis of an EST (yolk sac) tumor of the vagina. After 5 cycles of chemotherapy, the alpha-fetoprotein had normalized and repeat vaginal biopsies for suspected residual disease was negative for malignancy. To allow preservation of sexual and reproductive function, chemotherapy as a sole modality of treatment for EST should be considered.
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Affiliation(s)
- Judith Lacy
- Division of Pediatric and Adolescent Gynecology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Godbole P, Outram A, Wilcox DT, Duffy PG, Sebire NJ. Myogenin and desmin immunohistochemistry in the assessment of post-chemotherapy genitourinary embryonal rhabdomyosarcoma: prognostic and management implications. J Urol 2006; 176:1751-4. [PMID: 16945640 DOI: 10.1016/j.juro.2006.03.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE Posttreatment genitourinary embryonal rhabdomyosarcoma often shows well differentiated rhabdomyoblasts, which are detectable on routine histological staining. Definite areas of residual undifferentiated rhabdomyosarcoma indicate residual/recurrent disease. However, the recent use of immunohistochemical staining with desmin and myogenin in resected specimens and surveillance biopsies following adjuvant therapy may demonstrate scant positive staining cells that appear undifferentiated on light microscopy. To our knowledge the clinical significance of this finding is currently unknown. Therefore, we reviewed our retrospective experience with genitourinary embryonal rhabdomyosarcoma to examine the relationship between immunostain positive undifferentiated cells and subsequent clinical outcome. MATERIALS AND METHODS A total of 14 children with a median age of 2.75 years (range 8 months to 7 years) with genitourinary embryonal rhabdomyosarcoma were identified in the histopathology database. All had biopsy confirmation of the diagnosis, followed by multi-agent chemotherapy. Two children in whom there was obvious residual active tumor at the resection margins were excluded from further analysis. Histopathological findings in all patients on the resection/posttreatment biopsy were reviewed. All specimens were immunostained with desmin and myogenin to detect residual undifferentiated rhabdomyoblasts. The relation between histopathological findings and outcome was determined. RESULTS There were 14 cases of genitourinary embryonal rhabdomyosarcoma. In 2 cases (14%) residual embryonal tumor was pathologically confirmed following initial treatment. In 12 cases no obvious residual tumor was present following initial therapy. Rhabdomyosarcoma affected the bladder in 10 cases and the vagina in 2. There were no distant metastases in any child. Ten patients underwent local resection following chemotherapy and 2 underwent followup biopsies only without resection. A total of 11 cases showed well differentiated, posttreatment rhabdomyoblasts that was identifiable on routine hematoxylin and eosin staining with margins apparently free of tumor and 1 showed no morphological evidence of residual rhabdomyosarcoma. However, all cases demonstrated at least scant abnormal desmin and myogenin positive cells in the specimens. Four patients had no further treatment and none had clinical recurrence. All were well 10 years (range 8 to 13) after treatment. Eight patients received further treatment (chemotherapy and/or radiotherapy) based on clinical and pathological findings, followed by further resection in 3. One patient died of disease but 7 were well a median of 7.2 years (range 8 months to 13 years) after treatment. CONCLUSIONS The significance of undifferentiated myogenin/desmin positive cells in genitourinary embryonal rhabdomyosarcoma in the absence of morphological residual/recurrent embryonal rhabdomyosarcoma remains unclear since such cells can be detected in all cases of posttreatment embryonal rhabdomyosarcoma. In some cases findings are associated with clinical disease recurrence, while others with identical histopathological findings following initial treatment have no clinical sequelae even in the absence of further treatment. In genitourinary embryonal rhabdomyosarcoma close and regular clinical surveillance is essential. Desmin/myogenin immunohistochemistry to detect scattered undifferentiated cells does not appear to provide useful prognostic information.
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Affiliation(s)
- P Godbole
- Department of Paediatric Urology, Great Ormond Street Hospital for Children, London, United Kingdom.
