Analysis of related factors of cervical intraepithelial neoplasia complicated with vaginal intraepithelial neoplasia

PurposeTo explore the underlying risk factors and to prevent misdiagnosis of cervical intraepithelial neoplasia (CIN) coexisted with vaginal intraepithelial neoplasia (VaIN).MethodsClinical data of patients pathologically diagnosed with CIN were collected from January 2017 to December 2018. A total of 446 cases were analyzed, including 406 cases of single lesions (‘CIN single’ group) and 40 cases complicated with VAIN (‘VAIN concurrent’ group).ResultsThe median age of the VAIN concurrent group was 53 years (46.25–59 years), and the median age of the CIN single group was 44 years (36–50 years). Regarding menopausal status, there were 28 cases (70.0%) in the VAIN concurrent group and 89 cases (21.9%) in the CIN single group (P < 0.005). The median load of high-risk human papillomavirus (Hr-HPV) in the VAIN concurrent and CIN single group was 923.4 relative light units/cutoff (RLU/CO) (145–2172.2 RLU/CO) and 229.155 RLU/CO (18.615–638.1275 RLU/CO), respectively (P = 0.037). The results revealed that the menopausal status was an independent risk factor for VAIN occurrence in CIN patients. The risk of VAIN in menopausal patients was higher than that in non-menopausal CIN patients (OR = 8.311, 95% CI 4.062–17.005). Age and HPV load were also related to the concurrence of VAIN and CIN.ConclusionExaminations regarding vaginal screening are of great importance in the diagnosis of perimenopausal and postmenopausal CIN patients, especially patients with Hr-HPV load. Colposcopy and tissue biopsy should also be performed, when necessary, to avoid misdiagnosis and the appearance of vaginal lesions.This is a preview of subscription content, access via your

Melanoma anal, una patología radicalmente distinta al melanoma cutáneo, con un pronóstico infausto / Anal melanoma, a radically different pathology from cutaneous melanoma with a tragic prognosis

No disponible

Metástasis vaginal por cáncer de recto detectada por 18F-FDG PET/TC / Vaginal metastasis from rectal cancer detected by 18F-FDG PET/CT

No disponible

Carcinosarcoma primario de vagina: neoplasia infrecuente. Reporte de caso y revisión de la literatura / Primary carcinosarcoma of the vagina: an uncommon neoplasm. Case report and literature review

Los tumores mixtos mullerianos del tracto genital femenino o carcinosarcomas son un grupo raro de neoplasiascomprendiendo menos del 2% de todos los canceres de origen ginecológico (1). El carcinosarcoma primario de vagina es un tumor muy raro, siendo muy pocos los casos reportados en la literatura

The Mullerian mixed tumors of the female genital tract or carcinosarcomas are a rare group of neoplasms com-pending less than 2% of all gynecological cancers origin (1). Primary carcinosarcoma of vagina is a very rare,being very few cases like this that have been reported in the literature

Desensitization to filgrastim in a 2-year-old girl with a vaginal endodermal sinus tumor

No disponible

Metástasis vaginal de carcinoma urotelial de vía urinaria superior / Vaginal metastasis of upper urinary tract urothelial carcinoma

Las metástasis vaginales de carcinomas uroteliales han sido descritas en raras ocasiones. Presentamos un caso de carcinoma urotelial de vía urinaria superior, metastatizado en vagina, en una paciente que comenzó con un cuadro de dolor en fosa renal izquierda y hematuria. La paciente fue sometida a nefroureterectomía izquierda y escisión de la lesión vaginal. Este caso revela la variabilidad en el mecanismo de diseminación de los carcinomas uroteliales

Vaginal metastases from urothelial carcinomas have been reported in rare cases. We present a case of vaginal metastasis of upper urinary tract urothelial carcinoma in a patient who presented with pain in the left renal Fossa and haematuria. The patient underwent left nephroureterectomy and excision of the vaginal injury. This case reveals variability in the mechanism of spread of urothelial carcinomas

Melanoma maligno de las mucosas: melanoma vaginal a propósito de un caso / Mucosal malignant melanomas. A propos of a case of vaginal melanoma

