Carcinoma of the vulva

Carcinoma of the vulva is best evaluated by a definite protocol investigating patient evaluation, therapy, and follow-up. The histologic type of the cancer, initial lesion size, and the presence or absence of regional lymph node metastasis proved to be important parameters in overall survival. The primary treatment is surgical and should be extensive enough to remove the lesion. Inoperable patients are those with bony metastasis or those with metastasis outside the pelvis. Survival in invasive cancer is 91.7% when the lesion is less than 3 cm in diameter and regional lymph nodes are negative. Overall survival is 65% in invasive lesions and 95% in intraepithelial cancer. Cosmetic and functional results are good. Lifetime follow-up is important with a continued search for second primary malignancy.     

Carcinoma of the vulva

The objective of this review is to summarize the published data about squamous carcinoma of the vulva and to identify promising areas for future investigation. Rather than the routine use of complete radical vulvectomy, a radical wide excision of the vulvar lesion to achieve at least a 1-cm gross margin appears sufficient to treat the primary lesion. A surgical assessment of the groin is required for all patients who have invasion greater than 1 mm. Ipsilateral groin node dissection can be performed through a separate incision. All the nodal tissue medial to the vessels and above the fascia should be removed. Sentinel node evaluation may be a significant step forward, but the false-negative rate is not well enough defined to consider this a standard. Patients with positive inguinal nodes at groin dissection should receive radiation therapy to the ipsilateral groin and hemipelvis. For those patients who have unresectable primary disease or if nodes are palpably suspicious, fixed, and/or ulcerated preoperatively, chemoradiation is the preferred option. Exenterative procedures may rarely be required. Chemotherapy for recurrent or metastatic disease has not been proven to be of value. Although survival rates are high for those with negative nodes, the morbidity associated with standard radical techniques has prompted innovation. Adequately powered trials aimed at further reducing morbidity without compromising survival are underway.     

Malignant tumors involving the vulva

Of the 37 cases seen by us, operation was not recommended in 3 patients because of metastatic lesions to bone or lung found on routine x-ray study of the skeleton and lungs. Needless to say, such studies are essential in all cases of malignancy. In 2 cases considered resectable as a result of clinical and x-ray studies, at the time of operation, unexpected metastases were found to involve the psoas muscle or other retroperitoneal soft tissues and precluded any possibility of extensive resection, including eviscerectomy. One patient refused surgery. All, except one patient in whom resection was attempted only one week ago, failed to survive more than four months (Table VII).

7. Foolow-up. Total cases, 37

     

9.

Carcinoma of the vulva.   总被引：1，自引：0，他引：1  

M P Hopkins  J Nemunaitis-Keller 《Obstetrics and Gynecology Clinics of North America》2001,28(4):791-804

Vulvar cancer will probably become a more common disease as the population ages. It is primarily a disease of the elderly. Fortunately, most vulvar cancers remain localized for extended periods of time and can be treated adequately with radical surgery.     

10.

Non-Hodgkin's lymphoma involving the vulva.     

R Vang  L J Medeiros  A Malpica  C Levenback  M Deavers 《International journal of gynecological pathology》2000,19(3):236-242

Non-Hodgkin's lymphomas (NHL) involving the vulva are rare. We report the clinicopathologic and immunohistochemical findings of six cases of vulvar NHL. The age of the patients ranged from 43 to 71 years (mean 60 years), and 5 presented with a vulvar mass. Two patients had neoplasms localized to the vulva, and two patients had a history of NHL that secondarily involved the vulva; in another patient the stage was unknown, and the sixth patient had stage IVA mycosis fungoides/Sezary syndrome involving the vulva. Each tumor was classified according to the revised European-American classification of lymphoid neoplasms: four were diffuse large B-cell lymphoma, one was peripheral T-cell lymphoma, and one was mycosis fungoides/Sezary syndrome. Two patients were treated with chemotherapy and radiotherapy, one patient received chemotherapy and phototherapy, one patient was treated with chemotherapy, and in two patients the treatment is unknown. Clinical follow-up, available for 4 cases, ranged from 7 months to 5 years. One patient with low-stage NHL responded to therapy, but relapsed and died of disease 2 years later. Two patients with generalized NHL that secondarily involved the vulva died of disease 7 months and 5 years, respectively, after the diagnosis of vulvar involvement was established. The patient with mycosis fungoides/Sezary syndrome is alive with disease at 4 years. The three patients in this study who died and our review of the literature indicate that NHL involving the vulva is usually an aggressive disease.     

11.

Carcinoma in situ of the vulva   总被引：1，自引：0，他引：1  

J D Woodruff 《Clinical obstetrics and gynecology》1991,34(3):669-676

     

12.

