Vulvar Cancer Research Articles

Benign Vulvar Conditions: Comprehensive Overview

Benign ailments of organs surround a large spectrum of non-diseased environments that influence the genitalia of outdoor girls. These environments can cause pain, aches, and misery for the damaged objects. This review supports a concise survey of mild vulvar ailments and their dispassionate presentations, sickness, and management. Lichen sclerosis (LS) is a non-meansfinishing angering condition characterized by tingling, pain, and atrophic adjustments. Early acknowledgments and the state of affairs are sent via email to save you from never-ending confusion. Lichen planus provides accompanying mauve, polygonal papules, and erosions, and its management involves syndrome aid and immunosuppressive remedies, which are unavoidable. Vulvar dermatoses, together with touch rash and rash, frequently present with pruritus and call for identification and removal of determinants. Vulvar intraepithelial neoplasia (VIN) is characterized by pre-malignant changes in the vulvar skin. Welltimed disease and invasion are essential for the development of vulvar tumors. Bartholin gland cysts and abscesses can result in pain, lumps, seepage, and marsupialization. Vestibulodynia and vulvodynia are caused by incessant vulvar pain, making it essential to use multidisciplinary techniques for efficient management. Understanding favorable vulvar illnesses and their distinct dispassionate visages is vital for proper disease management and tailored treatment plans. This records healthcare thought providers to determine appropriate care, relieve signs, and upgrade the reputation of the boom for stirred people.

Benign vulvar tumors: A series of 60 cases

Benign vulvar tumors: A series of 60 cases

A Review of Latest Guidelines to Treat Lymphoedema Post Vulva Cancer

A Review of Latest Guidelines to Treat Lymphoedema Post Vulva Cancer

Prevalence of prescribing topical corticosteroids to patients with lichen sclerosus following surgery for vulvar cancer: a survey among gynaecologic oncologists in The Netherlands

Background Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis which can progress to precursor lesion differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar squamous cell carcinoma (VSCC). The risk of developing recurrent vulvar cancer following LS-associated VSCC is high. Evidence suggests that treatment of LS with topical corticosteroids (TCS) can prevent progression to dVIN, VSCC and recurrences. However, current guidelines do not give any recommendation on the management of LS following surgery for VSCC. The aim of this study was to conduct a survey among all registered gynaecologic oncologists (GOs) in the Netherlands to evaluate the current management of LS patients without a history of VSCC (LSnoVSCC) and patients with LS following surgery for VSCC (LSVSCC). Methods An online survey was distributed to all registered GOs in the Netherlands. Primary outcome measures were the frequency, type and duration of TCS treatment prescribed for LSnoVSCC and LSVSCC patients, separately. As a secondary outcome measure, reasons for treating or not treating patients with LSnoVSCC and LSVSCC with TCS were analysed. Results Forty-four GOs completed the survey, resulting in a response rate of 75%. TCS were prescribed more often to patients with LSnoVSCC as compared to patients with LSVSCC (86% versus 52%, respectively, p < 0.001). If treatment was initiated, ultra-potent (class IV) TCS were most commonly prescribed for an indefinite period of time for both patient groups. The most reported reason for treating patients in both groups with TCS was symptoms, followed by clinical aspects of the lesion and prevention of progression to dVIN and VSCC. Conclusion The majority of GOs who participated in our study endorse the utilisation of long-term ultra-potent TCS therapy in both patients with LSnoVSCC and LSVSCC. Nevertheless, Dutch GOs are currently prescribing TCS more frequently to patients with LSnoVSCC than to patients with LSVSCC.