Los melanomas malignos de las mucosas son tumores raros. Se localizan con más frecuencia en la cavidad nasal, la cavidad oral, la conjuntiva ocular, la mucosa genital y el área perianal. La característica clínica más frecuente en estos melanomas es la presencia de una hiperpigmentación macular extensa e irregular plana, en ocasiones moteada, que se extiende durante años, antes de elevarse. El melanoma del tracto genital femenino es la segunda neoplasia primaria más frecuente de la vulva, representando un 3% de todos los melanomas diagnosticados en la mujer. El melanoma vaginal se origina en áreas de melanosis o de hiperplasia melanocítica atípica. La mayoría de los casos ocurre en mujeres caucásicas y alrededor de la 6.a década de la vida. El síntoma más común es el sangrado genital. El melanoma maligno de las mucosas tiene un comportamiento agresivo con una alta tasa de fracaso local y metástasis. La supervivencia a los 5 años es menor del 20%

Mucosal malignant melanomas are rare tumors. They are usually located in the nasal cavity, oral cavity, conjunctiva, genital mucosa, and the perianal area. The most common clinical feature of these melanomas is the presence of extensive and irregular, sometimes mottled, macular hyperpigmentation. These tumors are usually flat for years before becoming elevated. Melanoma of the female genital tract is the second most common primary neoplasm of the vulva, accounting for 3% of all melanomas diagnosed in women. Vaginal melanoma arises in areas of melanosis or atypical melanocytic hyperplasia. Most cases occur in Caucasian women around the sixth decade of life. The most common symptom is vaginal bleeding. Mucosal malignant melanoma has an aggressive course with a high rate of local failure and metástasis. Five-year survival is less than 20%

Distribución de genotipos del virus del papiloma humano en una población de mujeres españolas no vacunadas con enfermedad de vulva y vagina / The distribution of human papillomavirus genotypes within a population of non-vaccinated Spanish women with vulvar and vaginal pathology

En este estudio se han analizado un total de 86 muestras procedentes de biopsias vulvares y vaginales obtenidas en el Hospital General Universitario Gregorio Marañón de Madrid, con objeto de determinar la distribución de los genotipos del virus del papiloma humano (VPH) y el nivel de coinfección. Las muestras comprenden 61 casos de lesiones benignas vulvares (VBL), 5 lesiones intraepiteliales vulvares variedad usual (u-VIN), 2 carcinomas vulvares de células escamosas (VSCC), 9 lesiones benignas vaginales (VaBL), 4 lesiones intraepiteliales vaginales grado I (VaIN), 4 lesiones vaginales intraepiteliales grado II/III (VaIN-II/III) y un carcinoma vaginal epidermoide (VaSCC). El genotipado fue realizado con amplificación por PCR e hibridación reversa dot blot. En el total de esta serie de lesiones se detectaron 33 genotipos distintos de HPV, entre los que se incluyen 10 asociados con un alto riesgo de carcinogénesis (VPH-AR), 2 asociados con un riesgo altamente probable de carcinogénesis (VPH-PAR) y 5 asociados con un bajo riesgo de carcinogénesis (VPH-BR). En 3 muestras se detectó un VPH de genotipo indeterminado (VPH-X). Los genotipos de HPV más frecuentemente encontrados fueron el VPH-6 (10,3%; IC 95%: 6,6-15,1%), el VPH-16 (8,5%; IC 95%: 5,2-13%) y el VPH-11 (7,6%; IC 95%: 4,5-11,9%). El VPH-18 solamente fue detectado en el 0,9% (IC 95%: 0,1-3,2%) del total de virus encontrados en todas las lesiones. La coinfección por distintos genotipos del VPH se halló en el 30,2% del total de las lesiones (AU)