Carcinoma in situ of the vulva     

J D Woodruff 《Clinical obstetrics and gynecology》1985,28(1):230-239

     

13.

Carcinoma in situ of the vulva     

WOODRUFF JD  HILDEBRANDT EE 《Obstetrics and gynecology》1958,12(4):414-424

     

14.

Carcinoma basocelular de vulva     

María del Mar Martín Moya  Fátima Amaya Navarro  María del Mar Berenguel Ibáñez  Aurora Carrillo Lopera  Gabriel Fiol Ruiz 《Progresos de Obstetricia y Ginecología》2014

Basal cell carcinoma of the vulva is a rare entity and there are few publications on this topic. We therefore decided to report a case of this tumor and to review the literature on its prevalence, clinical features, treatment, and prognosis.     

15.

Carcinoma of the vulva in pregnancy.     

T Ghosh  P J Banfield 《Journal of obstetrics and gynaecology》2004,24(6):702-703

     

16.

Benign skin diseases affecting the vulva     

《Obstetrics, Gynaecology and Reproductive Medicine》2019,29(9):264-270

Vulval skin disease is common in gynaecological practice. This review aims to enhance clinical skills in patient assessment, vulval examination and treatment of common benign vulval skin disease illustrated through cases. Although simple treatments are often beneficial (e.g. use of emollients and topical steroids), many patients have complex disease and can present with more than one condition and therefore careful assessment and an individualised management approach is essential. Understanding of when to refer onwards to a vulval specialist service is important to optimise clinical outcomes. Clinical outcomes to consider for all patients with vulval skin disease should include: (i) a reduction in symptoms (e.g. less itch, fewer flare-ups) (ii) an improvement in function (e.g. sexual function, mobility); and (iii) increased confidence in self-management (e.g. management of flare-ups and self-examination).     

17.

Carcinoma of the vulva; treatment and prognosis     

McKELVEY JL 《Obstetrics and gynecology》1955,5(4):452-455

     

18.

Techniques and results in the management of anal and perianal Crohn's disease   总被引：12，自引：0，他引：12  

R D Fry  E I Shemesh  I J Kodner  A Timmcke 《Surgery, gynecology & obstetrics》1989,168(1):42-48

We reviewed our experience with 73 patients who had Crohn's disease and underwent local anorectal surgical procedures for perianal suppurative disease during a ten year period. All but one of these patients had intestinal granulomatous disease. The average length of follow-up study was 4.6 years. By using conservative, local anorectal surgical procedures and intensive medical treatment, we were able to establish adequate drainage of abscesses, reduce the inflammatory process and relieve symptoms. Extensive drainage procedures were avoided to preserve the anal sphincter. A sliding endorectal flap repair provided satisfactory results for rectovaginal fistulas and anterior anal fistulas. Proctectomy was eventually necessary in nine patients, the primary indication being severe perianal disease in five. By performing complete excision of the perineal disease at the time of proctectomy, we were able to achieve primary healing of the perineal wound in eight of these patients. Patients were classified according to five categories of results: healed after initial local treatment, eight patients; healed after more than one local treatment, 30 patients; incomplete healing with acceptable condition, 17 patients; healed after fecal diversion, nine patients, and required proctectomy, nine patients. The majority of patients with Crohn's disease and anal and perianal suppurative disease can be managed by meticulous drainage of sepsis and preservation of the anal sphincter.     

19.

Carcinoma of the vulva in pregnancy. Case report     

M. S. RAHMAN Associate Professor  J. RAHMAN Assistant Professor  M. H. AL-SIBAI Assistant Professor  S. A. AL-SULEIMAN Assistant Professor 《BJOG : an international journal of obstetrics and gynaecology》1982,89(3):244-246

     

20.

Carcinoma of the vulva: epidemiology and pathogenesis.     

C P Crum 《Obstetrics and gynecology》1992,79(3):448-454

Vulvar squamous carcinoma is an uncommon neoplasm that afflicts a spectrum of women and has been associated with granulomatous vulvar diseases, human papillomaviruses (HPVs), and chronic inflammatory disorders of the vulva. This review summarizes the epidemiologic, histopathologic, and viral data supporting the division of invasive vulvar carcinomas into distinct subsets. Although HPVs have received attention as etiologic agents, histopathologic and viral data indicate that a substantial proportion of vulvar carcinomas in this country may not be related to a veneareally transmitted agent. One of the principal challenges is to produce studies integrating the various disciplines in order to place HPV in proper perspective and develop strategies to identify women at risk for vulvar carcinomas that are not associated with this virus.     

Refused surgery	1	Died in 1 month
No therapy, surgery not advised due to	3	Died, 4 months, 2 months,
metastasis to bone or lung		1 month, respectively
Surgery attempted, not completed due to	2	(1) Died 1 month
distant metastasis, nonresectable		(1) Living 1 week
Resectable, surgery completed	31

Carcinoma of the vulva.

