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1.
Dermatol Online J ; 26(7)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32898403

RESUMO

Poorly controlled and long-standing hidradenitis suppurativa (HS) increases the risk of squamous cell carcinoma (SCC). We report a 54-year-old woman with an over 20-year history of HS, who had previously undergone wide perineal excision with secondary intention healing and presented with a painful verrucous vulvar plaque and proximal non-healing perineal wound. The patient had four perineal scouting biopsies performed and excisional biopsy with no evidence of high-grade dysplasia or carcinoma on histology. Chromogenic in situ hybridization was negative for HPV 16 and 18 mRNA; the patient's HIV and HSV PCR were also negative. Our patient was treated with interferon alfa-2b with notable clinical improvement. There is currently no standardized stepwise approach to monitoring verrucous lesions in HS patients with significant risk factors for SCC. Our report highlights a vigilant approach to monitoring. If scouting biopsies are negative, complete testing for high risk HPV strains (HPV 16 and 18) is warranted. If negative, we recommend follow up every 6 months with no further biopsies except if overt clinical changes are observed. We also recommend treatment of verrucous changes to decrease risk of possible malignant conversion. Interferon alfa-2b was effective in decreasing the verrucous lesion burden in our patient and may be considered.


Assuntos
Hidradenite Supurativa/complicações , Interferon alfa-2/uso terapêutico , Verrugas/tratamento farmacológico , Biópsia , Carcinoma de Células Escamosas/prevenção & controle , Transformação Celular Neoplásica , Condiloma Acuminado/patologia , Diagnóstico Diferencial , Feminino , Hidradenite Supurativa/cirurgia , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Períneo/patologia , RNA Viral/análise , Falha de Tratamento , Vulva/patologia , Verrugas/etiologia , Cicatrização
2.
Maturitas ; 140: 72-79, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32616374

RESUMO

OBJECTIVE: we aimed to explore the use of an estro-androgenic symptom questionnaire in women (EASQ-W), including items typically associated with menopausal hypoestrogenism and some others possibly related to androgen insufficiency that may be relevant to further characterize women reporting VVA/GSM at midlife. METHODS: web-based survey involving a representative sample of 1505 Italian women (age range: 40-65 years). The responders completed a structured, online questionnaire, reporting symptoms (yes/no option) and rating them (from 1 to 10), if present during the past 4 weeks. A factor analysis methodology (principal component analysis and K-MEANS clustering algorithm) was used to segment women. Statistically significant differences between groups were determined at the 95 % level of confidence. RESULTS: more than half of our study sample were aged 50-65 years (n = 901; 59.9 %) and 55 % were postmenopausal women (PMW). We obtained 8 principal domains of the EASQ-W with PMW reporting significantly more severe symptoms in the majority of domains related to well-being at mid-life. The K-MEANS clustering algorithm identified 4 clusters of women characterized by different symptoms: vasomotor (VMS; n = 341), sexual (SEX; n = 301), poorly symptomatic (LOWSYMPT; n = 766), sexual and anatomic, mainly at genital level (SEX + ANAT; n = 97), independently from the menopausal status. The cluster SEX + ANAT was the one reporting overall more symptoms in each of the other principal domains. Some symptoms (impression of being diminished in height, deterioration in work performance, more memory lapses/confusion than before, more wrinkles/signs of aging in the mirror, put on more tummy than usual) and the entire urological (UROL) cluster were significantly more reported by women in the cluster SEX + ANAT. Even when only severe symptoms were analysed, women in the SEX + ANAT cluster were the ones more symptomatic. The SEX only cluster identified younger women, with significantly less day and night hot flushes and sweats and less vaginal dryness and low lubrication associated with sexual pain as compared to SEX + ANAT. CONCLUSION: our results provide insight into the constellation of symptoms associated with VVA/GSM by identifying women with distinct clusters of complaints that may require a tailored diagnostic and therapeutic approach across age and menopause.


