[Balneological treatment of pruritus vulvae, kraurosis vulvae and leuloplakia vulvae].
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Adult↗
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Diseases of vulva. Classification and incidence of 877 patients seen consecutively in vulva clinic.
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Female↗
Relation of lichen sclerosus et atrophicus of the vulva to development of carcinoma.
One hundred and seven patients with lichen sclerosus et atrophicus (LS&A) of the vulva were studies to determine the malignant potential of the LS&A. Five patients had coexisting invasive carcinoma of the vulva or perineum with the LS&A, and 1 patient had coexisting intraepithelial vulvar carcinoma on the clitoris. None of these, however, was known to have LS&A prior to the biopsy for carcinoma of the vulva. The high association of carcinoma and LS*A is probably a result of selection of 2 unusual lesions sent for consultation and evaluation. Squamous hyperplasia in the vulva occurred in association with LS&A in 37 (35%) patients, but only 6 patients had areas of dysplasia coexisting with LS&A. These areas of dysplasia, like the 5 invasive carcinomas, occurred in an area of the vulva where the LS&A was minimal or absent. Follow-up data were obtained on 92 patients with LS&A. Only 1 developed carcinoma of the vulva, which occurred 12 years after identification of the LS&A. When carcinoma arises in the vulva in a patient with vulvar LS&A, it tends to arise in areas of minomal LS&A or isolated areas of relatively normal vulvar skin. This study did not provide evidence of carcinoma arising from LS&A. Five of the 92 patients developed 6 malignant neoplasms in other sites, including carcinoma of the endometrium (3 patients), lung (1 patient), and simultaneous carcinomas of the colon and cervix (1 patient).
Adolescent↗
Human papillomavirus coinfections of the vulva and uterine cervix.
DNA filter in situ hybridisation (FISH) was used to determine the presence of human papillomavirus (HPV) genotypes 6/11, 16/18, and 31/33 in cell scrapes of the cervix and vulva of 128 women who had precancerous lesions and/or HPV infection of the cervix diagnosed by cytology, colposcopy, and histology. HPV-DNA was found in 87 (68%) vulval and 95 (74%) cervical cell scrapes, and in both the vulval and cervical scrapes of 73 (57%) women, but not in either the vulva or the cervix of 19 women (15%). Of the HPV-DNA-positive smears, the prevalence of the HPV types was 61% HPV 16/18, 14% HPV 6/11, 3% HPV 31/33, and 22% HPV 6/11 and 16/18. By contrast, HPV-DNA was not detected in the cervical smears of a control group of 35 women who were assessed to be free of cervical abnormalities by colposcopy and cytology. The epithelial response of the vulva and the cervix to application of 5% acetic acid was assessed by colposcopy and the results correlated with the presence of HPV genotypes. A possible or definite disorder of the cervix and vulva was detected by colposcopy in 95 (74%) and 96 (75%) of the 128 cases, respectively. The colposcopic assessment of the vulva was inconclusive in ten cases (8%), and only eight women (6%) were found to be free of both a vulval and cervical disorder. This study shows subclinical papillomavirus infections of the vulva frequently coexist with HPV infections and precancerous lesions of the cervix.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Paget's disease of the vulva.
Thirty-six patients with Paget's disease of the vulva were reviewed. Median age of the patients at diagnosis was 64 years (range 41-84 years). Five patients (14%) had an associated invasive adenocarcinoma of the vulva at the time of diagnosis. Of 31 patients with superficial noninvasive Paget's disease, 28 were available for follow-up. Treatment of patients with superficial Paget's disease was surgical and based on the extent of disease. Procedures performed included total vulvectomy (25), wide local excision (4), and skinning vulvectomy with skin graft (1). The median follow-up was 108 months (range 6-266 months). Twenty-two of twenty-eight patients remained free of disease. Six patients have required multiple procedures for recurrent superficial Paget's disease. Treatment of Paget's disease of the vulva is surgical. Radical surgery is the preferred treatment of patients with an associated invasive adenocarcinoma; three of five patients with an invasive adenocarcinoma were long-term survivors. Patients with superficial Paget's disease of the vulva should be treated by local excision utilizing frozen-section margin evaluation as a guide to extent of excision. Only one patient with an initial diagnosis of superficial Paget's disease of the vulva developed invasive adenocarcinoma.