Extensive Vulvectomy and Reconstructive Flaps for Advanced Vulvar Cancer in Young Woman: Case Reports

Introduction: : Vulvar cancer is a rare disease accounting for approximately 5% of female genital tract tumors worldwide. It is a squamous cell cancer that mostly affects older women over the age of 65. In the existing body of literature, no instances of vulvar cancer have been documented in the form of case reports. Therefore, this study aimed to report the challenges and outcomes of vulvectomy with reconstructive flap in vulvar cancer survivors in a 39-year-old woman. Case Presentation: A 39-year-old woman with a palpable lump around the vulva was present and being examined. The anatomic pathology report (APR) features suggested poorly differentiated malignant tumors. A neoadjuvant chemotherapy was then administered to the patient aimed at shrinking the size of the tumor. However, there was no effective response to the chemotherapy, which resulted in a progressive tumor. Extensive vulvectomy and reconstructive flap were carried out to support quality of life, and the outcomes were reported, including flap, survival, complications, and mortality. These outcomes were evaluated between November 2021 and March 2023. No total flap loss was observed, and neither was there any donor site morbidity or mortality during the process. Conclusions: This study showed that vulvar cancer was a rare condition at a young age. Advanced vulvar cancer was found in the patients and extensive vulvectomy surgery was carried out followed by a pedicled ALT flap. This option was currently the best for immediate reconstruction due to the preservation of sensibility and tissue availability in the donor areas. The result showed no wound dehiscence, marginal necrosis, or surgical site infection. After 15 months of follow-up, the flap was observed to have good vascularization. The association of the Gynecologist with the Plastic Surgeon offered palliative care to improve the quality of life of the patient and provide good postoperative results.

Factors influencing the supportive care needs of female patients with genital cancer in South Korea.

Genital cancers are particularly important compared to other cancers because of the psychological impact they have on the individual. This study investigated the complexity in illness and quality of life among female genital cancer patients and determined the effects of these factors on supportive care needs to provide evidential data for the development of nursing intervention strategies to reduce supportive care needs in female genital cancer patients. This cross-sectional study collected data from July 22 to August 17, 2021. The study subjects were 103 female outpatients and inpatients aged 19 years or older who were treated for cervical cancer, endometrial cancer, ovarian cancer, or other female genital cancers such as vulvar cancer and vaginal cancer in a university hospital in Korea. The data were analyzed with t-tests and Scheffé's test using SPSS 26.0. The factors affecting supportive care needs were examined using hierarchical regression. The average age of the subjects was 56.41 (±9.91) years. Cervical cancer was the most common diagnosis at 42.7%, followed by ovarian cancer at 34.0%, and endometrial cancer at 21.4%. The factors affecting supportive care needs included a middle school education or below (β = 0.21, P = .028), unemployment (β = 0.23, P = .018), complexity in illness (β = 0.32, P < .001), and quality of life (β = -0.68, P < .001). Developing a strategy for managing the complexity in illness and quality of life caused by various variables including disease stage and type of treatment is necessary to reduce the supportive care needs of female genital cancer patients. Improving their quality of life through effective communication with healthcare providers is essential.

Vulvar adenofibroma and pregnancy: A case study, at the regional hospital of Thiès

Introduction: Benign vulvar epithelial tumors developing from glandular structures are rare. Given the resemblance of vulvar fibroadenomas to those of mammary locations, some authors have put forward the hypothesis of development from accessory mammary glands. Case Report: We report a case of hyperalgesic giant vulvar fibroadenoma occurring in a 22-year-old female patient at 28 weeks, 3 days gestation. She was admitted for a painful mass on the right labia majora that had been present for two years, with a remarkable increase in volume during pregnancy. Faced with the acute vulvar pain and the discomfort caused by the mass, the decision to perform a vulvar lumpectomy was made and carried out semi-urgently, leading to the excision of a mass weighing 1103 grams. Microscopic examination revealed an adenofibroma. The patient gave birth vaginally at 38 weeks of gestation to a male baby weighing 3115 grams, 10 weeks after lumpectomy. Conclusion: Fibroadenoma is a benign tumor located in most cases in the breast, its location in the vulva is rare and can lead to a diagnostic delay. Surgical treatment by complete excision allows healing.

