Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.839
Filtrar
1.
Medicine (Baltimore) ; 99(27): e20859, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629673

RESUMO

RATIONALE: Extra osseous Ewing sarcoma (ES), an uncommon malignant neoplasm, accounts for about 15% of Ewing sarcoma, which mainly affects paravertebral region, lower extremity, chest wall, retroperitoneum, pelvis, and hip. Here is a 54-year-old woman of primary vaginal Ewing sarcoma with uterine fibroid, which has been fewly known or reported. PATIENT CONCERNS: The patient was admitted to our hospital because of vaginal pain. Her uterus showed as parallel position and enlarged as about 3 months of pregnancy size. DIAGNOSIS: Magnetic resonance imaging (MRI) and ultrasonography (US) demonstrated 2 heterogeneous masses in the vagina and uterus, respectively. Ultrasound-guided puncture biopsy revealed a malignant tumor in the right lateral vaginal wall. INTERVENTIONS: The patient was treated by hysterectomy, bilateral salpingo-oophorectomy, and tumors excision, with the subsequent treatment of chemotherapy. OUTCOMES: The patient recovered well without local recurrence for >1 year. LESSONS: Primary vaginal Ewing sarcoma is extremely rare. The treatments of uterine fibroid include uterine artery embolization and surgical options, While wide local excision followed by adjuvant chemotherapy and/or radiotherapy should be recommended for the vaginal ES.


Assuntos
Leiomioma/complicações , Sarcoma de Ewing/complicações , Sarcoma de Ewing/diagnóstico , Neoplasias Vaginais/complicações , Neoplasias Vaginais/diagnóstico , Feminino , Humanos , Leiomioma/diagnóstico , Pessoa de Meia-Idade , Sarcoma de Ewing/patologia , Neoplasias Vaginais/patologia
2.
Zhonghua Fu Chan Ke Za Zhi ; 55(5): 322-326, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32464720

RESUMO

Objective: To explore the preliminary clinical values of colposcopy in the diagnosis of vaginal invasion in cervical cancer. Methods: A retrospective review of the clinical records of patients (31 cases) with cervical cancer treated in Xuzhou Cancer Hospital from April 2015 to August 2019. For those with early-stage cervical cancer and the vagina invasion being difficult to be determined, those with advanced cervical cancer and the scope of vaginal invasion being difficult to be judged, and those with obvious vaginal tumor and underexposed cervix or inconspicuous cervical lesion and the primary location needing to be identified, colposcopy-guided vaginal and cervix biopsy were performed before treatment. Results: (1) Image characteristics of colposcopy and pathological diagnosis: among 31 cases, 30 of them had the similar images of vagina and cervix. The images were dense acetowhite and (or) thick mosaic, coarse punctate and atypical vessels. Lugol's staining was uniformly bright yellow or brown. Pathological biopsy of vaginal wall: 27 cases were metastatic carcinoma, 3 cases were vaginal intraepithelial neoplasia (VaIN) Ⅱ-Ⅲ. One case showed dense acetowhite epithelium and atypical vessels image in cervix and thin acetowhite epithelium in upper 1/3 vagina which disappeared in two minutes; the results of vaginal biopsy was chronic inflammation. (2) Vaginal invasion diagnosed by colposcopy: among 31 cases, 14 of them without invasion of uterine side, vaginal invasion was judged as followed by colposcopy, being consistent with biopsy: 1 case of chronic vaginitis, 2 cases VaINⅡ, 1 case VaINⅢ, 6 cases upper 1/3 vagina invasion, 4 cases lower 1/3 vagina invasion. Among 10 cases with invasion of uterine side, vaginal invasion were identified by colposcopy, being consistent with biopsy: 4 cases upper 1/3 vagina invasion and 6 cases upper 1/2 vagina invasion. Five cases who had clinical diagnosis of vaginal cancer were diagnosed as cervical cancer with vaginal invasion by colposcopy, being consistent with biopsy. Two cases with no obvious lesions of cervix and vagina were diagnosed as cervical cancer with vaginal invasion by colposcopy, being consistent with cervical and vaginal biopsy: 1 case with stage Ⅳ (transfer to the left supraclavicular lymph node) and 1 case with stage Ⅱ a1. Conclusions: Colposcopy and multi-point biopsy have complementary diagnostic value for the cervical cancer cases that the invasion and scope of vagina are difficult to be determined by physical examination and (or) imaging examination. Thus the range of vaginal resection for patients underwent operation and the lower boundary of pelvic radiation field for those underwent radiotherapy could be fixed, so as to make the treatment much more individualized and humanized; the indications need further discussion.