Adenocarcinoma↗
[A case of Paget's disease of the vulva with bladder metastasis].
A very rare case of bladder metastasis of the Paget's disease of the vulva is reported. A 83-year-old woman first experienced an eczematoid eruption on the vulva 12 years earlier. It was diagnosed as Paget's disease of the vulva and treated with radiation 8 years earlier. In March, 1985 a biopsy of the vulva revealed a recurrence of Paget's disease. In August, 1986 she had a sudden attack of left flank pain. The excretory urogram showed bilateral hydronephrosis and transurethral echogram of the bladder demonstrated large nodular tumors of the bladder. Transurethral biopsies of the bladder revealed Paget's disease. Total cystourethrectomy with bilateral ureterocutaneostomy and wide skin excision of the vulva with skin transplantation were performed. The pathological specimen showed several yellowish-white nodular tumors of the bladder, which obstructed both ureteral orifices. Microscopically typical Paget's cells were seen, some of which were stained with PAS before and after amylase and with alcian blue. Postoperatively she developed a severe complication of necrosis of the small intestine due to thrombosis of superior mesenteric artery and died of panperitonitis on the 55th postoperative day. Related reports were also reviewed.
Aged↗
Abnormalities of lymphocyte transformations in women with intraepithelial carcinoma of the vulva.
Cellular immunity of the delayed type in women with intraepithelial carcinoma (carcinoma is situ) of the vulva was investigated by an in vitro assay of mitogen-induced lymphocyte transformations. Test results from 9 patients were compared to those of 23 age-matched control subjects. Lymphocyte transformation responses in counts per minute were significantly lower for women with carcinoma in situ of the vulva than for control subjects for phytohemagglutinin-P (at 50 microgram/ml) 6238 and 28,102 (P less than 0.0001); for phytohemagglutinin-P (at 165 microgram/ml 7222 and 21,417 (P less than 0.001); for concanavallin A, 14,988 and 41,888 (P less than 0.0001); and pokeweed mitogen, 20,861 and 49,601 (P less than 0.001). No significant differences in lymphocyte transformations were noted between these two groups to the specific antigens, Candida or streptokinase-streptodornase. Four patients with carcinoma in situ of the vulva were also found to have intraepithelial carcinoma of the cervix and/or vegina. The occurrence and clinical course of carcinoma in situ of the vulva in some women may be related to an underlying defect in cellular immunity. Immunosuppression may also explain the frequent association noted between carcinoma of the vulva and the development of other malignant neoplasms.
Adolescent↗
Quantitative microbiology of human vulva.
The microbial flora of the vulva is described and compared with the flora of the forearm by utilizing the detergent scrub method. Microbial counts were higher on the vulva (2.8 x 10(6)/cm2) than on the forearm (6.4 x 10(2)/cm2). Lipophilic diphtheroids, coagulase negative staphylococci, micrococci, non-lipophilic diphtheroids and lactobacilli formed the dominant flora of the vulva. Streptococci, Gram negative rods and yeasts were also noted. The highest incidence of S. aureus was noted on the vulva (67%) followed by perianal (30%), nose (30%), and the forearm (11%).
Adult↗
Adenosquamous carcinoma of skin appendages (adenoid squamous cell carcinoma, pseudoglandular squamous cell carcinoma, adenocanthoma of sweat gland of Lever) of the vulva: a clinical and ultrastructural study.
History and clinical findings of 18 cases of adenosquamous carcinoma of the skin appendages found among 135 cases of primary carcinoma of the vulva seen at the University of Minnesota Hospital between 1951 and 1970 were analyzed. In addition, two recent cases of this tumor were studied with conventional transmission electron microscopy. Adenosquamous carcinoma of the vulva showed poorer survival and a higher rate of lymph node metastases than squamous cell carcinoma of the corresponding stages (carcinoma in situ excluded). In four out of thirteen cases, the metastatic lesions in the lymph nodes retained glandular pattern. The ultrastructure showed mucin-producing columnar cells lining glandular lumina, and poorly differentiated squamous cells elsewhere; further, cells of the intermediate type between the two were present. This study indicates that adenosquamous carcinoma of the vulva is a distinctively separate entity from squamous cell carcinoma of the vulva, and possibly arises from mucin-producing cells of the skin appendages as suggested by Johnson and Helwig.