The diagnosis and management of vulval intraepithelial neoplasia

Key content High‐risk human papilloma virus (HPV)‐associated vulval high‐grade squamous intraepithelial lesions and HPV‐independent differentiated vulval intraepithelial lesions represent distinct disease processes with different risks of progression to vulval squamous cell carcinoma. First‐line medical management is appropriate for women with biopsy‐confirmed vulval high‐grade squamous intraepithelial lesions who have been adequately counselled on the risk of occult invasive disease. Topical treatment should be undertaken in the context of a specialist clinic because it is not suitable for all patients. Surgical management is needed for differentiated vulval intraepithelial neoplasia. Learning objectives To understand the clinical, histological, and pathological classification of squamous intraepithelial lesions and diagnostic challenges. To be able to contribute to the multidisciplinary investigation and diagnosis of squamous intraepithelial lesions. To understand the basis for patient‐centred counselling on the investigation, diagnosis and treatment of suspected squamous intraepithelial lesions. Ethical issues Treatment must be tailored towards the patient's appreciation of risk and benefit, informed by the clinical and pathological features of the disease.

Jinekolojik Kanser veya Meme Kanserli Kadınların COVID-19 Pandemisi Sırasında Sağlık Bakımı Arama Davranışı, Psikososyal Belirtileri ve Sıkıntı Düzeylerinin Belirlenmesi

Objective: The study was conducted to determine the health-seeking behaviors, psychosocial symptoms and distress levels and related factors of women diagnosed with gynecological or breast cancer during the pandemic period. Materials and Methods: This descriptive, cross-sectional study was completed with a total of 109 women who had ovary, endometrium, cervix, vagina, vulva, or breast cancer. The study was conducted between October and December 2020, and data were collected online using an information form, Distress Thermometer and The Brief Symptom Inventory. Results: There was a decrease in the frequency of going to the hospital for diagnosis (54.8%), treatment (32.3%), and rehabilitation (58%) services during the COVID-19 pandemic process. Our study results indicated that 89% of women experienced distress, according to Distress Thermometer. The mean Brief Symptom Inventory scores were found to be statistically significantly higher in women who stated that they experienced distress, whose chemotherapy treatment was postponed, and who obtained more information from the Internet during this period. Conclusions: This study highlighted the pandemic’s impact on healthcare-seeking behaviors and distress experiences of women with gynecological or breast cancer. Our results indicate a restriction on receiving health services during this period in women. Also, our results showed that most women experienced distress.

Squamous cell carcinoma in situ of the vulva

Currently, squamous vulvar cancer is rare, which is why there is limited experience among health personnel in recognizing and managing this type of tumor location. The purpose of this case is to present the case of an 87-year-old woman with an ulcerative lesion on the vulva who underwent left vulvectomy with a report of squamous cell carcinoma in situ pathology, with favorable post-surgical evolution and without the need for adjuvant treatment when the inguinal lymph node was negative for metastasis.

PD-L1 expression in vulvar cancer: a systematic review and meta-analysis.

Programmed cell death ligand-1 (PD-L1) expression in cancer may predict clinical response to immunotherapeutic treatment with PD-1/PD-L1 inhibitors. Within the vulvar cancer field, PD-L1 expression has only been assessed by a few studies. We conducted a meta-analysis to examine the prevalence of PD-L1 positivity in vulvar cancer. PubMed, Embase, and Cochrane were searched for articles reporting on PD-L1 expression in vulvar cancer. Study selection and data extraction were performed independently by two authors. We extracted data on PD-L1 prevalence in vulvar cancer according to combined positive score (CPS) and tumour proportion score (TPS). Cutoff values for positivity were ≥1 or ≥10 for CPS and ≥1% and ≥5% for TPS. Random-effects models were used to estimate pooled PD-L1 prevalence, with 95% confidence intervals (CIs). Tests of between-study heterogeneity were evaluated by the I2 statistics. Sources of heterogeneity were explored by subgroup analyses and meta-regression. In total, 19 studies were included. Pooled PD-L1 prevalence in vulvar cancer was 83.4% (95% CI: 70.8-91.3; I2 = 80.0) and 53.9% (95% CI: 37.4-69.6; I2 = 93.0) according to CPS and TPS, respectively. Based on TPS, human papillomavirus (HPV)-associated vulvar squamous cell carcinomas (SCC) showed a lower PD-L1 prevalence (39.9%; 95% CI: 13.3-74.2) compared with HPV-independent SCC (62.6%; 95% CI: 33.7-84.6), but meta-regression showed no significant variation in PD-L1 prevalence by HPV status. PD-L1 prevalence was similar in advanced (44.9%; 95% CI: 29.8-61.1) and localized vulvar cancer (56.7%; 95% CI: 18.9-76.7). In conclusion, PD-L1 expression in vulvar cancer is frequent but between-study heterogeneity was high. Based on a subgroup of heterogenous studies, we found no strong variation in PD-L1 prevalence according to HPV status and stage.

