ALA-Photodynamic treatment in Lichen sclerosus-clinical and immunological outcome focusing on the assesment of antinuclear antibodies.

BACKGROUND: Lichen sclerosus (LS) is a difficult to treat, often relapsing disease with unknown background. Autoimmune diseases also coexist with LS. Over recent years photodynamic therapy (PDT) has been shown to be a noninvasive and successful therapeutic approach for the effective treatment of many conditions. However, the change of immune status of the patients based on ANA antibodies has not been yet reported. Our aim was to observe the clinical response followed by possible changes in autoimmune antibodies levels before and after PDT for LS. MATERIAL AND METHODS: We enrolled 100 women with Lichen sclerosus with or without a concomitant autoimmune disease. All patients received 10 cycles of PDT (65 treated with DIOMED Light, 35 with PhotoDYN Light). We assessed autoimmune antibodies before and after PDT in addition to the clinical response evaluation.Two-year prospective controlled before-and-after study. RESULTS: Following PDT, patients showed a significant attenuation in symptoms' intensity (itching, pruritus, vulvar discomfort). After therapy 41% of patients had partial response, 51% of patients had no symptoms and 8% had persistent or worsened symptoms. The most frequent autoimmune disease were thyroid disorders, followed by vitiligo and arthritis. 57% patients with an additional autoimmune disease before PDT had ANA antibodies. The mean level of ANA in this group diminished significantly after PDT treatment (261.74 IU/ml before vs. 123.20 IU/ml after treatment). CONCLUSION: Based on our results, we assume that PDT may influence the immune status of patients with Lichen sclerosus.

[Total pelvic exenteration in vaginal cancer--case report]. / Calkowite wytrzewienie narzadów miednicy mniejszej z powodu raka pochwy--opis przypadku.

Vaginal cancer is a rare neoplasm and in about 65% to 90% of cases it is a metastatic one. It is diagnosed in women aged from 60 to 70 years, but it can also appear in younger patients. Squamous cell carcinoma is the most frequently found histopathological type. Risk factors for the development of vaginal cancer are thought to be similar to those of cervical cancer. We present a case of a 52-year old woman with vaginal cancer treated with brachytherapy. Due to neoplasm recurrence, additional examinations were performed in the course of one year. The patient was qualified for total pelvic exenteration. A leakage from the abdominal wound was observed post operatively. It was successfully noninvasively treated. In 3 months time she was hospitalized because of the superficial abdominal abscess which was located next to the left ureterostomy. The patient undergoes regular gynecological, surgical and urological control examinations. So far the results do not show any recurrence of the neoplastic process. Total pelvic exenteration should be considered in selected groups of patients.

Efficacy of photodynamic therapy in vulvar lichen sclerosus treatment based on immunohistochemical analysis of CD34, CD44, myelin basic protein, and Ki67 antibodies.

INTRODUCTION: Lichen sclerosus (LS) is a chronic skin and mucosa inflammatory disease. It affects mainly the female anogenital area especially in postmenopausal period. The main symptoms include pruritus, burning, pain, sometimes urinary problems, or difficulties in defecation. Usually, porcelain-white plaques are seen in the skin and mucosa. The etiology and pathogenesis of LS are still uncertain. There are some research studies on possible genetic predisposition, yet autoimmune, hormonal, or infectious factors are not excluded. The typical treatment of LS is mainly pharmacological, although the alternative treatment method used in LS is photodynamic therapy (PDT), which is noninvasive technique based on selective destruction of lesions. Our study is focused on molecule markers of vascularisation (CD34), nervous cell function (myelin basic protein [MBP]), keratinocyte function (CD44), and proliferation index (Ki67) in cases treated with photodynamic method. MATERIALS AND METHODS: A group of 100 patients treated in our department was included in the study. All 100 women had LS on the basis of clinical and histological criteria. All the subjects underwent PDT. In all cases, skin biopsies were taken before and after treatment, and samples were analyzed with CD34, CD44, MBP, and Ki67 antibodies using immunohistochemical staining. RESULTS: The study shows the high efficacy of PDT in LS treatment including beneficial changes to CD34, CD44, and MBP immunostained molecules. The Ki67 proliferation index did not change significantly. A significant increase of CD34 (microvessel density), MBP, and CD44 expression was confirmed in the histological images and in the partial or full remission of clinical objective and subjective symptoms. CONCLUSIONS: The PDT is a very effective therapeutic method in LS treatment.

Effectiveness of photodynamic therapy in the treatment of lichen sclerosus: cell changes in immunohistochemistry.

BACKGROUND: Vulvar lichen sclerosus (LS) affects primarily women at postmenopausal age and its background remains unknown. One of the treatment modalities is photodynamic therapy (PDT). The aim was to investigate the efficacy of PDT in women with LS and the analysis of protein expression before and after PDT. MATERIAL AND METHODS: From 04.2006-01.2008 28 women, with LS underwent photodynamic diagnosis and next PDT: six-courses every second week with using 5-aminolevulinic acid (ALA) as a photosensitizer. Punch biopsies were taken before and after treatment and immunohistochemistry was done with Ki67,CD44,CD34 and CD3. RESULTS: Before PDT all patients suffered from pruritus and after in 89.3% the relief was noted. The histological examination showed that 35.7% patients hadn't LS after therapy completion. Anti-CD44 staining intensities was scored qualitatively - there were no statistical difference at the expression of protein CD44 in the epidermis (p>0.05) before and after therapy. Microvessel density was assessed at the hot spots, marked with anti-CD34. Statistical difference in AVD before and after therapy: (p<0.05). The staining intensity of Ki-67 didn't differ before and after PDT (p>0.05). The expression of CD3 on T lymphocytes showed statistical difference of the lymphocytic infiltration before and after PDT ( p<0.05). CONCLUSION: The immunohistochemical staining in vulvar LS showed increasing microvessel density and decreasing lymphocytic infiltration. There were a clinical, and less histological improvement in patients with LS. We suggest that the photodynamic therapy is an effective, alternative treatment in some but not all patients with LS. Therefore, further studies are needed.

Chlamydia trachomatis infection in women with lichen sclerosus vulvae and vulvar cancer.

OBJECTIVE: Chronic infections in the urogenital area often precede or coexist with vulvar cancer. A strong connection between some tumours and the-appearance of Chlamydia trachomatis infection has been observed, but there is little information concerning a connection of that infection with vulvar cancer and lichen sclerosus vulvae (LS). The aim of this study was the analysis of frequency of antigens appearance and antibodies of IgM and IgG Chlamydia trachomatis in patients with vulvar cancer and LS and we wanted to find the correlation between Chlamydia trachomatis infection and vulvar cancer and LS. METHODS: 80 women treated in the Clinic of Vulva Diseases at the Department and Clinical Ward of Gynaecology, Obstetrics and Oncological Gynaecology in Bytom, in the Silesian Medical University in Katowice were divided into two groups - 30 were treated for vulvar cancer and 50 were treated because of LS. We took bacterial smears vagina and cervical smears for presence of Chlamydia trachomatis antigens and peripheral blood to mark antibodies of IgM and IgG Chlamydia trachomastis. RESULTS: Chlamydia trachomatis antigen was found in 20% women with vulvar cancer and in 12% women with LS (p>0.05). In 13,3% cases with vulvar cancer we observed IgM Chlamydia trachomatis antibodies. In the group with LS IgM antibodies appeared in 16% women (p>0.05). In 50% patients with vulvar cancer in blood serum we observed IgG Chlamydia trachomatis antibodies, and in 16% women with LS (p<0.001). CONCLUSIONS: Previous Chlamydia trachomatis infection can lead to vulvar carcinogenesis.

Sexual functions and depressive symptoms after photodynamic therapy for vulvar lichen sclerosus in postmenopausal women from the Upper Silesian Region of Poland.

INTRODUCTION: Although lichen sclerosus (LS) may affect women's physical functioning, mood, and quality of life, restricting their physical activities, sexual, and non-sexual contacts, there are limited data on the sexual functioning of women diagnosed with LS. AIMS: The aim of the study was to evaluate the influence of photodynamic therapy for vulvar LS on sexual functions and depressive symptoms in postmenopausal women from the Upper Silesian Region of Poland. METHODS: A total of 65 women aged 50-70 visiting an outpatient clinic for assessment of vulvar dermatoses were screened for the clinical trial. Finally, 37 women who met all the inclusion/exclusion criteria were included in the study. All the subjects were treated by topical laser therapy (photodynamic therapy). Sexual functions and depressive symptoms were assessed before and after the therapy using Female Sexual Function Index and Beck Depression Inventory, respectively. MAIN OUTCOME MEASURES: Sexual behaviors, sexual functions, and depressive symptoms in females after photodynamic therapy for vulvar LS. RESULTS: The total FSFI score was significantly lower after the treatment of vulvar LS as compared with the baseline (median 24.6 vs. 15.9). However, the prevalence of clinically significant FSD was stable throughout the medical intervention except lubrication disorders (higher prevalence after the treatment: 40% vs. 68.57%). Although the scores of BDI at the baseline dropped significantly after the photodynamic therapy (median 12.0 and 9.0, respectively), there were no significant differences in the prevalence of depressive symptoms (48.65% vs. 45.94%). CONCLUSIONS: Topical laser therapy for vulvar LS has a good clinical outcome, especially in the context of no major negative effects on sexual functioning and the positive impact on the severity of depressive symptoms in postmenopausal women. However, patients should be informed about the possible lubrication disorders following the treatment.

[Vulvovaginitis in young girls]. / Stany zapalne narzadów plciowych u dziewczynek.

Vulvovaginitis is the most common cause of gynecological complaints in young girls. Factors which cause vulvovaginitis include, among other things, low level of sexual hormones (hypoestrogenism), the anatomical proximity of the rectum and delicate vulvar skin and vaginal mucosa. Usually vulvovaginitis in young girls is caused by non-specific factors. The aim of the study was to present the most frequent causes of vulvovaginitis in young girls.

[Photodynamic therapy in vulvar intraepithelial neoplasia]. / Terapia fotodynamiczna w leczeniu sródnablonkowej neoplazji sromu.

INTRODUCTION: Vulvar intraepithelial neoplasia may lead to vulvar cancer. Vulvar cancer is a rare (accounting for about 2,5-5% of all malignant neoplasms), female genital organs cancer. Photodynamic therapy is a new treatment for a wide variety of malignancies and premalignant dysplasias. We wanted to examine the effectiveness of photodynamic therapy (PDT) on vulvar intraepithelial neoplasia (VIN). DESIGN: The aim of the study was to analyze the effectiveness of photodynamic therapy (PDT) on vulvar intraepithelial neoplasia (VIN). MATERIAL AND METHODS: We have analyzed 20 women with VIN, who were treated in our center - Clinic of Vulvar Diseases. All these women had photodynamic diagnosis (PDD), photodynamic therapy followed (PDT), with 5% ALA applied to the entire vulva. CONCLUSIONS: We have noted the reduction of subjective complaints, but the histopathological improvement was observed in fewer degree.

[Dermatofibrosarcoma protuberans of the vulva]. / Dermatofibrosarcoma protuberans okolicy sromu.

Dermatofibrosarcoma protuberans (DFSP) is a locally malignant neoplasm derived from fibrous tissue. Similar picture of such lesions to malignant tumors as well as to benign changes creates a risk of too gentle treatment and consequently of recurrence and malignant transformation of the lesions with possible remote metastases. Therefore accurate diagnosis and aggressive surgical treatment can prevent the recurrence of the tumor. Authors of the study present case report of 49-year-old woman with DFSP of vulvar area.

Therapeutic effects of 5-ALA-induced photodynamic therapy in vulvar lichen sclerosus.

BACKGROUND: Lichen sclerosus (LS) is a rarely diagnosed, chronic inflammatory skin and mucosal condition. Its therapy is difficult and frequently not satisfactory. The data on photodynamic therapy (PDT) of vulva are promising but scanty. The aim of our study was to evaluate the therapeutic efficacy of photodynamic therapy in genital LS in women. METHODS: Twenty-four patients with clinical and histopathological diagnosis of lichen sclerosus accompanied with chronic vulvar itching, lasting between 3 months and 11 years, with human papillomavirus (HPV), bacterial and mycotic infections excluded, received three to six PDT cycles (180J, 700mW/cm(2)) in 14 days long intervals. Simultaneously they received no topical corticosteroids. Photodynamic diagnosis (PDD) was conducted prior to therapy and 4 weeks after its completion. RESULTS: In 17 patients, the itching ceased completely, in 6 women it decreased, in 1 patient the itching continued, none of the patients presented exacerbation of itching. PDD after completion of therapy revealed in 10 patients normal, green fluorescence of vulva and in 14 women pathological, red fluorescence, usually fainter than before PDT. CONCLUSION: PDT is an effective therapeutic modality for chronic itching in lichen sclerosus.

[Photodynamic diagnosis and therapy in gynecology--current knowledge]. / Diagnostyka i terapia fotodynamiczna w ginekologii--aktualny stan wiedzy.

Photodynamic diagnosis (PDD) is a new method based on the detection of different forms of fluorescence of tissues after previous administration of photosensitizers. The photosensitizer is gathered in the pathological tissue at much higher concentration than in the healthy tissue, thus the fluorescence differs. Localizing wrong fluorescence allows precise choosing of the spot to collect tissue for histopathological or cytological study. Photodynamic therapy (PDT) is a technique in which tissue is irradiated with light after the use of a photosensitizing drug that produces singlet oxygen, which has a cytotoxic effect. The authors describe new trends in photodynamic diagnosis and treatment of some vulvar epithelial diseases (VIN, lichen sclerosus, condylomata acuminata) and cervical intraepithelial neoplasia. They describe photodynamic method in their own studies: diagnosis and treatment of lichen sclerosus and diagnosis of uterine cervix cancer.

[Surgical treatment of vulvar cancer in 101-year old patient--a case report]. / Przypadek leczenia operacyjnego raka sromu u 101-letniej pacjentki--opis przypadku klinicznego.

OBJECTIVES: Vulva cancer makes up 2.5-5% of all malignant neoplasms developing within the female genital organs. The average age of patients with vulvar cancer is 60 years, and most cases occur between 70-80. The great majority of cases (95%) belong to squamous cell carcinoma with endophytic or exophytic growth, for example carcinoma verrucosum. It is malignant neoplasms showing a significant histologic maturity, which however, does not cause metastases. STUDY DESIGN: This is a case report concerning a 101 year old patient with vulvar cancer treated surgically. CONCLUSIONS: In cases of vulvar cancer, surgical treatment is still the method of choice. The surgical removal of the tumor together with the surrounding tissues proved to be sufficient.

[The coexistence of vulvovaginal warts and cervical dysplasia with HPV infection and cervicitis]. / Wspólistnienie klykcin pochwy i sromu oraz dysplazji szyjki macicy z infekcja HPV oraz stanem zapalnym szyjki macicy.

We present a case of 30-year old female patient with persistent cervicitis and vulvovaginal warts. In the course of diagnosis were found cervical dysplasia and a HPV infection type 6 and 11. In therapy we applied antibiotics, chemical therapy of the warts, laser vaporization of the warts, laser conisation, immunotherapy. Three years' intensive therapy didn't lead to satisfactory results. Finally hysterectomy led to the acceptable therapeutical effect.