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Shinkoda Y, Tanaka S, Ijichi O, Yoshikawa H, Nonaka Y, Tanabe T, Nishikawa T, Ishikawa S, Okamoto Y, Kaji T, Tahara H, Takamatsu H, Nagata K, Kawano Y. Successful treatment of an endodermal sinus tumor of the vagina by chemotherapy alone: a rare case of an infant diagnosed by pathological examination of discharged tumor fragment. Pediatr Hematol Oncol 2006; 23:563-9. [PMID: 16928651 DOI: 10.1080/08880010600856972] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 7-month-old infant was noted to have vaginal bleeding that was accompanied by a discharged tumor fragment. The histological diagnosis was endodermal sinus tumor. Her serum alpha-fetoprotein (AFP) was increased to 358.7 ng/mL, and magnetic resonance imaging showed a 1.8 x 1.0 cm tumor in the vagina. She received combination chemotherapy with cyclophosphamide, pirarubicin, carboplatin, and etoposide. The tumor in the images disappeared and the serum level of AFP returned to the normal range after 2 cycles. Treatment was complete without surgical or radiological therapy. More than 45 months after the completion of chemotherapy, she is alive without signs of recurrence.
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Affiliation(s)
- Yuichi Shinkoda
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Abstract
We present a unique case of a neuroendocrine syndrome in a patient with Stage IV vaginal melanoma metastatic to the liver that was successfully palliated with octreotide. Similar to the carcinoid syndrome, the patient exhibited chronic diaphoresis, intermittent low-grade fevers, dizziness, nausea with vomiting, and hot flashes. The symptoms on admission of acute hypotension, acute exacerbation of abdominal pains, and intractable nausea with vomiting suggested a neuroendocrine crisis secondary to massive degranulation and hormone release. Consistent with our hypothesis, her plasma chromogranin A was found to be elevated. Octreotide was used successfully to palliate her symptoms. When the octreotide was stopped, all her symptoms returned. As the use of octreotide is gaining application in palliative care, this case highlights the effectiveness of its use in a select group of patients whose symptoms would be otherwise difficult to manage.
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Affiliation(s)
- Alexander W Jahng
- Department of Medicine, University of California at Irvine Medical Center, Orange, California 92868, USA
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Salvatierra A, Tarrats A, Gomez C, Sastre JM, Balaña C. A case of c-kit positive high-grade stromal endometrial sarcoma responding to Imatinib Mesylate. Gynecol Oncol 2006; 101:545-7. [PMID: 16487996 DOI: 10.1016/j.ygyno.2006.01.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 12/16/2005] [Accepted: 01/03/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND High-grade endometrial stromal sarcoma (HGES) is an aggressive disease with dismal prognosis. Surgery is the standard treatment, and radiotherapy seems to reduce local relapse. No other treatment has proved to be useful in the case of non-resectable diseases. CASE A 41-year-old woman suffering HGES, with positive staining for CD117 (c-kit) and large abdominal and retroperitoneal mass progressing after chemotherapy, was treated with Imatinib Mesylate. After 3 months, objective response was documented and radical surgery performed. Two years after surgical intervention, she is currently free of the disease. CONCLUSION The response seen with Imatinib should be further investigated in a larger number of cases.