Assuntos
Colposcopia , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Neoplasias Vaginais/diagnóstico por imagem , Neoplasias Vaginais/patologia , Biópsia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Vagina , Esfregaço Vaginal
3.
J Gynecol Obstet Hum Reprod ; 49(6): 101729, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-23573

RESUMO

INTRODUCTION: In the context of the COVID-19 pandemic, specific recommendations are required for the management of patients with gynecologic cancer. MATERIALS AND METHOD: The FRANCOGYN group of the National College of French Gynecologists and Obstetricians (CNGOF) convened to develop recommendations based on the consensus conference model. RESULTS: If a patient with a gynecologic cancer presents with COVID-19, surgical management should be postponed for at least 15 days. For cervical cancer, radiotherapy and concomitant radiochemotherapy could replace surgery as first-line treatment and the value of lymph node staging should be reviewed on a case-by-case basis. For advanced ovarian cancers, neoadjuvant chemotherapy should be preferred over primary cytoreduction surgery. It is legitimate not to perform hyperthermic intraperitoneal chemotherapy during the COVID-19 pandemic. For patients who are scheduled to undergo interval surgery, chemotherapy can be continued and surgery performed after 6 cycles. For patients with early stage endometrial cancer of low and intermediate preoperative ESMO risk, hysterectomy with bilateral adnexectomy combined with a sentinel lymph node procedure is recommended. Surgery can be postponed for 1-2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For patients of high ESMO risk, the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) should be applied to avoid pelvic and lumbar-aortic lymphadenectomy. CONCLUSION: During the COVID-19 pandemic, management of a patient with cancer should be adapted to limit the risks associated with the virus without incurring loss of chance.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias dos Genitais Femininos/cirurgia , Pandemias , Pneumonia Viral/epidemiologia , Quimioterapia Adjuvante , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , França , Neoplasias dos Genitais Femininos/complicações , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/terapia , Ginecologia , Humanos , Comunicação Interdisciplinar , Obstetrícia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Receptores de Retorno de Linfócitos , Risco , Sociedades Médicas , Neoplasias Trofoblásticas/tratamento farmacológico , Neoplasias do Colo do Útero/terapia , Neoplasias Vaginais/terapia , Neoplasias Vulvares/cirurgia
4.
J Gynecol Obstet Hum Reprod ; 49(6): 101729, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32247066

RESUMO

INTRODUCTION: In the context of the COVID-19 pandemic, specific recommendations are required for the management of patients with gynecologic cancer. MATERIALS AND METHOD: The FRANCOGYN group of the National College of French Gynecologists and Obstetricians (CNGOF) convened to develop recommendations based on the consensus conference model. RESULTS: If a patient with a gynecologic cancer presents with COVID-19, surgical management should be postponed for at least 15 days. For cervical cancer, radiotherapy and concomitant radiochemotherapy could replace surgery as first-line treatment and the value of lymph node staging should be reviewed on a case-by-case basis. For advanced ovarian cancers, neoadjuvant chemotherapy should be preferred over primary cytoreduction surgery. It is legitimate not to perform hyperthermic intraperitoneal chemotherapy during the COVID-19 pandemic. For patients who are scheduled to undergo interval surgery, chemotherapy can be continued and surgery performed after 6 cycles. For patients with early stage endometrial cancer of low and intermediate preoperative ESMO risk, hysterectomy with bilateral adnexectomy combined with a sentinel lymph node procedure is recommended. Surgery can be postponed for 1-2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For patients of high ESMO risk, the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) should be applied to avoid pelvic and lumbar-aortic lymphadenectomy. CONCLUSION: During the COVID-19 pandemic, management of a patient with cancer should be adapted to limit the risks associated with the virus without incurring loss of chance.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias dos Genitais Femininos/cirurgia , Pandemias , Pneumonia Viral/epidemiologia , Quimioterapia Adjuvante , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , França , Neoplasias dos Genitais Femininos/complicações , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/terapia , Ginecologia , Humanos , Comunicação Interdisciplinar , Obstetrícia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Receptores de Retorno de Linfócitos , Risco , Sociedades Médicas , Neoplasias Trofoblásticas/tratamento farmacológico , Neoplasias do Colo do Útero/terapia , Neoplasias Vaginais/terapia , Neoplasias Vulvares/cirurgia
5.
Int J Clin Oncol ; 25(7): 1412-1417, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32219631

