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At least 19 recordsLinked to original sources
PubMed1991

[Results of different forms of therapy in vulvar neoplasms].

In this retrospective study 216 patients who have been treated for malignant vulva neoplasms between the years 1968 and 1987 at the Department of Obstetrics and Gynaecology of the University of Kiel are reviewed. Staging according to the Figo-Classification revealed stage I in 13.0%, stage II in 63.0%, stage III in 20.2% and stage IV in 3.8%. During these years treatments applied to these elderly patients often with multimorbidity, aside from the combined treatment according to Berven (27.9%) was in the majority of cases a modified radical treatment (34.1%). The modified radical treatment consisted primarily of simple vulvectomy and tumor excision followed by radiation therapy. Primary radiation therapy was performed in the cases where either local or general noperabilityx was established (29.3%). The 5-years-survival rate of the investigated patients was 31.7%, whereby radical vulvectomy which was performed in a few cases offered the best results. A comparison between the modified radical therapy and the combined therapy according to Berven resulted in equally divided staging groups similar 5-years-survival rates of 39% and 38% respectively. However, the modified radical therapy group demonstrated better results in the first 4 years. Within the modified radical treatment group patients undergoing simple vulvectomy revealed a better survival rate after 3 years than did patients undergoing tumor excision followed by radiation therapy. The long term results of these two modes of modified treatment equal out over 10 years. Therefore, from the results presented we recommend in the case of elderly patients with multimorbidity the modified radical therapy via simple vulvectomy.

Aged↗
PubMed1978

[Electroresection and electrocoagulation as therapy for vulvar neoplasms].

A survey of the results attained by the most prominent authors of the individual therapy methods is given. After electro-resection and -coagulation of the vulvar tumor followed by roentgen or telecobalt irradiation, patients are almost without pain. The primary mortality in 332 patients was 1,5% (= 5 cases) because lymphonodectomy was performed in only 66 cases (20%). The period of hospitalization lasts about four weeks and cosmetic healing is excellent. This therapy method can also be recommended for largely extended tumors as lack of local symptoms can be achieved up to 97%. Of the 332 patients treated at our hospital, almost equal numbers of patients were seen with carcinoma stage I and II and stage III and IV. In stage I and II (negative lymph nodes) 74,5% and in stage III and IV (positive lymph nodes) 38,4% were cured. 80% were aged between 61 and 90 years. In spite of this negative selection of patients which was also combined with the intercurrent mortality rate of 13% (= 43 cases), 193 of the 332 patients or 58,1% survived five years or longer. In the last five years the survival rate was even 62,2%. A survey of the results obtained by electrocoagulation in the last 30 years is given. Especially the enormous increase of high risks as diabetes (42,2%) and the great number of over-aged patients (83,3%) are emphasized.

Aged↗
PubMed1977

[Vulvar neoplasms and preoperative lymphography].

20 patients with histologically verified carcinoma of the vulva fulfilled the following conditions: general operability, preoperative lymphography, radical vulvectomy with inguinal lymph node resection and histological examination of all lymph nodes. It was studied how far the preoperative lymphography plays a role for the strategy of operative treatment of carcinoma of the vulva and eventually in the limitation of risks of operative treatment. A survey of the lymphatic drainage of the vulva underlines the importance of the knowledge of the lymphatic pathways for the operation and for the lymphography as performed in this hospital since 1972. The results suggest that lymphography shows an unacceptable high number of false-negative results in cases of metastatic involvement of the inguinal nodes (7 out of 10 cases), whereas it is reliable for the judgment of the iliac and paraaortal nodes. For this reason the resection of the inguinal nodes remains a necessary part of radical vulvectomy. The additional removal of intrapelvic lymph nodes has been restricted to patients with lymphographic signs of positive nodes. In our opinion preoperative lymphography is of considerable value to minimize the operative risk for patients with carcinoma of the vulva by means of a more precise preoperative diagnosis, stage-oriented therapy and postoperative control.

Aged↗
PubMed1991

Conservative surgery in vulvar-vaginal neoplasias and fertility. 3 clinical cases.