Vulvar and vaginal specimens were studied in order to determine the distribution of human papillomavirus (HPV) genotypes and co-infection occurrence. This information will contribute to the knowledge of HPV genotype distributions and provide an estimate of the prevalence of different oncogenic HPV genotypes found in patients in Madrid (Spain). A total of 86 vulvar and vaginal biopsies from the Hospital General Universitario Gregorio Marañón of Madrid were studied. These included 61 specimens with vulvar benign lesions (VBL), 5 usual vulvar intraepithelial lesions (u-VIN), 2 vulvar squamous cell carcinoma (VSCC), 9 vaginal benign lesions (VaBL), 4 vaginal intraepithelial lesions grade I (VaIN-I), 4 vaginal intraepithelial lesions grade II/III (VaIN-II/III) and one vaginal squamous cell carcinoma (VaSCC). HPV genotyping was performed with PCR amplification and reverse dot blot hybridization. 33 different HPV genotypes were detected, including 10 HPVs associated with a high risk of carcinogenesis, 2 HPVs associated with a highly likely risk of carcinogenesis and 5 HPVs associated with a low-risk of carcinogenesis. In 3 specimens, an uncharacteristic HPV genotype was detected. The most frequent HPV genotypes found were HPV-6 (10.3%; 95% CI: 6.6-15.1%), HPV-16 (8.5%; 95% CI: 5.2-13%) and HPV-11 (7.6%; 95% CI: 4.5-11.9%). HPV-18 was only detected in 0.9% (95% CI: 0.1-3.2%) of the total viruses detected in all lesions. HPV co-infections were found in 30.2% of all types of lesions. Benign lesions predominate in the pathology of the vulva and vagina. Although the presence of LR-HPVs is dominate among the BLV, the HR-HPVs are present in a significant number of cases (AU)

Melanoma maligno primario en vagina / Primary melanoma of the vagina

El melanoma primario de vagina es un tumor poco frecuente y agresivo, siendo común las metástasis en el momento de su diagnóstico. Las características citológicas de las células melanocíticas son difíciles de apreciar en una citología cérvico-vaginal. El estudio histológico debe basarse en técnicas inmunohistoquímicas (S100, MelanA y HMB45). El diagnóstico diferencial es con el carcinoma escamoso, cuando presenta un patrón epitelioide. Se ha de excluir siempre una metástasis de otra localización. Actualmente sin consenso en el tratamiento es un tumor con baja supervivencia (AU)

Primary melanoma of the vagina is an aggressive and uncommon tumor and with frequent metastases at diagnosis. It is difficult to visualize melanocytic cells in a gynecological smear. The diagnosis should be based on immunohistochemistry techniques (S100, MelanA, HMB45). The differential diagnosis is with squamous carcinoma when melanoma presents an epithelioid pattern. It is important to always exclude metastases from other locations. Currently, there is no consensus on treatment and survival is low. At this moment there's no treatment consensus for this poor survival tumour (AU)

Disuria y retención aguda de orinacomo primera manifestación de un linfoma vaginal primario. Aportación de un caso y revisión de la literatura / Dysuria and Acute Urinary Retencion as Initial Presentation of Primary Vaginal Lymphoma. Case Report and Bibliographic Review

OBJETIVO: Aportamos un caso de un linfoma vaginal primario cuya primera manifestación fue un episo-dio de disuria y retención aguda de orina, con revisión bibliográfica. MÉTODOS: Paciente, 36 años. Consulta en urología por disuria inicial que desencadena un episodio de retención aguda de orina. La exploración muestra engrosamiento de la pared vaginal. Se biopsia obteniendo el diagnóstico de linfoma no Hodgkin difuso de células grandes B vaginal primario. RESULTADOS: Los linfomas primarios del tracto genital femenino son infrecuentes. La tercera localización en frecuencia es la vagina. La manifestación más frecuente es el sangrado vaginal. Rara vez son los síntomas urinarios el primer signo. Su diagnóstico es por anatomía patológica. El tratamiento de elección es la poliquimioterapia según el protocolo Rituximab-CHOP. CONCLUSIONES: El Linfoma vaginal es una patología infrecuente. Es raro que la primera manifestación sean síntomas urológicos, más todavía que se presente en forma de retención urinaria aguda

OBJECTIVE: We report a case of primary vaginal lymphoma. The clinical presentation was an episode of dysuria and acute urinary retention. We performed a bibliographic review. METHODS: Thirty-six year-old patient who consulted in the urology clinic for hesitancy that triggered an episode of acute urinary retention. Physical examination revealed thickening of the vaginal wall. Biopsy was performed and diagnosis of diffuse large B-cell primary vaginal non-Hodgkin's lymphoma was obtained. RESULTS: Primary lymphomas of the female genital tract are rare. The third most frequent location is vagina. The most common manifestation is vaginal bleeding. Urinary symptoms are rarely the first sign. Diagnosis requires a biopsy. The first choice for treatment is Rituximab- CHOP immuno-chemotherapy. CONCLUSIONS: Vaginal lymphoma is a rare disease. Unfrequently, the first clinical manifestations are urinary tract symptoms, and even less acute urinary retention