RESUMO

OBJECTIVE: Definitive radiation therapy (RT), using external beam RT and/or brachytherapy, is a standard treatment option for primary vaginal carcinoma. However, this treatment has poor prognosis when applied to vaginal nonsquamous cell carcinoma (non-SCC). We aimed to clarify treatment outcome and surgical safety in early-stage primary vaginal non-SCC. METHODS: After receiving approval from the institutional review board, we retrospectively reviewed the clinical records and pathological samples of patients treated at our hospital between 1991 and 2018. Among 49 patients with primary vaginal carcinoma, 12 with histologically confirmed early-stage primary vaginal non-SCC were included in this study. RESULTS: In total, 40% of patients with primary vaginal carcinoma treated at our hospital had primary vaginal non-SCC. The average observation time was 34 months (median 53.3 months). Three patients had local recurrence: 2 in pelvic lymph nodes and 1 in the vagina. Furthermore, 2 patients died of their disease. Five-year local control rate of stage I and stage II non-SCC was 75% and 100%, respectively. Disease-specific survival rate of stage I and stage II non-SCC was 81.8% and 100%, respectively. No major morbidity was observed. Three patients required allogeneic blood transfusion, whereas 1 underwent autotransfusion. None of the 12 patients were discharged with self-catheterization. CONCLUSION: Five-year local control and disease-specific survival rates of patients surgically treated for vaginal non-SCC were favorable. Therefore, surgery could be a safe and reasonable option for early-stage primary vaginal non-SCC.


Assuntos
Neoplasias Vaginais/patologia , Neoplasias Vaginais/cirurgia , Adulto , Idoso , Feminino , Humanos , Linfonodos/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Pelve/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias Vaginais/mortalidade
6.
Lancet Oncol ; 21(3): e157-e167, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32135119

RESUMO

Primary vaginal cancer is a rare cancer and clinical evidence to support recommendations on its optimal management is insufficient. Because primary vaginal cancer resembles cervical cancer in many aspects, treatment strategies are mainly adopted from evidence in locally advanced cervical cancer. To date, the organ-sparing treatment of choice is definitive radiotherapy, consisting of external beam radiotherapy and brachytherapy, combined with concurrent chemotherapy. Brachytherapy is an important component of the treatment and its steep dose gradient enables the delivery of high doses of radiation to the primary tumour, while simultaneously sparing the surrounding organs at risk. The introduction of volumetric CT or MRI image-guided adaptive brachytherapy in cervical cancer has led to better pelvic control and survival, with decreased morbidity, than brachytherapy based on x-ray radiographs. MRI-based image-guided adaptive brachytherapy with superior soft-tissue contrast has also been adopted sporadically for primary vaginal cancer. This therapy has had promising results and is considered to be the state-of-the-art treatment for primary vaginal cancer in standard practice.


Assuntos
Braquiterapia , Imagem por Ressonância Magnética , Doses de Radiação , Radioterapia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X , Neoplasias Vaginais/radioterapia , Braquiterapia/efeitos adversos , Braquiterapia/mortalidade , Quimiorradioterapia , Feminino , Humanos , Tratamentos com Preservação do Órgão , Valor Preditivo dos Testes , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia Guiada por Imagem/mortalidade , Fatores de Risco , Resultado do Tratamento , Neoplasias Vaginais/diagnóstico por imagem , Neoplasias Vaginais/mortalidade , Neoplasias Vaginais/patologia
7.
Cancer Radiother ; 24(2): 106-113, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32063417

RESUMO

PURPOSE: The purpose of this study was to compare the efficacy of two applicators used in high dose rate vaginal brachytherapy. The first is the Stump Cylinder used in the "brachycenter" department at the Middle East Institute of Health in Lebanon and the second is the custom mold used in the radiotherapy department at Tenon Hospital in France. MATERIALS AND METHOD: A comparison of the clinical target volume and the doses received by the rectum and bladder was performed in order to determine the best method of treatment and to optimize the dose distribution. 95 patients were treated in both departments. RESULTS: The average values of the D95% dose received by the CTV were respectively 89.43% for the Stump Cylinder and 110.16% for the custom mold. The conformity index was 0.84 for the Stump Cylinder while it was 0.97 for the custom mold, which ensures a better dose distribution. For the rectum, the maximum dose D2cc taken by volume was 71.23% for the Stump Cylinder and 79.51% for the custom mold. The bladder was better protected with Stump Cylinder with a D2cc value of 65.81% against 94.88% for the custom mold. CONCLUSION: The underdosing obtained using the Stump Cylinder was due to the shape of upper part of the cylinder which was not conform with the shape of the vaginal vault in women. A better protection of the organs at risk was observed with the Stump Cylinder since the dose taken by the rectum and bladder using a custom mold can reach the tolerance limits.