Assuntos
Doenças Urogenitais Femininas/patologia , Vagina/patologia , Vulva/patologia , Adulto , Idoso , Atrofia , Análise por Conglomerados , Feminino , Inquéritos Epidemiológicos , Fogachos , Humanos , Internet , Itália , Menopausa , Pessoa de Meia-Idade , Sudorese , Avaliação de Sintomas
3.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(2): 58-60, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-191315

RESUMO

Las úlceras genitales constituyen un motivo frecuente de consulta en urgencias, especialmente en ginecología. Sin embargo, debido a la baja frecuencia de algunas de ellas, junto con el amplio diagnóstico diferencial que puede plantear cada caso, hacen que el diagnóstico de dichas lesiones, en ocasiones, sea difícil o erróneo. Presentamos el caso de una paciente menopáusica que consultó por una úlcera genital, cuyo diagnóstico fue de carcinoma basocelular. El conocimiento de esta entidad y sus hallazgos clínicos característicos, junto con una correcta anamnesis, permitirán realizar un apropiado diagnóstico de sospecha, facilitando el manejo de estas pacientes y evitando exploraciones innecesarias


Genital ulcers are a common reason for consultation in the emergency department, especially in Gynaecology. However, due to the low frequency of some of them, together with the wide differential diagnosis that can arise in each case, the diagnosis of these lesions can sometimes be difficult or erroneous. We present the case of a menopausal patient that consulted due to a genital ulcer, and was diagnosed with of basal cell carcinoma. The knowledge of this entity and its characteristic clinical findings, together with a correct anamnesis, will lead to an appropriate diagnostic suspicion, facilitating the management of these patients, and avoiding unnecessary examinations


Assuntos
Humanos , Feminino , Idoso , Vulva/lesões , Úlcera/diagnóstico , Doenças da Vulva/etiologia , Carcinoma Basocelular/diagnóstico , Vulva/patologia , Prurido Vulvar/complicações , Úlcera/etiologia , Úlcera/patologia , Doenças da Vulva/patologia , Doenças da Vulva/terapia , Diagnóstico Diferencial
5.
Maturitas ; 135: 34-39, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32252962

RESUMO

OBJECTIVES: To evaluate the safety of and patient satisfaction with fractional CO2 laser for the treatment of vulvo-vaginal atrophy (VVA) in postmenopausal patients. STUDY DESIGN: Patients affected by VVA were considered for the study. All women were treated using a Lumenis AcuPulse DUO (Lumenis, Yokneam, Israel) in fractionated mode with a 28 mm probe, FemTouch™. Pain during different steps of the procedure (introduction, rotation and extraction of probe and laser impulse transmission) was evaluated on a 7-point Likert scale. The occurrence of side-effects was evaluated at the end of the procedure, and in the three-month follow-up (after the last treatment) complications were classified as 'early' (occurring within 30 days) or late (after 30 days). Participant satisfaction was measured on a 7-point Likert scale (1= strongly disagree, 7= strongly agree). The institutional review board approved the study protocol. RESULTS: Fifty-three women were enrolled in the study. No severe complications occurred after a median follow-up of six months. One patient (1.9 %) reported dizziness immediately after treatment, which completely resolved within 15 min. A minor bleeding occurred related to tip introduction and rotation. One patient (1.9 %) aborted the procedure because of discomfort on probe introduction but decided to repeat the procedure after two weeks. Two patients (3.7 %) reported symptoms of dysuria within 7 days of the procedure. The mean overall pain score at first treatment, evaluated on the 7-point Likert scale, was 3.57 ± 1.50. The mean pain scores related to probe introduction and rotation were 3.13 ± 1.37 and 2.32 ± 1.08, whereas pain scores for extraction and laser impulse transmission were 1.23 ± 0.27 and 1.13 ± 0.37 respectively. Mean overall pain score (1.27; CI 95 % 0.83-1.71, p < 0.001) and pain scores related to probe introduction (0.54; CI 95 % 0.18-0.90, p = 0.001) and probe rotation (0.46; CI 95 % 0.12-0.90, p = 0.003) all statistically significantly decreased between the first and third treatment (Fig. 1). Mean pain scores related to laser activation (0.01; CI 95 % -0.06 - 0.20, p = 0.07) and extraction (0.08; CI 95 % -0.04-0.19, p = 0.31) did not change over the course of treatment. Overall, patient satisfaction with the procedure was high: 89.7 % of patients would highly (value 5-7) recommend the procedure and 94.9 % would be ready to repeat the procedure to maintain results. Discomfort related to treatment was lower than expected for 41 % of patients (value 5-7) and as expected for 48.7 % (value 3-4). CONCLUSION: Fractional CO2 laser for treatment of VVA seems a safe therapeutic option. No severe complications occurred. A minority of patients reported mild complications, but these resolved without the need for treatment. Most discomfort was related to probe introduction and rotation. Overall, patients were highly satisfied, and they would repeat laser treatment.