Adenocarcinoma↗
Multifocal invasive carcinoma of the vulva in a 25-year-old woman with Bowenoid papulosis.
This case report documents malignant progression associated with wart virus infection of the vulva in a 25-year-old female. The initial condition of Bowenoid papulosis and carcinoma in situ of the vulva was diagnosed on colposcopic biopsies performed to investigate chronic pruritus and superficial dyspareunia. This condition failed to resolve with local ablative therapy and progressed over a period of 8 months to multifocal invasive carcinoma of the vulva requiring radical surgery. Deoxyribonucleic acid hybridization studies on the operative specimen revealed the presence of human papilloma virus type 16. The role of human papilloma virus in the aetiology of Bowenoid papulosis and neoplasia of the vulva is discussed.
Adult↗
[Koilocytosis in precancerous conditions and cancer of the vulva].
The incidences of combination of koilocytosis and dysplasias of squamous epithelium of skin-mucous integument of vulva in 120 patients with kraurosis and leukoplakia and 166 patients with carcinoma of external genitalia (at the distance of 3-4 cm from the tumour) are studied. Vulva tissue of 100 women of the same age dying from non-tumourous conditions served as control. The increase of the koilocytosis incidence was observed at various stages of carcinogenesis (slight dysplasia--mild dysplasia--severe dysplasia--preinvasive carcinoma). koilocytes are not found in the invasive carcinoma. It is suggested to consider koilocytosis as one of additional morphologic signs of the risk of vulva carcinoma. The disappearance of koilocytes which are markers of the viral cell alteration in invasive carcinomas allows one to regard a viral damage of the vulva epithelium as one of the cocarcinogenic influences responsible for the development of squamous cell carcinoma.
Epithelium↗
Pre-neoplastic lesions of the vulva.
Preneoplastic lesions of the vulva have to be considered lesions "at risk" of facilitating the occurrence of invasive vulvar cancer. The Author examines the two categories of lesions commonly considered at risk for invasive epidermoid carcinoma of the vulva, carcinoma in situ and vulvar dystrophies. Carcinoma in situ of the vulva is characterized by an extreme clinical diversity contrasting with a remarkable uniformity of histologic pattern. The author describes two different clinical patterns, the young female type and the post-menopausal type. According to the new virologic progress, three conclusions may be drawn: 1) Oncogenic HPV is the common aetiology of all the carcinomas in situ of the vulva, whatever the clinical type; 2) Oncogenic HPV may directly induce any type of carcinoma in situ; 3) Oncogenic HPV possesses a very special carcinogenic effect with a long period of ascending trophism. Among the dystrophies, the hyperplastic one is the most at risk. The Author discusses the real autonomy of this entity. He concludes that hyperplastic dystrophy per se does not exist and it is always a mixed dystrophy.
Bowen's Disease↗
[A clinicopathological study of 11 patients with Paget's disease of the vulva].
A clinicopathological analysis of 11 patients with Paget's disease of the vulva was reported. A close association of this disease with cancer was strongly suggested in the histological examination. Nine of 11 patients had wide primary lesion; 4 patients had coexisting undifferentiated carcinoma (one patient with in situ sweat gland carcinoma) and one patient had squamous cell carcinoma in other lesion of the vulva. Five patients had downward growth of the tumor from the epidermis proper. There were, thus, only two patients who had Paget's cells confined within the epidermis. Three patients died of generalized metastasis of carcinoma and two patients had vulvar recurrence. The results of staining for PAS, PAS diastase resistant reaction, alcian blue, mucicarmin and carcinoembryonic antigen (CEA) were all positive in specimens with similar stainings to coexisting undifferentiated carcinoma of the vulva and metastasized lesions. CEA staining was positive in cytoplasm of Paget's cells and basal cells widely in the epidermis. It could be considered that the Paget's cells of the vulva originated multifocally from primitive stratum germinativum, which gave rise to the surface epithelium as well as all of the dermal appendages.
Aged↗
[Cytologic diagnosis of Paget's disease of the vulva].
