Flap repair: an effective strategy for minimising sexual morbidity associated with the surgical management of vulval intra epithelial neoplasia

Objective: To assess the sexual function after local excision and flap repair for symptomatic vulval intraepithelial neoplasia (Vin). Study Design: A retrospective analysis of five sexually active women who had persistent, symptomatic VIN diagnosed in a dedicated tertiary referral vulval clinic and treated with local excision and flap repair. Sexual function was assessed using a modified version of the Sabbatsberg Sexual Self-Rating Scoring (SRS) system. Results: The mean age of the cohort was 32 years (range 30 to 51). Four patients had previously been unsuccessfully treated with local excision. Follow up ranged from 5 to 33 months. The SRS scores were 90, 90, 81, 72 and 25. Endogenous depression may explain this last score. There has been no recurrence of VIN. Conclusion: In sexually active women with symptomatic VIN III, a flap reconstruction should be considered in addition to local excision as the treatment of choice (AU)

Angiomyofibroblastoma - a rare but distinct entity

A case of angiomyofibroblastoma of the vulva in a 23-year-old woman is presented. Clinical, histological and immunohistochemical features as well as the differential diagnosis and prognosis of this rare but distinct entity are discussed. Only about 65 cases are documented in the literature and to our knowledge this is the first case to be reported from the Caribbean(AU)

Carcinoma of the vulva in Trinidad: its clinical presentation and outcome - abstract

Carcinoma of the vulva comprises less than 3 percent of all gynaecological cancers. A review of the status of this relatively rare carcinoma in 24 Trinidadian women found 75 percent to be menopausal and 96 percent to be symptomatic with a mean duration of symptoms of 18 months. An advanced stage of disease was found in 70.7 percent and this, together with co-existing medical problems, accounted for the low operability rate of 68.4 percent. All 14 surgical cases suffered varying degrees of morbidity and there were 2 deaths. The 6 women who were deemed unsuitable for surgery died within months of presentation. Four of the 5 women with carcinoma in-situ benefited from excision-biopsy and remain disease free. Late diagnosis mainly due to a delay in clinical presentation adversely affected management. Improved health education concerning vulval diseases as well as closer clinical scrutiny of the vulva in symptomatic menopausal women would allow for earlier diagnosis and so reduce the unfavourable sentiments which surround this carcinoma (AU)

Late presentation of a vulval carcinoma in Trinidad

Carcinoma of the vulva is a disease mainly of post-menopausal women, and constitutes between 3 percent-5 percent of gynaecological malignancies. A retrospective study was undertaken of the clinical presentations, treatments and outcomes of all patients with vulval carcinoma presenting to the two major hospitals in North Trinidad between 1972-1989 (AU)

Radical vulvectomy: a 21 year review

The factors surrounding patients subjected to radical vulvectomy were examined. Most patients were over the age of 40 years. The standard butterfly incision was used in all but 2 cases. The histology in all cases was invasive squamous cell carcinoma. The main complications were primary haemorrhage, urinary tract infection and wound dehiscence. The mean hospital stay was 50 days and the mortality rate was 4 percent. (AU)

Vulval cancer following or co-existing with chronic granulomatous diseases of vulva: an analysis if its natural history, clinical manifestation and treatment

In this study a series of postgranulomatous vulval carcinoma is analysed. The epidemiological and clinical aspects are studied and guidelines for management of such tumours are given. The problem of clinical staging of this variety of tumour is discussed (AU)

Fibrosarcoma of the vulva: case reports and discussion

Three cases of fibrosarcoma of the vulva are reported. In two, surgical resection resulted in remission over four years. In the third case, presenting with metastasis of the lung and liver, the patient died without surgery been carried out. The low mitotic index found in the first two cases seems to lead to a favourable prognosis, whereas the inferior vulvar localization found in the last case seems to be more dangerous because its diffusion into the paravaginal space

Vulvar carcinoma in premenopausal Jamaican women

Between the years 1958 and 1973, 119 patients with primary invasive cancer of the vulva were treated at the University Hospital of the West Indies, Jamaica. Seventy-seven (64.7 percent) were premenopausal women. Because the pattern of the disease differed from that in late middle and older aged Jamaican women, the results of the disease are presented. The analysis stresses that vulvar carcinoma before menopause in our community is rare in the absence of various sexually transmitted granulomatous diseases of the vulva (AU)

The mortality of vulval carcinoma

Factors affecting mortality in fifty-two patients suffering from primary invasive carcinoma of the vulva are discussed. Suggestions for improvement in prevention and treatment are presented (AU)

Cancer involving the vulva

A report is presented of the more important data gathered from twenty eight consecutive cases of cancer involving the vulva. Features of interest commented upon include the high proportion of young women affected; the relationship to lesions of lymphogranuloma venereum and granuloma inguinale; and the association with low parity. Six patients received no treatment; two patients in whom invasion was of microscopic extent, had local vulvectomy; in the remaining 20 patients extensive surgical excision was performed. The results obtained in each group are presented. Because of the difficulty in achieving follow-up of patients, accurate survival figures are not obtainable; so far as can be determined, the five-year survival is in the region of 25 percent. Methods of achieving earlier diagnosis are discussed. (AU)

Ulcerating lesions of the vulva in Jamaica

A series of 58 patients with old or recent ulcerating lesions of the vulva are presented. Nine of these (15 per cent) were malignant. In 47 the diagnosis was uncertain, but probably was lymphogranuloma venereum or granuloma inguinale or both together. The latter group fall into three classes: (1) Those with active ulceration only: those might be due to either lymphogranuloma venereum or granuloma inguinale. The diagnosis depends on the lymphogranuloma venereumcomplement fixation test, the Frei test, the finding of Donovan bodies in tissue smears, on the histological appearance, and on therapeutic tests using sulphonamides or streptomycin. (2) Those with destructive lesions of the labia or urethra, which are thought to be caused by lymphogranuloma venereum. (3) Those with hypertrophic lesions of the vulva, which are thought to be caused granuloma inguinale, alone or in combination with lymphogranuloma venereum. Granuloma inguinale of the vulva probably pre-disposes to malignant change. infection with lymphogranuloma venereum alone probably does not pre-dispose to carcinoma. (AU)