Assuntos
Dióxido de Carbono/uso terapêutico , Lasers de Gás/uso terapêutico , Doenças Vaginais/cirurgia , Idoso , Atrofia/cirurgia , Feminino , Humanos , Israel , Pessoa de Meia-Idade , Satisfação do Paciente , Pós-Menopausa , Estudos Prospectivos , Resultado do Tratamento , Vagina/patologia , Vulva/patologia
6.
Int J Infect Dis ; 95: 153-156, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32311452

RESUMO

Herpes Simplex Virus (HSV) is the leading cause of genital ulcers worldwide. In Human Immunodeficiency Virus (HIV) co-infected individuals, rare hypertrophic pseudo-tumoral forms have been described as simulating squamous cell carcinoma or other viral infections such as those caused by Varicella zoster, Molluscum contagiosum and HPV induced lesions. Here, we report a case of hypertrophic genital herpes in an HIV-infected patient effectively treated with surgery and topical 5% imiquimod after the recurrence of lesions. A 45-year-old woman, HIV-positive for 17 years and on regular antiretroviral therapy, presented with a painful 2cm vulvar sessile lesion, a 1cm ulcerated lesion on the clitoral hood, and a slightly elevated lesion in the middle third of the tongue. Excisional biopsy and surgical removal of lesion were performed for histopathological exam. Histopathology of genital lesions showed evidence of chronic lymphoplasmacytic inflammation, intense ulcerated plasmacytosis, and squamous cells displaying HSV cytopathogenic effect. After three months, the patient presented with a new ulcerated perineal lesion. Histopathology showed evidence of chronic ulcerative-vegetative herpetic dermatitis. Consequently, topical 5% imiquimod was administered with successful results. Relapsing character and atypical genital disease evolution with an exophytic pseudotumoral injury have been noted in patients co-infected with HIV and HSV, necessitating anatomopathological recognition for diagnostic confirmation and exclusion of malignancy. Local immunotherapy should be considered as treatment approach.


Assuntos
Antivirais/uso terapêutico , Coinfecção , Infecções por HIV/complicações , Herpes Genital/tratamento farmacológico , Herpes Genital/patologia , Imiquimode/uso terapêutico , Feminino , Herpes Genital/complicações , Herpes Genital/diagnóstico , Humanos , Hipertrofia , Pessoa de Meia-Idade , Úlcera/patologia , Vulva/patologia
7.
Obstet Gynecol ; 135(2): 311-318, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31923074