Unlike exfoliative cytology for detection of cervical neoplasia and its precursors, the cytologic detection of invasive and intraepithelial neoplasia of the vulva still presents some problems. In cases of Paget's disease of the vulva--a special form of intraepithelial neoplasia with typical histological features--primary cytologic diagnosis is possible. The cytologic criteria that led to preoperative detection are demonstrated on two cases of Paget's disease of the vulva. However, a Paget carcinoma has still to be excluded histologically.
Aged↗
[Dystrophy and precancerous changes in the vulva: symptoms, histology and therapy].
The article reports about the relatively rare diseases kraurosis vulvae (lichen sclerosus et atrophicus) and leucoplakia vulvae and the symptoms, aetiology, histology and therapy of these diseases. Both diseases are considered to be a "dystrophy" since 1976, by international convention. This publication is a report on 168 patients treated during the last 20 years (1964-1983). 34 patients suffered from diabetes mellitus (21%); 73.2% of the women were aged between the 61st and 90th year of life. 15 women already had an incipient vulvar carcinoma besides kraurosis (8.9%). Precancerous alterations, such as morbus Bowen (29 cases), morbus Paget of the vulva (6 cases), and erythroplasia of Queyrat are subsequently discussed.
Adult↗
Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group.
Although cure rates are high, the morbidity of radical operation for carcinoma of the vulva is substantial. Between 1983-1989, member institutions of the Gynecologic Oncology Group entered 155 patients in a prospective evaluation of modified radical hemivulvectomy and ipsilateral inguinal lymphadenecctomy for clinical stage I vulvar cancer. Only patients with neoplastic thickness of 5 mm or less, without vascular space invasion, and negative inguinal lymph nodes were eligible for this study. There have been 19 recurrences and seven deaths from disease among the 121 eligible and evaluable patients. Patients whose disease recurred on the vulva were frequently (eight of ten patients) salvaged by further operation. Five of the seven deaths due to cancer occurred among patients whose first recurrence was in the groin. Acute and long-term morbidity as well as hospital stay were each less than in the Group's previous experience in a comparable patient population treated with radical vulvectomy and bilateral inguinal-femoral lymphadenectomy. There was a significantly increased risk of recurrence but not death when compared with these same historic controls. Modified radical hemivulvectomy and ipsilateral inguinal lymphadenectomy is an alternative to traditional radical operation for these selected patients with stage I carcinoma of the vulva. The number of patients who experienced recurrence in the operated groin is of concern and may be attributable to the decision to leave the femoral nodes intact.
Adult↗
Microbiology of specialized skin: the vulva.
Human vulvar skin is an example of specialized skin. This is not only true for its gross and microscopic anatomy and physiology, but also for its microbiology. To the microbiologist, the vulva consists of several distinct ecotopes. These are defined by the physical factors, especially occlusion, nutrient factors, and by the close proximity to the vagina, the urethra, and the anus, which may result in contamination with the flora typical for those sites. Of the vulva ecotopes, only the labia majora have been seriously studied. The microbial flora of the labia majora is characterized by a high density of microorganisms, as is typical for occluded areas of the body, by the presence of organisms common for intertriginous skin such as gram-negative rods, and by the carriage of organisms unique for the vulva and probably related to urethral and vaginal flora such as the nonpathogenic neisseria, lactobacilli, and Gardnerella vaginalis. Finally, the labia majora skin is a preferred site of Staphylococcus aureus carriage that can be of clinical and epidemiological relevance.
Female↗
Adhesion of Corynebacterium pilosum by pili to epithelial cells of bovine vulva.
Piliated (P+) and nonpiliated (P-) clones of Corynebacterium pilosum were selected, and their adhesion to the epithelial cells of the bovine vulva and vaginal vestibule was examined. The number of P+ bacteria of C pilosum that adhered to vulval epithelial cells was greater than that of P- bacteria. The adhesion of P+ bacteria, but not P- bacteria, to the epithelial cells was inhibited by the antipilus antiserum; therefore, the adhesion of C pilosum to the epithelial cells of the vulva was primarily dependent on the pili. The number of C pilosum that adhered to the epithelial cells of the bovine vulva and of the vaginal vestibule increased by decreasing the pH.
Adhesiveness↗