Mesotelioma maligno de túnica vaginal / Malignant mesothelioma of tunica vaginalis

No disponible

Síndrome paraneoplásico ocular: retinopatía asociada al cáncer / Ocular paraneoplastic syndrome: cancer-associated retinopathy

Caso clínico: Se presenta un síndrome paraneoplásico ocular con una retinopatía asociada al cáncer (RAC) que producía déficit visual, disminución de calibre y envainamiento de las arteriolas retinianas. El ERG mostraba grandes alteraciones de las ondas a y b. El proceso tumoral no se descubrió hasta pasados 6 meses, en que apareció una neoplasia escamosa que invadía útero y vagina. Discusión: Los síndromes paraneoplásicos son manifestaciones secundarias a la producción de sustancias, por las células neoplásicas, que actúan a distancia del foco tumoral. El síndrome RAC es una reacción autoinmune cruzada de antígenos de origen tumoral con la recoverina de la retina. El oftalmólogo debe conocer la existencia de estas manifestaciones paraneoplásicas oculares porque pueden constituir el primer signo de un tumor maligno no diagnosticado (AU)

Case Report: We review a patient with ocular manifestations of a paraneoplastic syndrome. It was a cancer-associated retinopathy (CAR) in a woman with visual loss, and attenuated and sheathed retinal arterioles. The electroretinography (ERG) showed severe abnormalities of the a and b-waves. The tumour process was not discovered until 6 months later, when a squamous neoplasia that invaded the uterus and vagina was observed. Discussion: Paraneoplastic syndromes are a group of manifestations produced as a remote effect of cancer cells. CAR syndrome is caused by autoimmune reactions to retinal antigens induced by aberrant expression of recoverin in cancer tissues. Ophthalmologists must be aware of ocular paraneoplastic signs as they can be the first manifestations of a malignant tumour (AU)

Three or four fractions per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. The long-term results on vaginal relapses and toxicity

BACKGROUND: High-dose-rate brachytherapy (HDR-BT) is an accepted part of treatment for endometrial carcinoma and is usually performed in 1-2 fractions per week using different total doses and doses per fraction. To reduce the overall treatment time, HDR-BT was administered with a 3-4 days/week schedule. PATIENTS AND METHODS: From June 2003 to December 2008, 164 patients with stage I-IIIc endometrial carcinoma were treated with HDR-BT (4-5 Gy per fraction). The patients were divided into two groups; Group 1 (40/164 patients) was treated with HDR-BT alone (6 fractions; 4 fractions/week) and Group 2 (124/164 patients) was treated with both (External Beam Radiotherapy [EBRT] + HDR-BT: 3 fractions/week). Complications were analyzed using RTOG scores for rectum and bladder and the objective scores of LENT-SOMA for vaginal complications. RESULTS: The mean followup was 48 months. In Group 1, 35 % of patients underwent treatment in ≤10 days and 65 % in >10 days. In Group 2, 53.2 % received treatment in ≤5 days and in 46.8 % in >5 days. Vaginal relapse was observed in only two patients (1.2 %), both having received adjuvant EBRT + HDR-BT. Acute vaginal toxicity appeared in 8.5 % and late vaginal toxicity in 20.7 % of patients with 13.4 % being G1, 6.7 % G2 and only 0.6 % being G4. No statistically significant differences were found in complications in either brachytherapy group regardless of the overall time. CONCLUSION: In our series, three fractions given in 3-5/days after EBRT or six fractions in 10 days, is a safe regimen in terms of complications and local control (AU)