In this article we present three clinical cases of patients affected by vulvar neoplasm. Since the patients were very young when the disease was diagnosed, we decided for a conservative treatment. All patients underwent a surgical non-mutilant therapy which guaranteed a surgical radicality and, at the same time allowed them a normal reproductive life. Later all patients conceived and their pregnancies developed physiologically till the end. One patient died 23 years later; the two other are still alive and disease-free.

Adenocarcinoma↗
PubMed1988

The predominance of human papillomavirus type 16 in vulvar neoplasia.

Southern transfer analysis for human papillomavirus genomic sequences was conducted on 152 vulvar and vaginal tissue specimens obtained from 86 patients. Histopathologic diagnoses included condyloma acuminatum, intraepithelial neoplasia, and invasive cancer. In six patients, lesions of more than one pathologic type were identified. Vaginal lesions constituted less than 5% of tissues examined. Distribution of lesions was as follows: condyloma, 93 lesions from 57 patients; intraepithelial neoplasia, 47 lesions from 29 patients; and invasive carcinoma, 12 lesions from six patients. Seventy-five percent of the patients were white. The mean age of the patients increased from 25 years for condyloma to 38 years for vulvar intraepithelial neoplasia III to 56 years for invasive cancer. A viral diagnosis was made in 81% of condylomas, 84% of vulvar intraepithelial neoplasia III, and 58% of invasive carcinomas. Distribution of viral types differed markedly for the various histopathologies. Types 6/11 accounted for 77% of condylomas and 0% of vulvar intraepithelial neoplasia III. Type 16 was recovered from 12% of condylomas and 81% of vulvar intraepithelial neoplasia III. Type 18 was identified in a small proportion in both categories; type 31 was seen in a few vulvar intraepithelial neoplasia III lesions. In invasive carcinomas, type 16 was the predominantly identified virus. Papillomavirus type 16 emerges as the dominant oncogenic virus in vulvar neoplasms. Its presence in a large percentage of condylomas raises the issue of an "atypical condyloma" as a precursor of neoplasia.

Adult↗
PubMed1992

Paget's disease and melanoma of the vulva. Use of a panel of monoclonal antibodies to identify cell type and to microscopically define adequacy of surgical margins.

The ability of a panel of monoclonal antibodies generated in this laboratory to identify "pagetoid" melanoma cells and distinguish them from true Paget's adenocarcinoma cells in a retrospective analysis of vulvar neoplasms was investigated. Paraffin blocks of formalin and Carnoy's fixed tissue from 15 cases of vulvar Paget's disease and 11 cases of primary vulvar melanoma were retrieved and sections were incubated with the following panel of monoclonal antibodies: HMB45, a melanoma-specific monoclonal antibody; and 35 beta H11 and 34 beta E12, two different anti-cytokeratin monoclonal antibodies, to low molecular and high molecular weight cytokeratins, respectively. The anti-melanoma monoclonal antibody (HMB45) positively identified the melanoma cells, distinguishing them from normal melanocytes, in all 11 cases of melanoma. In contrast, the HMB45 antibody failed to react with the intraepithelial neoplastic cells in all cases of Paget's disease. These latter malignant cells were strongly positive only with the monoclonal anti-low molecular weight cytokeratin antibody 35 beta H11. This latter antibody absolutely distinguished tumor cells from neighboring uninvolved squamous epithelium, which was positive only with the monoclonal antibody 34 beta E12. Using this panel of monoclonal antibodies, the surgical margins could also be better evaluated; in at least one case the surgical margin thought by histological evaluation to be free of tumor was demonstrated by immunocytochemistry to be positive for tumor. In the vulvectomy specimens obtained in both diseases, Paget's or melanoma cells were identified in sections histologically interpreted as free of tumor. Thus, a panel of monoclonal antibodies is able to identify, with high sensitivity and specificity, vulvar melanoma cells and absolutely distinguish them from vulvar Paget's cells and can help in evaluating surgical margins in a more accurate manner.

Antibodies, Monoclonal↗
PubMed1989

Malignant rhabdoid tumor of the vulva: is distinction from epithelioid sarcoma possible? A pathologic and immunohistochemical study.