Genomic characterization of vulvar squamous cell carcinoma reveals differential gene expression based on clinical outcome

ObjectiveThe greatest challenge in the management of vulvar squamous cell carcinoma (VSCC) is treatment of recurrent disease where options for surgery and radiation have been exhausted, or treatment of disease where distant metastasis is present. Identification of mutations differentially expressed between tumor from patients who died of aggressive disease and tumor from patients with an indolent course could reveal novel prognostic indicators and guide development of therapeutic drugs. MethodsFrom 202 consecutive patients with VSCC, patients who recurred and died of disease (group A) were identified and matched by age, tumor size, depth of invasion and nodal status with those whose disease did not recur (group B). Tumors from 21 patients were subjected to whole exome sequencing of DNA and RNA, immunohistochemistry (IHC) antibodies of PD-L1 and P16, and in-situ hybridization (ISH) for high-risk HPV. ResultsAnalysis of DNA and RNA revealed six genes that were strongly differentially expressed between group A and B: TGM3, ACVR2A, ROS1, NFEL2, CCND1 and BCL6. Clinically relevant DNA mutations were significantly greater in group A versus B: 7 vs 2.3 mutations per patient. The most common genomic alterations were mutations in TP53 and the promoter region of TERT. Other common genomic events include alterations of FAT1, CDKN2A, PIK3CA, CCND1, and LRP1B. All samples were MSI stable and tumor mutational burden (TMB) was similar in groups A and B. Most VSCC specimens (81%) were positive for PD-L1. ConclusionsACVR2A and TGM3 are significantly under-expressed in tumors with poor outcome, suggesting they may play a role in tumor suppression. Clinical outcome of VSCC appears independent of MSI, TMB, or PD-L1 status.

Vulvar cancer incidence and net survival in Sweden 1960 to 2019: A population-based national study.

Vulvar cancer is a rare gynecological cancer affecting mostly older women. The aim of this population-based study was to investigate the incidence and net survival of vulvar cancer in Swedish women from 1960 to 2019. Data were retrieved from the mandatory Swedish Cancer Registry consisting of all women diagnosed with vulvar cancer between 1960 and 2019. Only women with a morphologically verified diagnosis of vulvar cancer were included. The individuals were then further matched with the Swedish Death Registry up until May 31, 2020. In total, 8499 women were included with the following morphologies: squamous cell carcinoma 7250 (85.8%), malignant melanoma 539 (6.4%), adenocarcinoma 401 (4.8%) and other: 259 (3.1%). More than 50% of vulvar cancer cases occurred in women aged between 65 and 84 years of age. The 5-year age-standardized net survival increased from 53.0% (95% confidence interval [CI] 48.9-57.5) in 1960 to 72.1% (95% CI 68.8-75.5) in 2019. The proportion of adenocarcinoma among all cases increased from 2.0% to 8.7% between the 1960s and 2010s and an increase in age-standardized 5-year net survival was found for adenocarcinoma. The age-standardized incidence of vulvar cancer cases in Sweden was stable between 1960 and 2019. During the study period, an increase in adenocarcinoma and a decrease in malignant melanoma cases was found. Five-year net survival increased by 20 percent units during the study period. For squamous cell carcinoma, an increased age-specific 5-year net survival was observed for all age groups, apart for women aged ≥85.

A missing opportunity to alleviate suffering: the case of vulvar cancer

A missing opportunity to alleviate suffering: the case of vulvar cancer

The development of in vitro organotypic 3D vulvar models to study tumor-stroma interaction and drug efficacy.