RESUMO

OBJECTIVE: To compare pain control during vulvar biopsy after either application of 5% lidocaine-prilocaine cream or injection of 1% lidocaine. METHODS: In a single-site randomized trial, patients who needed vulvar biopsy on a non-hair-bearing surface were recruited from a gynecologic oncology clinic to compare lidocaine-prilocaine cream (placed at least 10 minutes before biopsy) with lidocaine injection (at least 1 minute prior). A sample size of 53 participants in each arm (N=106) was planned. Pain was recorded using a 100 mm visual analog scale at three time points: baseline, after application of anesthesia, and after biopsy. The primary outcome was highest pain score recorded. Secondary outcomes were pain score at biopsy, patient experience, and tolerability and acceptability. Linear regression was used to compare the primary outcome between arms while controlling for baseline vulvar pain. A convenience analysis was performed in March 2019. RESULTS: From October 2018 to March 2019, 38 patients completed informed consent and were randomized. Participants were women with median age of 60 years. Most characteristics between groups were similar. Nineteen were analyzed in the lidocaine-prilocaine group, and 18 were analyzed in the lidocaine injection group. The median highest pain score in the lidocaine-prilocaine group was 20.0 mm vs 56.5 mm in the lidocaine injection group. Controlling for baseline pain, the highest pain score in the lidocaine-prilocaine arm was 25.7 mm lower than in the lidocaine injection arm (95% CI [-45.1 to -6.3]; P<.01). Patients randomized to lidocaine-prilocaine had a significantly better experience than those receiving injected lidocaine (median experience score 2.0 mm vs 17.0 mm; P=.02). CONCLUSION: Lidocaine-prilocaine cream before vulvar biopsy resulted in a lower maximum pain score and a significantly better patient rating of the biopsy experience when compared with lidocaine injection. Lidocaine-prilocaine cream, alone, is a reasonable option to use for vulvar biopsy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03654417.


Assuntos
Biópsia por Agulha/métodos , Combinação Lidocaína e Prilocaína/uso terapêutico , Lidocaína/uso terapêutico , Bloqueio Nervoso/métodos , Vulva/patologia , Idoso , Anestésicos Locais/uso terapêutico , Feminino , Humanos , Injeções , Modelos Lineares , Pessoa de Meia-Idade , Pomadas , Dor/prevenção & controle , Manejo da Dor , Medição da Dor , Satisfação do Paciente , Períneo , Vulva/cirurgia
8.
Support Care Cancer ; 28(6): 2507-2512, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31970513

RESUMO

PURPOSE: VVA is a common disease, with approximately 50% of all postmenopausal women having related symptoms. VVA has a significant impact on the personal and sexual lives and on many aspects of women's self-esteem and emotional well-being. It is particularly frequent and severe in patients treated for BC, where it originates significant economic and social costs. Given the lack of published evidence on this subject, a Delphi Panel was carried out to evaluate:The epidemiology of VVA and of its risk-factors/comorbidities in ItalyThe present standard of care and unmet medical needsThe comparison between recent US epidemiological data and the Italian situationThe health resources used in VVA BC The burden of illnessDespite the considerable negative impact on quality of life, a disparity between the high prevalence of this condition and the infrequent clinical diagnosis is documented in medical practice and in surveys. This inaccuracy is thought to be primarily a consequence of patients' unwillingness and/or reluctance to report symptoms in the clinical setting and of health-care professional's difficulty in approaching this sensitive topic during routine consultations. METHODS: A Delphi Panel methodology was used: a first round of written questionnaires, followed by a plenary meeting with a facilitator and by two additional rounds of telephone interviews. RESULTS: The prevalence of the condition in Italy can be estimated in 115,000 cases out of 380,000 BC survivors. The Panel confirmed that the epidemiological findings of a recent pharmacoeconomic analysis of a US claims database can be applied to Italian patient population. The Panel confirmed also an estimate of 4.25 additional cases/100/yr of UTI (urinary tract infection) in VVA BC patients (vs. a non-VVA-matched population), of 3.68 additional cases of vulvovaginitis, of 6.97 cases of climacteric symptoms, and of 3.64 cases of bone and joint disorders. As far as the resource use is concerned, in the VVA BC populations, 33.4 additional gynecological visits/100/year can be expected, along with 22.8 additional cancer screenings, 7.07 additional outpatient visits and 5.04 screenings for HPV. CONCLUSIONS: Even in Italy, a diagnosis of VVA, especially in a BC population, is associated with a relevant increase in the burden of illness and social costs, compared to a control population matched for age without VVA. This is due essentially to an increase in comorbidities and resource utilization with the consequence that an adequate treatment could reduce the impact of the condition.