Assuntos
Braquiterapia/instrumentação , Desenho de Equipamento , Proteção Radiológica/instrumentação , Reto/efeitos da radiação , Bexiga Urinária/efeitos da radiação , Neoplasias Vaginais/radioterapia , Feminino , França , Humanos , Líbano , Medicina de Precisão/instrumentação , Doses de Radiação , Radioterapia Guiada por Imagem
8.
Arch Gynecol Obstet ; 301(3): 769-777, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31993733

RESUMO

PURPOSE: Malignancies of the vagina are rare, but colposcopy-directed biopsies play a major role in detecting vaginal intraepithelial lesions. Data of accuracy in detecting neoplasia of the vagina are very rare compared to accuracy in detecting cervical neoplasia. The aim of this study was to evaluate the accuracy of colposcopy-directed biopsy in comparison with clinical findings of the examiner. METHODS: The accuracy of colposcopy-directed biopsy was compared with the clinical finding in relation to the patient's age and the examiner's level of training. This was done in combination with PAP-smear, HPV-test results, and the history of other malignancies of the lower genital tract. The data were collected between January 2014 and February 2018 at the certified Dysplasia Unit of the University Hospital Erlangen. RESULTS: In total, 253 biopsies from 253 women from the vagina were obtained. The overall accuracy of biopsy in comparison with clinical finding was 52.17% for all entities-benign lesions, low-grade squamous intraepithelial lesions (LSILs), high-grade squamous intraepithelial lesions (HSILs), and vaginal carcinoma. The accuracy for detecting HSIL was 82.46% (47/57), with an underdiagnosis rate of 15.79% and an overdiagnosis rate of 1.79%. CONCLUSION: With a sensitivity of over 80%, colposcopy-directed biopsy plays an important role in detecting vaginal-HSIL. A highly experienced practitioner is increasing the sensitivity in detecting vaginal-HSIL. Careful examination is required in women with a history of HSIL of the lower genital tract or with simultaneous neoplasia because they are of greater risk of developing vaginal malignancies. The combination of careful clinical work up, PAP-smear, HPV-testing, and colposcopy-guided biopsy is crucial in detecting vaginal-HSIL.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia/métodos , Neoplasias Vaginais/diagnóstico , Adulto , Neoplasia Intraepitelial Cervical/patologia , Neoplasia Intraepitelial Cervical/cirurgia , Feminino , Humanos , Estudos Retrospectivos , Neoplasias Vaginais/patologia , Neoplasias Vaginais/cirurgia
10.
BMC Womens Health ; 20(1): 12, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964370

RESUMO

BACKGROUND: In the literature under review there are about 300 reported cases of vaginal leiomyomas with none from Cameroon. We report a case of vaginal leiomyoma and highlight the diagnostic challenges faced at the Douala Referral Hospital (DRH), Cameroon. CASE PRESENTATION: A 36-year-old G3P3002 sexually active Cameroonian married woman reported dysuria, dyspareunia, cessation of sexual intercourse and offensive smelling vaginal discharge for 6 months and a 3-year history of a vaginal tumour; she was misdiagnosed despite ultrasonography and magnetic resonance imaging (MRI) but was corrected by an experienced radiologist. She underwent first look laparoscopy, surgical excision of the tumour through the vagina and histopathology analysis that confirmed leiomyoma. CONCLUSION: Posterior location of vaginal leiomyomas found in this case is a rare occurrence. The diagnosis is based on careful examination and preoperative imaging (ultrasonography and MRI). However, the definitive diagnosis is usually made intra-operatively. We combined laparoscopic exploration of the internal genital organs and per vaginal excision of the vaginal leiomyoma. Thus, we recommend frozen section biopsy to exclude leiomyosarcoma.