Leiomioma vaginal / Vaginal leiomyoma

Los leiomiomas son los tumores pélvicos más frecuentes en la mujer. Habitualmente se localizan en el útero siendo inusual encontrarlos en otras localizaciones como la vagina. Se presenta el caso de una paciente de 42 años que acude a consulta por una tumoración de 2 años de evolución en zona vulvovaginal izquierda sin otra sintomatología. Al examen se palpa una tumoración en el labio mayor izquierdo que se extiende hacia fosa isquiorectal de unos 4 cm y que impronta hacia el recto pero sin infiltrarlo. La RMN de pelvis muestra una tumoración de naturaleza sólida-quística vulvar y/o vaginal probablemente de naturaleza neoplásica que no involucra suelo pélvico y que llega hasta periné. Se realiza la extirpación del tumor por vía vaginal sin complicaciones. El estudio anatomopatológico confirmó el diagnóstico de leiomioma benigno. Se hace una revisión sobre el tema (AU)

Uterine leiomyomas are the most common pelvic tumors in women. These neoplasms are usually found in the uterus and their development in other locations, such as the vagina, is unusual. We report the case of a 42-year-old woman who presented with a 2-year history of a tumor in the left vulvovaginal area with no other symptomatology. On examination, a tumor of approximately 4 cm could be palpated inside the left labia majora. The tumor extended to the ischiorectal fossa with an impression in the rectum but without infiltration. Pelvic magnetic resonance imaging showed a solid-cystic vulvar and/or vaginal tumor of likely neoplastic origin which did not involve the pelvic diaphragm and which reached the perineal area. Tumoral enucleation was performed through the vaginal route, with no complications. Pathological study confirmed a benign leiomyoma. A review of the topic is provided (AU)

Carcinoma verrugoso de vagina. Presentación de un caso / Verrucous carcinoma of the vagina. A case report

Los carcinomas verrugosos de vagina son neoplasias poco frecuentes, con un crecimiento lento, localmente invasivo, que no suelen metastatizar y con unas características macro y microscópicas específicas. Describimos un caso de carcinoma verrugoso de cúpula vaginal en paciente postmenopáusica histerectomizada 4 años antes por prolapso uterino grado IV, discutiéndose su diagnóstico diferencial y tratamiento. El carcinoma verrugoso de vagina es un tumor poco frecuente que plantea el diagnóstico diferencial con el condiloma acuminado, el carcinoma escamoso clásico y el condilomatoso, siendo el tratamiento de elección la exéresis quirúrgica completa (AU)

Verrucous carcinoma of the vagina is a rare neoplasm. This entity is a slow-growing, locally invasive but generally nonmetastasizing neoplasm, with a characteristic gross and microscopic appearance.We report a case of verrucous carcinoma of the vagina in a postmenopausal woman diagnosed 4 years after transvaginal hysterectomy for grade 4 uterine prolapse. We also discuss the differential diagnosis and treatment.Verrucous carcinoma of the vagina is a rare neoplasm. The differential diagnosis includes typical squamous cell carcinoma, warty carcinoma, and condyloma acuminatum. Surgery remains the most effective treatment (AU)

Patología del tracto genital inferior asociada al virus del papiloma humano en mujeres españolas / Lower genital tract lesions associated with human papillomavirus in Spanish women

Objetivo. Evaluar la frecuencia de lesiones del tracto genital inferior asociadas a virus del papiloma humano (VPH) en mujeres españolas atendidas en la práctica clínica diaria. Material y métodos. Estudio observacional, retrospectivo, de corte transversal y multicéntrico en el que ginecólogos recogieron información sobre mujeres atendidas en los 6 meses previos con diagnóstico de neoplasias intraepiteliales de cérvix (CIN), vagina (VaIN), vulva (VIN), adenocarcinomas in situ (AIS) y/o verrugas genitales. Resultados. La población de estudio fue de 5.665 mujeres (mediana de edad 32 años) atendidas por 385 ginecólogos, con un total de 6.200 diagnósticos (de novo 82,5%). La mayoría de los casos presentó un diagnóstico de CIN (71,6%), seguido de verrugas genitales (20,8%), AIS (3,6%), VIN (2,0%) y VaIN (1,9%). Las lesiones de grado 1 fueron las más frecuentes entre los casos de CIN y VaIN. La mayoría de las pacientes con CIN, independientemente del grado, tenían entre 30 y 44 años (90% era < 45 años). La mayoría de mujeres con VaIN 1 (71%), AIS (77,2%) y verrugas genitales (96%) eran también < 45 años. Por el contrario, la mayoría de los diagnósticos de VaIN 2/3 se efectuaron en pacientes > 45 años (63,6%). No hubo diferencias respecto a la edad en las mujeres con diagnóstico de VIN. Conclusiones. CIN y verrugas genitales constituyen los diagnósticos más frecuentemente realizados por ginecólogos españoles dentro de la patología del tracto genital inferior asociada a VPH (aproximadamente, el 70 y el 20%, respectivamente, del total). La mayor carga de enfermedad se encuentra en mujeres de 30-44 años (CIN cualquier grado, AIS y VaIN 1). La mayoría de los condilomas se diagnostican antes de los 30 años, mientras que las lesiones de VIN y VaIN 2/3 se presentan con más frecuencia en mujeres > 60 años (AU)