Assuntos
Neoplasias da Mama/patologia , Vagina/patologia , Vulva/patologia , Atrofia/epidemiologia , Neoplasias da Mama/epidemiologia , Sobreviventes de Câncer , Técnica Delfos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Pós-Menopausa , Prevalência , Qualidade de Vida , Comportamento Sexual , Inquéritos e Questionários
9.
Clin Exp Dermatol ; 45(2): 187-193, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31389062

RESUMO

BACKGROUND: Vulvar melanoma (VM) is rare and is often diagnosed late. Dermoscopy may aid in its recognition, differentiating VM from other more common vulvar lesions, such as melanosis and naevi. However, little is known about the dermoscopic features of thin VM. AIM: To retrospectively analyse a series of histopathologically diagnosed thin VMs and to highlight their most suggestive dermoscopic features. METHODS: A multicentre, retrospective study was conducted, including histopathologically proven thin VMs, either intraepidermal or with Breslow thickness ≤ 0.5 mm, diagnosed during the period 2016-2018. We particularly focused on their dermoscopic characteristics to highlight the most suggestive dermoscopic diagnostic clues. RESULTS: In total, 14 cases of early-stage VM were included, in women with a mean age at diagnosis of 64.86 years. The most frequently affected sites were the labia minora. Of these, 11 cases were unifocal. Dermoscopy most often revealed structureless areas, grey globules and areas, irregular black-brown dots, blue and white structures, and red areas. CONCLUSIONS: In our experience, early-stage VM often exhibits dermoscopic features that are more typical of thicker cutaneous melanomas. Dermoscopy may provide useful clues for the prompt diagnosis of thin VM.


Assuntos
Dermoscopia , Melanoma/patologia , Vulva/patologia , Neoplasias Vulvares/patologia , Idoso , Idoso de 80 Anos ou mais , Dermoscopia/métodos , Feminino , Genitália Feminina/patologia , Humanos , Melanoma/diagnóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Vulvares/diagnóstico
10.
Urology ; 135: 11-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605681

RESUMO

OBJECTIVE: To elucidate current understanding on the pathophysiological mechanism of genital lichen sclerosus (LS), urologic manifestations, and treatment options. MATERIALS AND METHODS: The Medline/PubMed and Embase databases were systematically reviewed for publications pertaining to LS. After applying inclusion and exclusion criteria, references were assessed for relevance to the pathophysiology, presentation, and treatment of LS by title and abstract review by 2 independent reviewers, yielding 186 articles for assessment. RESULTS: The contemporary understanding of the epidemiology and histology of LS is reviewed herein. Additionally, we explore in detail the 3 hypotheses regarding the pathophysiological mechanism contributing to disease presentation: infectious etiology, primary immune dysregulation, and the isotraumatopic response. We summarize the available biological evidence supporting each hypothesis. This discussion provides context for understanding LS morbidity and may spur new avenues of research. For the clinician, we review the clinical presentation of disease, including the risk of progression to squamous cell carcinoma. The current medical and surgical treatment options are also detailed. CONCLUSION: LS remains a potentially insidious disease which may lead to debilitating urinary and sexual dysfunction. Cross disciplinary research should aim for earlier detection, as well as more effective and durable treatment. The exact cause of LS remains unknown.


Assuntos
Balanite Xerótica Obliterante/diagnóstico , Líquen Escleroso e Atrófico/diagnóstico , Líquen Escleroso Vulvar/diagnóstico , Administração Tópica , Balanite Xerótica Obliterante/epidemiologia , Balanite Xerótica Obliterante/terapia , Biópsia , Circuncisão Masculina , Diagnóstico Diferencial , Progressão da Doença , Feminino , Glucocorticoides/uso terapêutico , Humanos , Líquen Escleroso e Atrófico/epidemiologia , Líquen Escleroso e Atrófico/terapia , Masculino , Pênis/patologia , Pênis/cirurgia , Prevalência , Resultado do Tratamento , Vulva/patologia , Líquen Escleroso Vulvar/tratamento farmacológico , Líquen Escleroso Vulvar/epidemiologia
11.
Histopathology ; 76(1): 128-138, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31846523