Vulvar squamous cell carcinoma (VSCC) is a rare disease with a poor prognosis. To date, there's no proper in vitro modeling system for VSCC to study its pathogenesis or for drug evaluation. We established healthy vulvar (HV)- and VSCC-like 3D full thickness models (FTMs) to observe the tumor-stroma interaction and their applicability for chemotherapeutic efficacy examination. VSCC-FTMs were developed by seeding VSCC tumor cell lines (A431 and HTB117) onto dermal matrices harboring two NF subtypes namely papillary fibroblasts (PFs) and reticular fibroblasts (RFs), or cancer-associated fibroblasts (CAFs) while HV-FTMs were constructed with primary keratinocytes and fibroblasts isolated from HV tissues. HV-FTMs highly resembled HV tissues in terms of epidermal morphogenesis, basement membrane formation and collagen deposition. When the dermal compartment shifted from PFs to RFs or CAFs in VSCC-FTMs, tumor cells demonstrated more proliferation, EMT induction and stemness. In contrast to PFs, RFs started to lose their phenotype and express robust CAF-markers α-SMA and COL11A1 under tumor cell signaling induction, indicating a favored 'RF-to-CAF' transition in VSCC tumor microenvironment (TME). Additionally, chemotherapeutic treatment with carboplatin and paclitaxel resulted in a significant reduction in tumor-load and invasion in VSCC-FTMs. We successfully developed in vitro 3D vulvar models mimicking both healthy and tumorous conditions which serve as a promising tool for vulvar drug screening programs. Moreover, healthy fibroblasts demonstrate heterogeneity in terms of CAF-activation in VSCC TME which brings insights in the future development of novel CAF-based therapeutic strategies in VSCC.

Indocyanine green fluorescence imaging: an effective method to find inguinal sentinel lymph node in a case of vulvar carcinoma.

The aim was to demonstrate that the technique of near infrared range/indocyanine green (NIR/ICG) could aid the detection of inguinal sentinel lymph nodes in patients with vulvar cancer, in addition to technetium-99m (Tc-99m) scanning. We present a case report of sentinel lymph node detection in a patient with vulvar cancer with two methods: Tc-99m scan and NIR/ICG. The video showed that bilateral inguinal lymph nodes were detected both by Tc gamma probe and NIR/ICG. NIR/ICG may be a safe and effective alternative method for identifying sentinel lymph nodes in cases of early-stage vulvar cancer, although more evidence is required.

Pigmented vulvar basal cell carcinoma in a Hispanic patient treated with Mohs micrographic surgery.

Pigmented vulvar basal cell carcinoma in a Hispanic patient treated with Mohs micrographic surgery.

Gynaecological cancer incidence and mortality trends in a Brazilian State with medium human development index: A 22-year analysis

ObjectiveThis study aimed to analyse trends in incidence and mortality rates of gynaecological cancer (GC) in Sergipe, a medium Human Development Index (HDI) state in northeastern Brazil during 1996–2017. MethodsData were obtained from the Population-based Cancer Registry of Aracaju and Brazilian Mortality Information System database. We included vulvar (VUC), vaginal (VAC), cervical (CC), uterine (UC; C54-C55), ovarian (OC), placental (PC), and unspecified female genital organ cancers. Crude rates, and age-standardised incidence and mortality rates (ASIR and ASMR, respectively) were calculated using a denominator of 100,000 women. We assessed changes in trends using the annual percentage change (APC) and the average APC (AAPC), using the Joinpoint Regression Program. ResultsFrom 1996–2017, GC ASIR exhibited a declining trend (AAPC: −3.1), while ASMR increased (AAPC: 2.1). CC had the highest ASIR and ASMR over the years, ranging from 11.6 to 34.3 cases and 4.2–9.0 deaths per 100,000, respectively. Annual decreases in ASIR were observed for CC (AAPC: −5.2) and VAC (AAPC: −5.5). OC saw an increase in mortality rates (AAPC: 1.9; 1996–2017), and CC experienced an increase during 1996–2003 (APC: 6.9). VUC displayed a substantial rise in ASMR from 2001 to 2009 (APC: 27.1), followed by a decrease (APC: −11.3). An increase in mortality trends for UC was observed during 1996–2004 (APC: 10.0), while its ASIR remained relatively unchanged over the years. ConclusionWhile overall GC incidence trends declined, mortality rates either increased or failed to decrease significantly. Therefore, additional efforts are required to enhance prevention, diagnosis, and treatment strategies, aimed at reducing and managing the burden of GC in the future.

