Perineal reconstruction with biologic graft vulvoplasty for verrucous carcinoma treated by repeated vulvar excisions: a case report.

Vulvar neoplasia represents 5% of malignancies in female genital tract and 0.6% of all cancers in women. Although it is known to be a rare type of cancer, which occurs especially in elderly women, its incidence is increasing in young females because of its association with the human papillomavirus (HPV). In this paper, we report the case of a 46-year-old woman, gravidity 4, parity 3, with a medical history of multiple vulvar excisions for recurrent ulcerative vulvar lesions during a period of 11 years. The first lesion appeared in 2003, it was excised and the histopathological result showed squamous cell carcinoma with undifferentiated areas and chronic ulcerative inflammation. The patient underwent radiation therapy remaining at the end of it a small-ulcerated lesion at the superior vulvar commissure, which was biopsied in 2004 showing chronic ulcerative inflammation with reparatory areas of squamous immature benign metaplasia In April 2014, a dermatological consult described vulvar scleroatrophic lichen confirmed by a biopsy. In November 2014, the patient presented to our clinic when a vicious vulvar scar was detected, with a transformed tegument with aspect of atrophic lichen. A perineal reconstruction including anal sphincter plasty was performed. Due to the important remaining skin defect, a Surgisis graft vulvoplasty was performed. The histopathological result of the excised suspect areas was vulvar intraepithelial high-grade neoplasia (VIN III). A retrospective histopathological review of the case established that is more accurate to consider that the vulvar lesions were, all along, a very well differentiated squamous cell carcinoma (verrucous carcinoma), which lacks cytopathic effect of HPV infection, has a low p53 expression but a high Ki67. Case evolution was favorable with the acceptance and integration of the biologic grafts at two months after surgery and normal healing.

The assessment of immunohistochemical profile of endometriosis implants, a practical method to appreciate the aggressiveness and recurrence risk of endometriosis.

UNLABELLED: Endometriosis represents a chronic female genital tract disease characterized by implants outside the endometrial cavity, leading to alteration of pelvic anatomy and having as result chronic pelvic pain and infertility. AIM: From the molecular perspective, the aim of studying endometriosis is identifying a cause and a consequence, that lead to the appearance and perpetual arising of new implants. The description of the immunohistochemical (IHC) profile of ectopic endometrium could represent a new element in the pathogenesis of endometriosis and also a practical method to appreciate the aggressiveness and possibility of recurrence of the disease. The study consisting of histopathological and immunohistochemical (IHC) analysis of the tissues excised included 14 patients, operated from June to December 2014, to which was confirmed the presumptive diagnosis of endometriosis, based on anamnesis, clinical examination and ultrasound appearance. We identified the expression of estrogen and progesterone receptors, whose presence in the ectopic endometrium guides the medical hormone postoperative treatment. We also identified the expression of a cellular proliferation marker - Ki-67, and inhibition marker of cellular apoptosis - Bcl-2, in order to characterize the aggressiveness of endometriosis implantations and a stromal marker CD10. Although there are plenty of medical and surgical therapeutic methods available, the treatment of endometriosis must be individualized for every patient taking into consideration the IHC analysis. Consolidation of surgical treatment by prescription of a medical long-term treatment is indispensable, because endometriosis is a chronic relapsing disease.