RESUMO

Vulval squamous cell carcinoma (VSCC) can arise through two distinct pathways [human papillomavirus (HPV)-associated and HPV-independent], and these VSCC variants are recognised as different disease entities on the basis of different aetiologies, morphological features, molecular events during oncogenesis, precursor lesions, prognosis, and response to treatment. The precursor of HPV-associated VSCC, variously referred to as high-grade squamous intraepithelial lesion (HSIL) [vulvar intraepithelial neoplasia (VIN) 2/3] or usual-type VIN, is morphologically identical to the more common HSIL (cervical intraepithelial neoplasia 2/3) of the cervix. The precursor lesions of HPV-independent VSCC include differentiated VIN, differentiated exophytic vulvar intraepithelial lesion, and vulvar acanthosis with altered differentiation; these have been under-recognised by pathologists in the past, leading to delays in treatment. This review will discuss the recent advances in diagnostic surgical pathology of VSCC and its precursors, and how these diagnoses can impact on patient management.


Assuntos
Carcinoma de Células Escamosas/patologia , Infecções por Papillomavirus/patologia , Vulva/patologia , Neoplasias Vulvares/patologia , Feminino , Humanos , Papillomaviridae , Infecções por Papillomavirus/virologia , Lesões Pré-Cancerosas/patologia
12.
Urologiia ; (5): 150-154, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808652

RESUMO

The symptoms of genitourinary syndrome of menopause are considered as typical for late menopausal period. However, these symptoms are increasingly diagnosed in perimenopausal and early menopausal period. Women seldom seek medical care, since autonomic menopausal symptoms are usually more bothersome. In many cases, doctors are not sure in necessity of any hormonal replacement. Moreover, a confusion still exists between systemic hormone replacement therapy (HRT) and local estrogen preparations. Besides moisturizers and local intravaginal estrogens, novel treatment modalities have emerged that extend therapeutic armamentarium.


Assuntos
Atrofia/terapia , Menopausa , Disfunções Sexuais Fisiológicas/terapia , Vagina/patologia , Doenças Vaginais/terapia , Vulva/patologia , Atrofia/diagnóstico , Atrofia/etiologia , Consenso , Feminino , Humanos , Lubrificantes/uso terapêutico , Reino Unido
13.
Praxis (Bern 1994) ; 108(16): 1085-1090, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31822232

RESUMO

Inflammatory Diseases of the Vulva - a Dermatologist's Point of View Abstract. Inflammatory vulvar diseases include a variety of disorders - many of which have a chronic course with significant morbidity. Diagnosis and especially treatment can be challenging for the clinician and warrant an interdisciplinary approach. This review covers the most common non-infectious and non-malignant vulvar diseases - from a dermatological point of view. The typical clinical symptoms, clinical appearances, treatment modalities of the main non-infectious vulvar diseases are highlighted; additionally, important dermatological differential diagnoses which should not be forgotten will be mentioned.


Assuntos
Inflamação , Doenças da Vulva , Dermatologistas , Diagnóstico Diferencial , Feminino , Humanos , Vulva/patologia , Doenças da Vulva/diagnóstico
14.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(4): 170-175, oct.-dic. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-184307

RESUMO

Introducción: Los quistes y abscesos de Bartholin pueden producirse en cerca del 2% de las consultas ginecológicas por año. Se han propuesto diferentes tipos de tratamientos (punción, marsupialización, esclerosis, escisión de la glándula, etc.), con porcentajes diferentes de recurrencia y complicaciones. Presentamos 5 casos en los que tras practicar escisión completa de la glándula por enfermedad benigna, aparecen como complicación tardía el dolor vulvar y la distorsión anatómica. Objetivo: Analizar los casos, así como su repercusión en la calidad de vida posterior. Resultados: Ante la enfermedad benigna de la glándula de Bartholin (quística abscesificada o no) debemos mantener la glándula para que siga ejerciendo su función y valorar la funcionalidad posterior, utilizando para este fin los test de calidad de vida en ese seguimiento que incluya la sexualidad. Por último, debemos mejorar nuestras prácticas asistenciales y, en caso de una evolución tórpida, no permitir la cronificación del estímulo doloroso