Epithelioid sarcoma (ES) and malignant rhabdoid tumor (MRT) have heretofore been regarded as two separate clinicopathologic entities. However, they have some histologic similarities, and both represent histogenetic and phenotypic enigmas. This study reports the pathologic and immunohistochemical findings of four vulvar neoplasms occurring in young women that represented diagnostic dilemmas because of their similarity to both ES and MRT. Only one case had the classic histologic features of ES, whereas, in our opinion, the other three cases fulfilled the histologic criteria of MRT, despite the fact that two of the three cases were reported earlier as examples of ES. Neither electron microscopy nor immunohistochemistry has been found to be helpful in separating ES from MRT, mainly because they share several ultrastructural and immunophenotypic features. The behavior of these vulvar tumors--ours and the few published examples of ES--is generally aggressive, more in keeping with MRT than classic ES. We believe that some, if not most, putative ES of the vulva are in fact MRT, a neoplasm with an unfavorable prognosis.

Adult↗
PubMed1992

Relationship between human papillomavirus infection and tumours of anogenital sites other than the cervix.

Although tissues in the case series of anal, penile, vaginal and vulvar neoplasms that have looked for evidence of HPV infection by probing for HPV DNA have been selected for convenience, they support the view that HPV, especially type 16, is associated with approximately 50% of these tumours. A higher percentage of the anal, vaginal and vulvar tumours are associated with HPV 16 than are penile tumours. This discrepancy may be due to the low number of penile tumours studied or to a true difference in the proportion of penile cancer cases related to HPV. HPV 6/11 and 18 are found less frequently at all anatomic sites. About 10% of tumours that are probed for these viruses are positive, although there are some notable exceptions such as a study that found 39% of penile tumours positive for type 18 and a study that found approximately two thirds of vulvar tumours positive for HPV 18 using Southern blot hybridization. For all of these tumours, there is likely to be a subset of the cases who develop their cancer through mechanisms that do not involve HPV. The case-control studies found a strong association with genital warts, number of sexual partners and, with the exception of vaginal cancer, smoking and/or heavy smoking at the time of diagnosis of the disease. A history of genital warts, smoking at diagnosis, and seropositivity to HSV2 are exposures that have also been found to be associated with cervical cancer. A population-based case-control study in western Washington and Vancouver, British Columbia that studied all anogenital cancers found that a history of genital warts was stronger among patients with vulvar, anal, vaginal and penile cancer than among those with cervical cancer. This was also true of smoking at diagnosis, with the exception of vaginal cancer, where there was little excess risk. This study and other supporting data indicate that these anogenital tumours share many of the same risk factors as cervical cancer.

Anus Neoplasms↗
PubMed1976

Current status of lymphography in patients with cancer.

In the early 1960's lymphography was received enthusiastically. Expectations were high that a very accurate diagnostic method for the detection of metastases had been found. This enthusiasm subsided after it became apparent that small lesions could not be discerned and that the images demonstrated were frequently nonspecific. Better correlation was achieved with advanced stages of cancer but because the presence of metastases was usually already known, it was questionable if the lymphogram contributed much to the management of the patient. In recent years, after the examination was placed in its proper prospective, the value and status of lymphography in patients with cancer were reassessed. The radiographic findings were divided into direct, or actual demonstration of metastastases, and indirect changes--those changes resulting from replacement of lymph nodes or blockage of the vessels by metastases. Lymphography proved particularly valuable in the diagnosis and staging of patients with pelvic cancer arising from such organs as cervix, uterus, vulva, ovary, and from tumors arising from the prostate, testicles, and penis. It also proved valuable in the assessment of extension of disease in melanomas of the extremities. The value of the positive lymphogram is easy to assess. However, when one encounters a "normal" lymphogram, one must realize that this does not exclude the presence of metastatic disease; it merely demonstrates that the the time of the study no lesions were recognized in visualized lymph nodes. Therefore, the negative lymphogram should not result in any modification of treatment which would have been prescribed under the same clinical circumstances if one did not have the lymphogram at hand.

Female↗
PubMed1976

Viruses and cancer of the lower genital tract.