Assuntos
Laparoscopia/métodos , Leiomioma/diagnóstico , Imagem por Ressonância Magnética , Ultrassonografia , Neoplasias Vaginais/diagnóstico , Adulto , Biópsia , Camarões , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Leiomiossarcoma/diagnóstico , Centros de Atenção Terciária , Vagina/diagnóstico por imagem , Vagina/patologia , Vagina/cirurgia
11.
J Comput Assist Tomogr ; 44(2): 193-196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929378

RESUMO

PURPOSE: The aim of this study is to analyze retrospectively the computed tomography and magnetic resonance imaging (MRI) features of pediatric vaginal endodermal sinus tumor (EST) and rhabdomyosarcoma (RMS) in a case series. METHODS: Seven children with vaginal EST and 2 children with vaginal RMS underwent MRI and/or computed tomography examination before the biopsy and treatment. Images were evaluated by 2 observers for the following features: (a) tumor extent; (b) margin; (c) tumor shape; (d) tumor size; (e) architecture (solid, cystic, or mixed cystic-solid); (f) hemorrhage, necrosis, and calcification; (g) magnetic resonance T2 signal intensity; (h) pattern of the enhancement; and (i) signal intensity on diffusion-weighted imaging and apparent diffusion coefficient (ADC) value. RESULTS: All of the 7 ESTs showed as a round-shaped solid mass with a location limited to the vagina without vulva and bladder invasion, whereas RMSs have an irregular grape-like appearance filling the whole vagina with vulva and bladder invasion. The invasion to the cervix was not observed in EST or RMS. Both EST and RMS were heterogeneously hyperintense on T2-weighted magnetic resonance images and enhanced remarkably and heterogeneously. Heterogeneous high signal on diffusion-weighted imaging were observed in vaginal EST and RMS. The ESTs showed a lower ADC value (mean, 1.04×10 mm/s), while RMSs showed a relatively high ADC value (mean, 1.51 × 10 mm/s). CONCLUSIONS: Computed tomography and MRI may be useful tools in diagnosing the vaginal RMS and EST.


Assuntos
Tumor do Seio Endodérmico/diagnóstico por imagem , Rabdomiossarcoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Neoplasias Vaginais/diagnóstico por imagem , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Retrospectivos , Vagina/diagnóstico por imagem
12.
BMJ Case Rep ; 13(1)2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31900300

RESUMO

A 28-year-old primigravida was evaluated for complaints of difficulty urinating and pelvic pain of 6-weeks duration. She denied fever, night sweats, weight loss or fatigue. Pelvic ultrasonography revealed a single fetal pole with cardiac activity and a 7 cm mass in the anterior vagina which encased the urethra. The diagnosis of diffuse large B-cell lymphoma germinal centre type was made on analysis of biopsied pelvic mass. Whole body MRI revealed the disease was limited to the vagina. The patient received six cycles of Rituximab-cyclophosphamide, doxorubicin, vincristine and prednisone with significant improvement in her symptoms. Serial ultrasounds over the subsequent months showed appropriate development of the fetus. Whole body MRI after treatment showed decreased size and decreased signal of the primary pelvic mass compatible with favourable treatment response. Challenges in the management of this rare presentation of lymphoma are discussed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Neoplasias Vaginais/tratamento farmacológico , Adulto , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Disuria , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Imagem por Ressonância Magnética , Dor Pélvica , Prednisona/uso terapêutico , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Rituximab/uso terapêutico , Ultrassonografia , Neoplasias Vaginais/diagnóstico por imagem , Vincristina/uso terapêutico
13.
BJOG ; 127(4): 448-454, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31769577

RESUMO

OBJECTIVE: To study the risk of vaginal cancer among hysterectomised women with and without cervical intraepithelial neoplasia (CIN). DESIGN: Population-based national cohort study. SETTING AND POPULATION: All Swedish women, 5 million in total, aged 20 and up, 1987-2011 using national registries. METHODS: The study cohort was subdivided into four exposure groups: hysterectomised with no previous history of CIN3 and without prevalent CIN at hysterectomy; hysterectomised with a history of CIN3/adenocarcinoma in situ (AIS); hysterectomised with prevalent CIN at hysterectomy; non-hysterectomised. MAIN OUTCOME MEASURE: Vaginal cancer. RESULTS: We identified 898 incident cases of vaginal cancer. Women with prevalent CIN at hysterectomy and those with a history of CIN3/AIS had incidence rates (IR) of vaginal cancer of 51.3 (95% CI 34.4-76.5) and 17.1 (95% CI 12.5-23.4) per 100 000, respectively. Age-adjusted IR-ratios (IRRs) compared with hysterectomised women with benign cervical history were 21.0 (95% CI 13.4-32.9) and 5.81 (95% CI 4.00-8.43), respectively. IR for non-hysterectomised women was 0.87 (95% CI 0.81-0.93) and IRR was 0.37 (95% CI 0.30-0.46). In hysterectomised women with prevalent CIN, the IR remained high after 15 years of follow up: 65.7 (95% CI 21.2-203.6). CONCLUSIONS: Our findings suggest that hysterectomised women with prevalent CIN at surgery should be offered surveillance. Hysterectomised women without the studied risk factors have a more than doubled risk of contracting vaginal cancer compared with non-hysterectomised women in the general population. Still, the incidence rate does not justify screening. TWEETABLE ABSTRACT: High risk of contracting vaginal cancer among hysterectomised women having prevalent CIN at surgery.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Histerectomia/estatística & dados numéricos , Neoplasias Vaginais/epidemiologia , Adulto , Estudos de Casos e Controles , Neoplasia Intraepitelial Cervical/etiologia , Neoplasia Intraepitelial Cervical/cirurgia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia , Neoplasias Vaginais/etiologia , Neoplasias Vaginais/cirurgia
14.
Int J Cancer ; 146(6): 1514-1522, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31173641