Introduction: Bartholin cysts and abscesses may occur in about 2% of gynaecological cases per year. Different types of treatment (puncture, marsupialisation, sclerosis, excision of the gland, etc.) have been proposed, with different percentages of recurrence and complications. A series of 5 cases are presented, in which, after practicing complete excision of the gland due to benign disease, vulvar pain and anatomic distortion appeared as late complications. Objective: To analyse the results based on the technique used, including the importance of late complications (pain and anatomical distortion), as well as their impact on the quality of later life. Results: Given the benign disease of the Bartholin gland (abscess or cyst), the gland must be maintained so that it can continue fulfilling its role. Its future functioning can be assessed during follow-up by using a quality of life test that includes sexuality. Finally, care practices in these patients must be improved, especially in the case of a slow progress, not allowing the development of chronic pain stimulus


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Glândulas Vestibulares Maiores/cirurgia , Qualidade de Vida , Doenças da Vulva/cirurgia , Glândulas Vestibulares Maiores/patologia , Doenças da Vulva/complicações , Vulva/patologia , Vulva/cirurgia , Sexualidade , Hipertonia Muscular/patologia , Hipertonia Muscular/cirurgia
15.
Dermatol Online J ; 25(9)2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31738847

RESUMO

The diagnosis of primary systemic amyloidosis, also known as AL (amyloid light-chain) amyloidosis, is often delayed owing to its nonspecific manifestations as well as its rarity. A 64-year-old woman presented with an eight-month history of significant weight loss, anemia, fatigue, and progressive painful cutaneous lesions on her hands, lips, back, perianal, and vulvar area that were originally treated unsuccessfully with antimalarials and systemic corticosteroids. Histopathological examination revealed an amorphous dermis with pale pink material that demonstrated positive birefringence with Congo red staining. Subsequently, the patient underwent a bone marrow biopsy, which uncovered a plasma cell myeloma, the source of her amyloidogenic protein production.


Assuntos
Amiloidose de Cadeia Leve de Imunoglobulina/etiologia , Mieloma Múltiplo/diagnóstico , Pele/patologia , Exame de Medula Óssea , Feminino , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/patologia , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/patologia , Vulva/patologia , Doenças da Vulva/patologia
16.
Medicine (Baltimore) ; 98(42): e17423, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626099

RESUMO

RATIONALE: Smooth muscle tumors of the vulva are infrequent neoplasms with diverse histologic features and unclear biologic behavior. Herein, we report a very rare case of vulvar epithelioid leiomyoma and review of previous reported cases of these tumors. In addition, we have discussed the representative diagnostic criteria of vulvar smooth muscle tumors and prognostic significance of epithelioid morphology. PATIENT CONCERNS: We recently met a 45-year-old woman with complaint of painful vulvar mass. INTERVENTIONS: Excisional biopsy was performed. DIAGNOSES: Pathologic examination revealed a vulvar epithelioid leiomyoma with multinodular growth pattern. Mitotic activity was rare and cellular atypia was not identified. Based on histology and immunohistochemical staining results, the case was diagnosed as vulvar epithelioid leiomyoma. OUTCOMES: After mass excision, the patient was discharged with no complication and there was no evidence recurrence for 6 months. LESSONS: After reviewing previous papers and diagnostic criterion, we thought that vulvar smooth muscle tumors with predominant epithelioid morphology may be associated with unfavorable prognosis, Therefore, pathologists should examine the epithelioid component in vulvar smooth muscle tumors carefully.