The importance of viruses as oncogenic agents in animals is well established. Recent work suggests that viruses may also be etiologically related to some human cancers. Herpes simplex virus type 2 (HSV-2) and the genital wart virus are prime suspects in carcinomas involving the female lower genital tract. In particular, a close association has been found between HSV-2 infection and cervical neoplasia in cytohistopathologic and seroepidemiologic studies. Preliminary results of prospective studies show further that women with genital herpetic infection are at increased risk of developing cervical neoplasia. Additional studies are also in progress on animal models, including subhuman primates, and efforts continue in the attempt to confirm the presence of viral genetic material or its expression in human cervical cancer cells. The possibility that human wart viruses have an oncogenic potential is suggested by clinicopathologic and electron microscopic observations. Further research is needed to ascertain the precise role of viruses in genital cancer.

Adenoviridae↗
PubMed1976

Future prospects of radiotherapy in gynecologic oncology.

Major areas of progress in radiotherapy over the past decade have included important refinements in equipment and treatment techniques, as well as improved and expanded training programs for radiation oncologists. In 1975, approximately 14% of all new cancers were gynecologic, representing almost 68,000 new cases. Although end results in treatment of early cervix and corpus uteri lesions are quite good, results in treatment of early cervix and corpus uteri lesions are quite good, results in treatment of the later stage lesions, as well as ovarian and vulvo-vaginal tumors, are discouraging. Progress in the future will center around five primary areas: 1) greater understanding and utilization of radiation sensitizing agents such as hyperbaric oxygen, metronidazol, and other electroaffinic agents, purine and pyrimadine analogs, and antibiotics such as Actinomycin D and Adriamycin; 2) introduction into clinical use of high LET particle beams, such as fast neutrons, pi mesons, low atomic number nuclei, and heavy accelerated nuclei; 3) combined modality therapy utilizing radiation and chemotherapy or radiation and immunotherapy for management of subclinical disease; 4) radiobiologic and clinical advances in the utilization of radiation and hyperthermia; and 5) improved understanding of the pathophysiology and natural history of the gynecologic malignancies with increasing use of staging laparotomies, lymphangiography and peritoneoscopy.

Female↗
PubMed1977

Carcinoembryonic antigen in cancer of the female reproductive system. Serial plasma values correlated with disease state.

The results of plasma carcinoembryonic antigen (CEA) determinations done over 600 patients with gynecologic malignancy will be presented. It would appear from this extensive survey that the likelihood of a patient having a positive value is increased with advancing stage and bulk of disease. The incidence of positive values in patients with clinical recurrence is quite impressive and presents a possible mode of follow-up for patients after standard treatment techniques have been administered for cervical cancer. Most interesting is the effect of radiation therapy or surgery on squamous cell cancer of the cervix and vulva in patients who have a positive value of the onset. Treatment of the disease by either modality appears to be associated with a precipitous drop in plasma value of CEA. Unfortunately, the presence or absence of CEA is not reliable and to date it is impossible to predict which patients with gynecologic malignancy will manifest a positive plasma value. Comments will be made concerning retro-de-differentiation and de-repression as a mechanism for the production of this antigen in patients with gynecologic cancer.

Adenocarcinoma↗
PubMed1977

Extramammary Paget's disease of the vulva. A clinicopathologic study of 13 cases.

The clinicopathologic findings of 13 patients having extramammary Paget's disease of the vulva are discussed with emphasis on its histogenesis and biological behavior. For the purpose of study and assessment of prognosis, these cases were divided into two groups, those with an underlying invasive cutaneous adnexal adenocarcinoma, and those lacking an underlying invasive lesion. Four cases contained invasive cutaneous adnexal adenocarcinoma; in one of these the invasion was superficial. Three of the cases with an invasive lesion and three other cases showed in situ adenocarcinoma of sweat glands. Surgical treatment is mandatory for both groups of patients. The prognosis was excellent for the patients having Paget's disease without an underlying invasive carcinoma. From the literature, the prognosis of those with an underlying invasive carcinoma of the vulva appears to be less favorable. Multiple surgical excisions may be required to control the recurrences and metastases. A frequent association with other internal malignancy was observed. In four cases, second malignancies were found. Of special interest was the demonstration in one case of columns of neoplastic cells extending from involved sweat glands to the surface epithelium via the intradermal sweat duct. Our study leads us to support the concept that the Paget's cells, in a number of cases, are derived from an underlying carcinoma in situ of sweat gland origin.

Adenocarcinoma↗