RESUMO

The study aim was to describe human papillomavirus (HPV)-attributable cancer burden in Rwanda, according to anogenital cancer site, HPV type, age and HIV status. Tissue specimens of cervical, vulvar, vaginal, penile and anal cancer diagnosed in 2012-2018 were retrieved from three cancer referral hospitals and tested for high-risk (HR) HPV DNA. Cervical cancer represented the majority of cases (598 of 738), of which 96.0% were HR-HPV positive. HPV-attributable fractions in other cancer sites varied from 53.1% in 81 penile, through 76.7% in 30 vulvar, 83.3% in 24 vaginal, up to 100% in 5 anal cases. HPV16 was the predominant HR-HPV type in cervical cancer (55.0%), followed by HPV18 (16.6%) and HPV45 (13.4%). HPV16 also predominated in other cancer sites (60-80% of HR-HPV-attributable fraction). For cervical cancer, type-specific prevalence varied significantly by histology (higher alpha-9 type prevalence in 509 squamous cell carcinoma vs. higher alpha-7 type prevalence in 80 adenocarcinoma), but not between 501 HIV-negative and 97 HIV-positive cases. With respect to types targeted, and/or cross-protected, by HPV vaccines, HPV16/18 accounted for 73%, HPV31/33/45/52/58 for an additional 22% and other HR-HPV types for 5%, of HPV-attributable cancer burden, with no significant difference by HIV status nor age. These data highlight the preventive potential of the ongoing national HPV vaccination program in Rwanda, and in sub-Saharan Africa as a whole. Importantly for this region, the impact of HIV on the distribution of causal HPV types was relatively minor, confirming type-specific relevance of HPV vaccines, irrespective of HIV status.


Assuntos
Neoplasias do Ânus/virologia , Neoplasias dos Genitais Femininos/virologia , Infecções por HIV/virologia , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Neoplasias Penianas/virologia , Adulto , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/patologia , Estudos Transversais , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/patologia , Genótipo , Infecções por HIV/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Neoplasias Penianas/epidemiologia , Neoplasias Penianas/patologia , Prevalência , Ruanda/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Neoplasias Vaginais/epidemiologia , Neoplasias Vaginais/patologia , Neoplasias Vaginais/virologia , Neoplasias Vulvares/epidemiologia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/virologia
16.
J Low Genit Tract Dis ; 24(1): 43-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31860574

RESUMO

OBJECTIVES: The aim of the study was to analyze the clinical features of women found to have vaginal intraepithelial neoplasia (VaIN), the treatment modalities that they were offered, and clinical outcomes after treatment and follow-up. MATERIALS AND METHODS: This is a retrospective review of all cases of biopsy-proven or treated VaIN occurring for a 15-year period at Southend University Hospital, United Kingdom. RESULTS: Eighty-eight cases of VaIN were identified. The age range was from 24 to 76 years, and 39% of cases were low grade (VaIN 1) and 60% high grade (VaIN 2 and 3). Sixty-five percent of patients had either already undergone or would go on to have treatment for cervical intraepithelial neoplasia. Of those with low-grade disease, 86% were managed conservatively with a 97% success rate. Similarly, with high-grade disease, 77% were managed with laser treatment with a success rate of 76% for primary treatment. Of the 6 cases of high-grade disease treated conservatively, 50% subsequently needed active treatment. There was 1 case of progression to vaginal cancer (1.3%). CONCLUSIONS: Vaginal intraepithelial neoplasia remains an uncommon premalignant condition. It can affect women of all ages and is commoner in those who are immunosuppressed. Observation of low-grade disease is safe and the abnormality often resolves spontaneously. For persistent disease or higher-grade abnormalities, there are many treatment options but laser vaporization is the most commonly used. However, because of the nature of VaIN, recurrence is common even after treatment and further management can be challenging. The overall rate of malignant progression is small but protracted follow-up may be necessary.