The expression and possible role of corticotropin-releasing hormone family peptides and their corresponding receptors in gynaecological malignancies and premalignant conditions: a systematic review.

The aim of this systematic review is to investigate the impact of corticotropin-releasing hormone (CRH) family peptides and their corresponding receptors on human physiology and disease onset, with a specific focus on gynaecological malignancies such as breast, endometrial, ovarian, vulvar, and cervical cancer. A comprehensive systematic review of 3 medical databases was conducted by 2 independent reviewers. We reviewed studies that explored the expression and role of CRH peptides in various aspects of cancer biology, in the context of breast, endometrial, ovarian, vulvar, and cervical cancer. Our findings reveal that CRH family peptides and their receptors, CRHR1 and CRHR2, are expressed in diverse gynaecological tissues, including cancer cells. Notably, we observed differential expression patterns among different gynaecological cancer types and stages, indicating potential associations with tumour aggressiveness and patient prognosis. Furthermore, CRH peptides were found to exert significant influences on critical cellular processes, such as cell proliferation, migration, invasion, and immune response, in gynaecological cancers. These findings highlight the multifaceted roles of CRH family peptides in gynaecological malignancies and emphasize the need for further research in this field. Therefore, understanding the mechanisms underlying the involvement of CRH family peptides in tumourigenesis may open new avenues for targeted therapeutic strategies in gynaecological malignancies.

&lt;i&gt;CCND1&lt;/i&gt; and &lt;i&gt;PTEN&lt;/i&gt; genes as markers of progression in vulvar cancer

Purpose of the study. Studying the relative copy number of 12 genes: MYC, PTEN, CCND1, PIK3CA, TP53, CDKN2A, MDM2, MCL1, NFKBIA, MTAP, BIRC2, KMT2C, to search for potential prognostic cancer markers in vulvar cancer (VR).Patients and methods. The study included 50 patients aged 29–80 years with the diagnosis of squamous cell carcinoma of the vulva without metastases – group 1 (n = 25) and with metastases to the lymph nodes – group 2 (n = 25). Total DNA from paraffin blocks of tumor and conditionally healthy vulvar tissue served as the material for the study. The relative copy number of genes (RCQ) was assessed using the RT-qPCR method: MYC, PTEN, CCND1, PIK3CA, TP53, CDKN2A, MDM2, MCL1, NFKBIA, MTAP, BIRC2, KMT2C and referencegenes: GAPDH and B2M. Raw RT-qPCR data were analyzed using Bio-Rad CFX Manager software (ver. 2.1). RCQ of the genetic locus was calculated using the formula 2-ΔCt. Analysis of the significance of differences included determination of the OR (CI 95 %), Chi-square, Mann-Whitney U-test. Differences were considered statistically significant at p &lt; 0.05.Results. Amplification was observed for 9 genes: MYC (48 % of cases), MCL1 (39 %), NFKBIA (46 %), CCND1 (52 %), PIK3CA (48 %), TP53 (62 %), MDM2 (40 %), BIRC2 (54 %), KMT2C (42 %); losses were recorded for 3 genes PTEN (44 % of cases), MTAP (32 %), CDKN2A (36 %). In the 2nd group of patients, a statistically significant 1.7-fold increase in RCQ of the CCND1 gene (p &lt; 0.05) and a 1.9-fold decrease in RCQ of the PTEN gene (p &lt; 0.05) were found.Conclusion. In the study, CCND1 amplification events and/or PTEN loss were associated with lymph node metastasis in RV patients. Thus, the copy numbers of these genes may serve as prognostic markers of the disease.