Vulvar cancer will probably become a more common disease as the population ages. It is primarily a disease of the elderly. Fortunately, most vulvar cancers remain localized for extended periods of time and can be treated adequately with radical surgery.     

Non-Hodgkin's lymphoma involving the vulva.

Non-Hodgkin's lymphomas (NHL) involving the vulva are rare. We report the clinicopathologic and immunohistochemical findings of six cases of vulvar NHL. The age of the patients ranged from 43 to 71 years (mean 60 years), and 5 presented with a vulvar mass. Two patients had neoplasms localized to the vulva, and two patients had a history of NHL that secondarily involved the vulva; in another patient the stage was unknown, and the sixth patient had stage IVA mycosis fungoides/Sezary syndrome involving the vulva. Each tumor was classified according to the revised European-American classification of lymphoid neoplasms: four were diffuse large B-cell lymphoma, one was peripheral T-cell lymphoma, and one was mycosis fungoides/Sezary syndrome. Two patients were treated with chemotherapy and radiotherapy, one patient received chemotherapy and phototherapy, one patient was treated with chemotherapy, and in two patients the treatment is unknown. Clinical follow-up, available for 4 cases, ranged from 7 months to 5 years. One patient with low-stage NHL responded to therapy, but relapsed and died of disease 2 years later. Two patients with generalized NHL that secondarily involved the vulva died of disease 7 months and 5 years, respectively, after the diagnosis of vulvar involvement was established. The patient with mycosis fungoides/Sezary syndrome is alive with disease at 4 years. The three patients in this study who died and our review of the literature indicate that NHL involving the vulva is usually an aggressive disease.     

Carcinoma basocelular de vulva

Basal cell carcinoma of the vulva is a rare entity and there are few publications on this topic. We therefore decided to report a case of this tumor and to review the literature on its prevalence, clinical features, treatment, and prognosis.     

Benign skin diseases affecting the vulva

Vulval skin disease is common in gynaecological practice. This review aims to enhance clinical skills in patient assessment, vulval examination and treatment of common benign vulval skin disease illustrated through cases. Although simple treatments are often beneficial (e.g. use of emollients and topical steroids), many patients have complex disease and can present with more than one condition and therefore careful assessment and an individualised management approach is essential. Understanding of when to refer onwards to a vulval specialist service is important to optimise clinical outcomes. Clinical outcomes to consider for all patients with vulval skin disease should include: (i) a reduction in symptoms (e.g. less itch, fewer flare-ups) (ii) an improvement in function (e.g. sexual function, mobility); and (iii) increased confidence in self-management (e.g. management of flare-ups and self-examination).     

Techniques and results in the management of anal and perianal Crohn's disease

We reviewed our experience with 73 patients who had Crohn's disease and underwent local anorectal surgical procedures for perianal suppurative disease during a ten year period. All but one of these patients had intestinal granulomatous disease. The average length of follow-up study was 4.6 years. By using conservative, local anorectal surgical procedures and intensive medical treatment, we were able to establish adequate drainage of abscesses, reduce the inflammatory process and relieve symptoms. Extensive drainage procedures were avoided to preserve the anal sphincter. A sliding endorectal flap repair provided satisfactory results for rectovaginal fistulas and anterior anal fistulas. Proctectomy was eventually necessary in nine patients, the primary indication being severe perianal disease in five. By performing complete excision of the perineal disease at the time of proctectomy, we were able to achieve primary healing of the perineal wound in eight of these patients. Patients were classified according to five categories of results: healed after initial local treatment, eight patients; healed after more than one local treatment, 30 patients; incomplete healing with acceptable condition, 17 patients; healed after fecal diversion, nine patients, and required proctectomy, nine patients. The majority of patients with Crohn's disease and anal and perianal suppurative disease can be managed by meticulous drainage of sepsis and preservation of the anal sphincter.     

Carcinoma of the vulva: epidemiology and pathogenesis.

Vulvar squamous carcinoma is an uncommon neoplasm that afflicts a spectrum of women and has been associated with granulomatous vulvar diseases, human papillomaviruses (HPVs), and chronic inflammatory disorders of the vulva. This review summarizes the epidemiologic, histopathologic, and viral data supporting the division of invasive vulvar carcinomas into distinct subsets. Although HPVs have received attention as etiologic agents, histopathologic and viral data indicate that a substantial proportion of vulvar carcinomas in this country may not be related to a veneareally transmitted agent. One of the principal challenges is to produce studies integrating the various disciplines in order to place HPV in proper perspective and develop strategies to identify women at risk for vulvar carcinomas that are not associated with this virus.