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Affiliation(s)
- Alejandro Salvatierra
- Medical Oncology Service, Institut Català d'Oncologia, Germans Trias i Pujol, Carretera Canyet s/n, 08916 Badalona, Barcelona, Spain
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Lin A, Ryu J, Harvey D, Sieracki B, Scudder S, Wun T. Low-dose warfarin does not decrease the rate of thrombosis in patients with cervix and vulvo-vaginal cancer treated with chemotherapy, radiation, and erythropoeitin. Gynecol Oncol 2006; 102:98-102. [PMID: 16406065 DOI: 10.1016/j.ygyno.2005.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 10/26/2005] [Accepted: 11/18/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We had previously reported an association between the use of recombinant human erythropoietin (rHuEPO) and thrombosis in patients with cervix and vulvo-vaginal cancer treated with chemotherapy and radiation. We hypothesized that low-dose warfarin would be effective prevention for thromboembolic events in this setting. METHODS A retrospective analysis of patients with cervical or vulvo-vaginal carcinoma receiving chemoradiation and rHuEpo was performed. Thirty-two patients received rHuEpo alone, and 24 received warfarin (1-2 mg) and rHuEpo. The primary endpoint was objectively proven symptomatic venous thrombosis. RESULTS There was no difference in the baseline characteristics (e.g. age, stage, body mass index, mean and peak hemoglobin, WBC and platelet counts, and number of transfusions) between these two groups. The rate of thrombosis also was not statistically different (P = 0.62). Nine of 24 patients had a symptomatic deep vein thrombosis (DVT) while receiving warfarin compared to 10 of 32 patients not on warfarin. There was no difference between the two groups in the percentage of patients with upper extremity DVT (P = 0.83) or lower extremity DVT (P = 0.64). CONCLUSION Daily low-dose warfarin did not alter the incidence of symptomatic DVT in patients with cervical or vulvo-vaginal cancer who received rHuEpo in conjunction with chemoradiation.
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Affiliation(s)
- Amy Lin
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA
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Novoa Vargas A, Grados García C, Bustillos de Cima R, Malagón Millán B. [Vagina cancer in a young woman exposed to diethylstilbestrol: case report and literature review]. Ginecol Obstet Mex 2005; 73:666-73. [PMID: 16583845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We analyzed a 20 year-old patient case exposed in utero to diethylstilbestrol, as probably predisposed factor in vaginal cancer. The histopathological report of the incisional biopsy was clear cell vaginal adenocarcinoma, stage III, widespread to the pelvic wall, with metastasis to regional lymph nodes, and lack of distant metastasis. We decided surgical management: protocolized laparotomy, peritoneal washing, retroperitoneal node biopsies and a radical hysterectomy, Piver III, with two thirds parts of vagina. By poor prognosis we decided to offer an adjuvant management, with systemic chemotherapy.
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Lin H, Huang EY, Chang HY, ChangChien CC. Therapeutic Effect of Topical Applications of Trichloroacetic Acid for Vaginal Intraepithelial Neoplasia after Hysterectomy. Jpn J Clin Oncol 2005; 35:651-4. [PMID: 16275678 DOI: 10.1093/jjco/hyi176] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We attempted to evaluate the therapeutic effect of trichloroacetic acid (TCA) for vaginal intraepithelial neoplasia (VaIN) after hysterectomy and to identify factors affecting persistence/recurrence. METHODS Twenty-eight post-hysterectomy patients with various grades of VaIN were enrolled in this study between January 2001 and December 2003. They were managed with intravaginal 50% TCA once weekly for 1-4 weeks, and all patients were followed up every 3 months for at least 1 year. Assessments by Papanicolaou smear and colposcopy were performed, as was biopsy when indicated during the follow-up period. Cox regression analysis was used to identify independent factors predicting persistence/recurrence. RESULTS In 20 of 28 patients (71.4%) VaIN went into remission. Treatment success was observed in all 11 patients with VaIN I, whereas only 9 out of 17 patients (53%) with VaIN II/III went into remission (P = 0.009). Severity of VaIN was the only significant independent predictor of persistence/recurrence (odds ratio = 3.5; 95% confidence interval = 1.1, 11.6; P = 0.038). The treatment was well tolerated with no major side effects. CONCLUSIONS Based on our findings, 50% TCA was a potential agent with minimal side effects for low-grade VaIN. Further prospective controlled study is warranted to verify our statements. However, as for high-grade lesions, further investigation with different TCA concentration is compelling.
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Affiliation(s)
- Hao Lin
- Department of Obstetrics and Gynecology, Chung Gung Memorial Hospital, Kaohsiung, Taiwan.
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