Objective. To assess the frequency of lower genital tract lesions associated with human papillomavirus (HPV) infection in Spanish women attended in routine gynecology practice. Material y methods. We performed an observational, retrospective, cross-sectional, multicenter study in which participating gynecologists collected information on women attended in the previous 6 months with a diagnosis of intraepithelial neoplasia of the cervix (CIN), vagina (VaIN), vulva (VIN), adenocarcinoma in situ (AIS) and/or genital warts. Results. The study population consisted of 5,665 women (median age 32 years) attended by 385 gynecologists, with a total of 6,200 diagnoses (de novo 82.5%).The majority of diagnoses were CIN (71.6%), followed by genital warts (20.8%), AIS (3.6%), VIN (2.0%) and VaIN (1.9%). In patients with CIN and VaIN, the most frequently diagnosed lesions were grade 1. Independently of the grade of the lesion, most patients with a diagnosis of CIN were aged 30 to 44 years (90% were under 45 years). Most of the women with VaIN grade 1 (71%), AIS (77.2%) or genital warts (96%) were also younger than 45 years. In contrast, most of the diagnoses of VaIN grades 2 and 3 corresponded to women older than 45 years. There were no differences in the frequency of diagnosis of VIN among age groups. Conclusions. Among lower genital tract lesions associated with HPV infection, the most frequent diagnoses made by Spanish gynecologists were CIN and genital warts (representing approximately 70% and 20% of all cases, respectively). Most of the burden of disease was found among women aged between 30 and 44 years (CIN, any grade, AIS and VaIN grade 1). Genital warts mainly occurred in women younger than 30 years, while VIN and VaIN grade 2 and 3 lesions were more frequently diagnosed in women older than 60 years of age (AU)

Metástasis vaginal del carcinoma de células renales / Vaginal metastasis from renal cell carcinoma

El carcinoma de células renales es un tumor de comportamiento impredecible, con alta tendencia a producir metástasis. Puede afectar la vagina, produciendo hemorragia genital. El tratamiento es la biopsia extirpación de la lesión (AU)

Renal cell carcinoma behaves unpredictably, with a strong tendency to produce metastasis, which can affect the vagina, leading to genital bleeding. Treatment is based on wide local excision of the lesion (AU)

Embarazo ectópico cervical: a propósito de 3 casos. Revisión de la práctica clínica / Cervical pregnancy: three cases report. a review of current clinical practice

Se describen 3 casos de embarazos ectópicos cervicales diagnosticados y tratados conservadoramente durante el año 2008 en el hospital de la zarzuela de Madrid. El primero con embolización selectiva de las arterias uterinas y tratamiento con metotrexato a dosis única; el segundo, con embolización uterina y metotrexato a dosis múltiple y el tercero mediante instilación de CLK intramniótica con control ecográfico para reducción embrionaria, embolización de arterias uterinas y metotrexato a dosis única. Se realiza una revisión de la literatura científica sobre los distintos métodos diagnósticos y terapéuticos de esta afección, que va en aumento en los últimos años (AU)

Three cases of cervical ectopic pregnancy treated medically are described. The first case with selective uterine artery embolization and methotrexate dose single, the second case with selective uterine artery embolization and methotrexate dose multiple, and the third case intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat was necesary, before selective uterine artery and methotrexate dose unique. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. The diagnostic and therapeutic methods are discussed and the literature is reviewed (AU)