Assuntos
Carcinoma in Situ/patologia , Carcinoma in Situ/terapia , Gerenciamento Clínico , Neoplasias Vaginais/patologia , Neoplasias Vaginais/terapia , Adulto , Idoso , Carcinoma in Situ/diagnóstico , Feminino , Hospitais , Humanos , Terapia a Laser , Pessoa de Meia-Idade , Observação , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido , Neoplasias Vaginais/diagnóstico , Adulto Jovem
17.
World J Surg Oncol ; 17(1): 206, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801560

RESUMO

BACKGROUND: Malignant transformation of endometriosis in the rectovaginal septum is rare and usually misdiagnosed as a colorectal or gynecological tumor. We report a rare case of primary endometrioid adenocarcinoma of the rectovaginal septum with invasion of the rectum. CASE PRESENTATION: A 57-year-old overweight woman presented with vaginal bleeding and self-reported left lower abdominal pain during the previous 2 weeks. Preoperative imaging showed a large pelvic mass with invasion of the rectum, suggestive of a gynecologic malignancy. Multiple endoscopic biopsies and immunohistochemical analyses of specimens was performed. The patient received joint gynecological-surgical laparotomy, and there were no intra- or postoperative complications. The histopathological diagnosis was rectovaginal endometrioid adenocarcinoma with rectum infiltration. The patient received adjuvant chemotherapy and achieved good treatment response, with no early complications. At 12 months after surgery, there was no evidence of recurrence. CONCLUSIONS: A high index of clinical suspicion is required for the diagnosis of endometrioid adenocarcinoma in the rectovaginal septum. Surgery combined with additional chemotherapy or radiotherapy seems to be a standard treatment, and hormonal therapy is optional. The efficacies of other therapies, including targeted medication and immunotherapy, are unknown.


Assuntos
Adenocarcinoma/patologia , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Neoplasias Retais/patologia , Neoplasias Vaginais/patologia , Adenocarcinoma/complicações , Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Endometrioide/complicações , Carcinoma Endometrioide/terapia , Terapia Combinada , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/terapia , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Neoplasias Retais/complicações , Neoplasias Retais/terapia , Neoplasias Vaginais/complicações , Neoplasias Vaginais/terapia
18.
Asian Pac J Cancer Prev ; 20(12): 3805-3810, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31870125

RESUMO

INTRODUCTION: Endometrial cancer (EC) is a leading cause of female cancer in developed countries. The total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymph node dissection is the primary management of endometrial cancer. Afterwards vaginal brachytherapy can be preferred either alone or combined with external beam radiotherapy to avoid the vault recurrence. This study was to assess the in-house multichannel applicator for HDR vaginal brachytherapy and dosimetric compression with the single channel applicator through DVHs. The main objective of this study was to design and development of an in-house multichannel applicator for HDR vaginal brachytherapy and dosimetric compression with the single channel applicator through DVHs. MATERIALS AND METHODS: The multichannel applicator is a solid cylinder with 3 cm diameter, 13 cm length. It has a central channel surrounded by eight channels with a periphery arrangement in a single circle. We randomly selected eleven patients with endometrial carcinoma and 7Gy/per fraction of HDR dose was prescribed to CTV. Retrospectively, two 3D inverse treatment plans were created for each patient, with single channel loading and multichannel loading and the dose distribution of both plans could be compared. CTV coverage, rectum and bladder doses were compared. RESULTS: The DVH analysis showed statistically significant difference between single and multichannel plan, that is for D95 of CTV (p=0.008), D100 of CTV (p=0.004) and 2cc of CTV (p=0.003). The p value for 1cc, 2cc and V70 are 0.003, 0.003 and 0.003 for rectum. On the other hand, bladder DVHs showed large difference between single and multichannel plan yet it is not statistically significant, and the p values for 1cc, 2cc and V 80 are 0.012, 0.009 and 0.225. CONCLUSION: The authors conclude that in house multichannel applicator with 3D inverse treatment planning techniques improves the dosimetric advantage over single channel applicators.