Assuntos
Leiomioma Epitelioide/patologia , Mixoma/patologia , Tumor de Músculo Liso/patologia , Neoplasias Vulvares/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Vulva/patologia
18.
Medicine (Baltimore) ; 98(41): e17018, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593076

RESUMO

Paget's disease can arise in the breast (mammary Paget disease) or in other locations (extramammary Paget disease) such as anogenital skin in both males and females (Paget disease of the vulva [PDV]). Underlying adenocarcinoma can be found in some cases. This study aims to report clinical aspects, surgical procedures, outcomes, and recurrences of patients with PDV.A retrospective chart review was conducted on patients with pathologically confirmed diagnosis of PDV managed at the Department of Obstetrics and Gynecology, University of Bari, and the "Giovanni Paolo II" National Cancer Institute in Bari, between 1998 and 2018.Records of 24 cases of PDV were examined. Median age of the patients at diagnosis was 69.3 (range 38-84), diagnosis of synchronous cancer was made in 2 cases and in 2 other cases of metachronous disease. Three patients had previously been diagnosed with other oncological diseases. All patients underwent surgery including wide local excision (6), simple vulvectomy (8), and extended vulvectomy (10). Lymphadenectomy was performed in 2 cases and reconstructions with advancement flaps in 7 cases. Four patients were found to have invasive disease and 1 had inguinal node involvement. Positive margins were found in 11 patients. Wound dehiscence and urethral stenosis were found in 4 and 1 case each. Eight recurrences (33.33%) were observed, regardless of positive surgical margins.PDV has a low rate of malignancy but a high rate of recurrence. It should be diagnosed early to avoid repeated surgery and to reduce symptoms and morbidity.


Assuntos
Adenocarcinoma/patologia , Doença de Paget Extramamária/patologia , Neoplasias Vulvares/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Doença de Paget Extramamária/cirurgia , Estudos Retrospectivos , Vulva/patologia , Vulva/cirurgia , Neoplasias Vulvares/cirurgia
19.
Rev Bras Ginecol Obstet ; 41(9): 575-578, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31480076

RESUMO

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.


Assuntos
Doenças Urogenitais Femininas , Tuberculose Pulmonar/complicações , Tuberculose Urogenital , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Feminino , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/tratamento farmacológico , Doenças Urogenitais Femininas/patologia , Humanos , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/patologia , Vulva/patologia
20.
Breast Cancer Res Treat ; 178(1): 135-140, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377895

RESUMO

PURPOSE: Vulvovaginal atrophy (VVA) is a commonly reported issue among breast cancer patients, and its aetiology is multifactorial. Treatment is difficult in these women, particularly because the use of oestrogens has traditionally been discouraged. Vaginal laser treatment has been reported to improve symptoms. We aimed to assess the impact on symptoms and sexual function of vaginal laser in women with early breast cancer (EBC). METHODS: We performed a single-arm investigator initiated pilot study of female EBC patients with symptomatic VVA. A total of 3 vaginal laser treatments were administered 4 weeks apart. Questionnaires were completed at baseline, 4, 8 and 12 weeks. Our primary endpoint was symptomatic improvement of VVA at 12 weeks on 10 cm visual analogue scales. Our secondary endpoints were improvement in sexual function using the Female Sexual Function Index (FSFI) and patient-reported improvements in symptoms, sexual function and quality of life. Statistical analysis was performed with a Wilcoxon Signed Rank test. RESULTS: 26 patients were enrolled between February 2016 and August 2017. All patients were post-menopausal, 25 of whom had received anti-oestrogen therapy for their breast cancer. Questionnaire compliance was high (98%) and all patients received the three pre-planned treatments. There was significant improvement in each of the VVA symptoms: dryness (p < 0.001), itch (p < 0.001), burning (p = 0.003), dysuria (p < 0.001) and dyspareunia (p < 0.001). Patients also reported improvement in sexual function on the FSFI (p ≤ 0.001). CONCLUSIONS: Patients receiving vaginal laser had improvement in VVA symptoms and sexual function. Further randomised sham-controlled trials are needed to further assess this treatment.


Assuntos
Neoplasias da Mama/complicações , Lasers de Gás/uso terapêutico , Disfunções Sexuais Fisiológicas/cirurgia , Vagina/patologia , Vulva/patologia , Administração Intravaginal , Atrofia , Feminino , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Resultado do Tratamento , Vagina/cirurgia , Vulva/cirurgia
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