Assuntos
Braquiterapia/instrumentação , Neoplasias do Endométrio/radioterapia , Desenho de Equipamento/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias Vaginais/radioterapia , Adulto , Idoso , Braquiterapia/métodos , Feminino , Seguimentos , Humanos , Histerectomia/métodos , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Prognóstico , Dosagem Radioterapêutica
19.
Rev. colomb. obstet. ginecol ; 70(4): 266-276, oct.-dic. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1093049

RESUMO

RESUMEN Objetivo: presentar el caso de una paciente con síndrome de Mayer-Rokitansky-Küster-Hauser, con diagnóstico de carcinoma escamoso en neovagina, y realizar una revisión de la literatura del tratamiento y pronóstico de las neoplasias o la infección por VPH de tejidos neovaginales en mujeres transgénero o con síndrome MRKH. Materiales y métodos: mujer de 56 años de edad que consulta en un hospital universitario regional de la ciudad de Sevilla (España). Tras la exploración clínica se aprecia una tumoración exofítica en fondo de vagina, con resultado de biopsia de carcinoma escamoso y cultivo positivo para virus del papilloma humano (VPH) tipo 16. Se realizó una búsqueda bibliográfica en la base de datos Medline vía PubMed, con los términos: "congenital abnormalities"; "mullerian aplasia"; "neovagina"; "vaginal neoplasms"; "squamous carcinoma"; "HPV infection", de reportes y series de caso, y estudios observacionales publicados desde el año 2000 hasta octubre de 2019 en inglés y español. Resultados: se incluyeron 14 estudios; de estos, siete correspondieron a carcinoma escamocelular, tres a adenocarcinoma y cuatro informan infección solo por VPH. Todos los carcinomas escamocelulares presentaban estadios avanzados por compromiso local o linfático y recibieron radioterapia con quimioterapia concomitante o cirugía radical. El pronóstico fue malo en tres de los casos. Las pacientes con adenocarcinoma también presentaron lesiones avanzadas con compromiso local, el tratamiento fue quirúrgico, con quimioterapia concomitante en dos de los casos. Solo una paciente tuvo seguimiento mayor a cinco años. La infección por VPH es frecuente en mujeres sometidas a construcción de neovagina. Conclusiones: las pacientes con neovagina son susceptibles de desarrollar carcinomas escamosos si se utilizaron injertos cutáneos, o adenocarcinomas en aquellas en las que se reconstruyó la vagina a partir de injertos tisulares intestinales. Dado que al momento del diagnóstico presentan compromiso local, a menudo requieren tratamientos radicales o combinados. Se debe investigar cuáles son las mejores estrategias de tamizaje de VPH, cáncer escamoso y adenocarcinoma en este tipo de pacientes.


ABSTRACT Objective: To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment and prognosis of vaginal neoplasms or HPV infection in transgender women or with MRKH syndrome. Materials and methods: A 56-year-old woman consulted to the Hospital Universitario of Sevilla (Spain). During the clinical examination, a exophytic tumor at the bottom of the vagina was found and the biopsy reported squamous carcinoma and positive nucleic acid amplification test for human papilloma (HPV) type 16. A literature search of case reports, case series and observational studies published from 2000 to October 2019 in English and Spanish was performed in Medline via PubMed, with the following terms: "congenital abnormalities"; "Mullerian aplasia"; "neovagina"; "Vaginal neoplasms"; "Squamous carcinoma"; "HPV infection" was performed. Results: 14 studies were finally included; seven corresponded to squamous cell carcinoma, three to adenocarcinoma and four reported HPV infection only. All of the squamous cell carcinomas were at advanced stages due to local or lymphatic compromise and received radiotherapy with concomitant chemotherapy or radical surgery. The prognosis was bad in three of the cases. Patients with adenocarcinoma also presented with advanced lesions due to local extensión and received surgical treatment and two cases received concomitant chemotherapy. Only one patient was followed-up for five years or more. HPV infection is common in women who underwent neovagina reconstruction. Conclusions: Patients with neovagina are susceptible to develope squamous carcinomas or adenocarcinomas depending if skin or intestinal tissue grafts are used. According to local compromise at the time of diagnosis, radical or combined treatments are required. Which screening strategies for HPV, squamous cell carcinomas and adenocarcinoma is to be investigated.


Assuntos
Humanos , Feminino , Carcinoma de Células Escamosas , Anormalidades Congênitas , Neoplasias Vaginais , Infecções por Papillomavirus
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA