Vaginal Cancer
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Cancer of the vagina is relatively rare, accounting for about 2% of gynaecological malignancies. There are two main types of vaginal cancer; squamous cell cancer and adenocarcinoma. Over four fifths of all vaginal cancers are squamous carcinoma, this is more common in women between the ages of 60 and 80. The other type of vaginal cancer; adenocarcinoma is usually found in young women under 30 years old.

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Latest Research Publications

Information Patients and the Public (9 links)


Information for Health Professionals / Researchers (6 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Fonder MA, Hunter-Yates J, Lawrence WD, Telang GH
Vestibular papillomatosis: a benign condition mimicking genital warts.
Cutis. 2012; 90(6):300-1 [PubMed]
Vestibular papillomatosis (VP) is a benign condition of the female genitalia that may be mistaken for condyloma acuminatum (genital warts). In contrast to condylomata, lesions of VP each grow from a distinct mucosal insertion; match the color of the surrounding mucosa; and are symmetrically distributed, limited to the inner labia minora and vaginal introitus. Recognition of this entity will help to prevent unnecessary stress, testing, and discomfort.


Humphrey P, Cornes P, Al-Booz H
Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement.
Br J Radiol. 2013; 86(1023):20120428 [PubMed] Article available free on PMC after 01/03/2014
OBJECTIVE: This quality assurance study assesses whether CT image-guided verification has led to improvements in the technique when compared with previous studies.
METHODS: The CT images were studied from a cohort of 105 consecutive patients with endometrial cancer having adjuvant brachytherapy to the vaginal vault in 2010. Images were taken at first insertion, checked for air gaps and treatment delivered. Images were later transferred to the planning system and air gaps between vaginal mucosa and vaginal cylinder were measured. Comparisons were made with the 2008 results from this centre and the literature series.
RESULTS: Images from two patients were not assessable owing to artefacts from hip replacements. Air gaps >2 mm were seen in 11/103 patients. Repositioning or use of a larger cylinder reduced air gaps to 7/103 patients. In total, 96/103 patients (over 93%) were able to achieve good vaginal contact throughout the treatment volume. This shows a significant improvement in applicator positioning in our centre since 2008 and also a significant improvement over the total data published in 2010 (Pearson χ(2) test=46.19; p<0.0001).
CONCLUSION: The vaginal cylinder technique with CT imaging was proven to be effective for 96/103 patients. It is necessary to consider whether there is a better technique for the few patients with air gaps >2 mm. ADVANCES IN KNOWLEDGE: For the vast majority of patients, this technique is well tolerated, without the need for analgesia, and will continue to be the first choice technique in this centre.


Carta G, Parisse V, Accurti V, et al.
Aggressive angiomyxoma of the vaginal wall at the initial stage: a case report.
Eur J Gynaecol Oncol. 2012; 33(6):669-71 [PubMed]
Aggressive angiomyxoma (AA) is a rare mesenchimal tumor usually located in the pelvic and perineal region. Less than 30 cases of aggressive angiomyxoma with vaginal location have been reported in the literature up to this date. The authors report the case of a 50-year-old female patient diagnosed with vaginal AA whose characteristics at its initial stage were macroscopically indistinguishable from those of a polypoid lesion. Therefore this case suggests that this type of tumor should be considered as part of the differential diagnosis of vaginal polypoid lesions.


Lambert AE, Mukati M, Shobeiri SA
Metastatic cancer in sigmoid neovagina: a case report.
Female Pelvic Med Reconstr Surg. 2013 Jan-Feb; 19(1):56-7 [PubMed]
UNLABELLED: We report a case of a 30-year-old woman with congenital anal cloaca who presented with vaginal bleeding and urinary retention from sigmoid neovagina. She was found to have metastatic mucinous producing adenocarcinoma in the neovagina.
BACKGROUND: Malignancy of neovagina is rare.
SUMMARY: We report a case of metastatic colorectal cancer after creation of a neovagina and urethra using sigmoid colon.


Olsen J, Jørgensen TR, Kofoed K, Larsen HK
Incidence and cost of anal, penile, vaginal and vulvar cancer in Denmark.
BMC Public Health. 2012; 12:1082 [PubMed] Article available free on PMC after 01/03/2014
BACKGROUND: Besides being a causative agent for genital warts and cervical cancer, human papillomavirus (HPV) contributes to 40-85% of cases of anal, penile, vaginal and vulvar cancer and precancerous lesions. HPV types 16 & 18 in particular contribute to 74-93% of these cases. Overall the number of new cases of these four cancers may be relatively high implying notable health care cost to society. The aim of this study was to estimate the incidence and the health care sector costs of anal, penile, vaginal and vulvar cancer.
METHODS: New anogenital cancer patients were identified from the Danish National Cancer Register using ICD-10 diagnosis codes. Resource use in the health care sector was estimated for the year prior to diagnosis, and for the first, second and third years after diagnosis. Hospital resource use was defined in terms of registered hospital contacts, using DRG (Diagnosis Related Groups) and DAGS (Danish Outpatient Groups System) charges as cost estimates for inpatient and outpatient contacts, respectively. Health care consumption by cancer patients diagnosed in 2004-2007 was compared with that by an age- and sex-matched cohort without cancer. Hospital costs attributable to four anogenital cancers were estimated using regression analysis.
RESULTS: The annual incidence of anal cancer in Denmark is 1.9 per 100,000 persons. The corresponding incidence rates for penile, vaginal and vulvar cancer are 1.7, 0.9 and 3.6 per 100,000 males/females, respectively. The total number of new cases of these four cancers in Denmark is about 270 per year. In comparison, the total number of new cases cervical cancer is around 390 per year. The total cost of anogenital cancer to the hospital sector was estimated to be 7.6 million Euros per year. Costs associated with anal and vulvar cancer constituted the majority of the costs.
CONCLUSIONS: Anogenital cancer incurs considerable costs to the Danish hospital sector. It is expected that the current HPV vaccination program will markedly reduce this burden.


Guo M, Gong Y, Wang J, et al.
The role of human papillomavirus type 16/18 genotyping in predicting high-grade cervical/vaginal intraepithelial neoplasm in women with mildly abnormal Papanicolaou results.
Cancer Cytopathol. 2013; 121(2):79-85 [PubMed]
BACKGROUND: The authors compared the predictive value of type 16 and/or 18 human papillomavirus (HPV) versus non-16/18 HPV types for high-grade (grade ≥2) cervical neoplasm/vaginal intraepithelial neoplasm and carcinoma (CIN/VAIN2+) in women with mildly abnormal Papanicolaou (Pap) results (ie, atypical squamous cells of undetermined significance [ASCUS] or low-grade squamous epithelial lesion [LSIL]).
METHODS: The authors retrospectively selected Pap specimens with HPV testing results obtained from 243 women (155 with ASCUS and 88 with LSIL Pap results) in their Department of Pathology. HPV genotyping was performed using the EasyChip HPV blot assay. The Pap specimens with HPV16/18 and non-16/18 HPV types were compared with follow-up biopsy results. Follow-up duration ranged from 1 month to 58 months (mean, 26 months).
RESULTS: In total, 58 of 155 specimens (37%) that had ASCUS and 29 of 88 specimens (33%) that had LSIL were positive for HPV16/18. CIN/VAIN2+ biopsies were identified in 43 of 155 women (28%) with ASCUS and in 28 of 88 women (32%) with LSIL. Women with ASCUS and HPV16/18 had a significantly higher rate (43%) of CIN/VAIN2+ than women with ASCUS and non-16/18 HPV types (19%; P = .003; odds ratio, 3.10; 95% confidence interval, 1.48-6.53). There was no statistically significant difference in the rate of CIN/VAIN2+ between women who had LSIL and HPV16/18 (45%) and those who had LSIL and non-16/18 HPV types (29%; P = .16; odds ratio, 1.96; 95% confidence interval, 0.77-4.97).
CONCLUSIONS: HPV genotyping for HPV16/18 improved risk assessment for women with ASCUS Pap results and may be used to predict the risk of CIN/VAIN2+ to better guide follow-up management.


Dane C, Rustemoglu Y, Kiray M, et al.
Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass.
Hong Kong Med J. 2012; 18(6):533-5 [PubMed]
Vaginal leiomyomas are rare benign solid tumours of the vagina. They can cause mechanical dystocia, which is a common problem in obstetrics leading to serious maternal and perinatal complications. Here we describe a patient with a vaginal leiomyoma diagnosed during the mid-trimester that could have caused dystocia. This 22-year-old woman presented with a vaginal mass and leaking vaginal fluid during pregnancy. On examination, a prolapsed, pedunculated mass, measuring 5 × 3 × 4 cm was detected in the anterior vaginal wall. Via a midline incision, the mass was easily enucleated and removed. Transvaginal surgical enucleation of the vaginal leiomyoma is usually curative and recommended as the initial treatment of choice to prevent for dystocia. Such treatment is indicated when the tumour is a potential obstacle to normal labour.


Perrotta M, Marchitelli CE, Velazco AF, et al.
Use of CO2 laser vaporization for the treatment of high-grade vaginal intraepithelial neoplasia.
J Low Genit Tract Dis. 2013; 17(1):23-7 [PubMed]
OBJECTIVE: In a series of cases of high-grade vaginal intraepithelial neoplasia (VaIN) at our institution, to analyze its clinicopathologic characteristics, diagnostic methodology, and therapeutic results obtained with the use of CO2 laser vaporization.
MATERIALS AND METHODS: Between January 2003 and December 2009, 28 patients with a diagnosis of high-grade VaIN were treated in our department using CO2 laser vaporization. Of the 28 patients, 7 were lost to follow-up; 21 patients were followed up with cytological examination and colposcopy for therapeutic response. Median follow-up was 25 months (range = 12-78 months). The setting is an urban referral center, a private hospital with a high-grade complexity.
RESULTS: Of the 21 patients evaluated, 18 are currently disease free after having undergone a single application of CO2 laser vaporization with a cure rate of 86% (95% CI = 63.7%-97%). Three patients (14%) presented with persistence/recurrence and required a second application. Of these 3 patients, 2 are currently disease free, whereas 1 patient progressed to invasive carcinoma 11 months after a second procedure and was managed with partial colpectomy and pelvic lymphadenectomy.
CONCLUSIONS: CO2 laser vaporization was effective for the initial treatment of high-grade VaIN. However, a long-term follow-up is required due to the recurrent character of this disease.


Kondi-Pafiti A, Grigoriadis C, Kalampokas T, et al.
Clinicopathological study of 112 cases of benign, pre-invasive and invasive lesions of the vagina: a 15-year review.
Eur J Gynaecol Oncol. 2012; 33(5):463-6 [PubMed]
OBJECTIVE: Benign vaginal lesions are mainly asymptomatic and often diagnosed during routine screening gynecological examinations. Additionally, vaginal intraepithelial lesions are asymptomatic and diagnosis is often confirmed after vaginal biopsy under colposcopic evaluation in cases of abnormal cytological Papanicolaou examination or synchronous cervical intraepithelial neoplasia. On the other hand, primary vaginal cancer is rare representing approximately 1-2% of all gynecological cancers. Metastatic invasion of the vagina is common especially in cases of advanced stage cervical cancer. The aim of this study was to examine the diagnostic approach, the management strategy, and the pathological findings in cases of benign, pre-invasive and invasive vaginal lesions that were diagnosed and treated in our Department.
MATERIALS AND METHODS: This was a 15-year retrospective study. Cases of benign, pre-invasive, and invasive vaginal lesions diagnosed during the last fifteen years at Aretaieion Hospital of the University of Athens, were analyzed.
RESULTS: During this study period 40 cases of vaginal cysts (35.7% of all vaginal lesions) were diagnosed. Surgical excision of the lesions was decided in all cases and histology showed that the most frequent cyst type was mucus-secreting Mullerian (30%). During the study period, 23 cases of vaginal intraepithelial neoplasia (VAIN, 20.5% of all vaginal lesions) were detected. In 43.5% of the cases, histological diagnosis revealed low grade VAIN, while the remaining cases were classified as high grade VAIN. Furthermore, 11 cases of primary vaginal cancer (9.8% of all vaginal lesions) were diagnosed. The vast majority of them (91%) were squamous cell carcinomas. Additionally, histology confirmed the diagnosis of metastatic invasion of the vaginal wall in 38 cases (34% of all vaginal lesions). In the majority of these cases (55.2%), primary cancer was located in the cervix.
DISCUSSION: Benign, pre-invasive and invasive vaginal lesions are relatively uncommon and usually accompany lesions in other sites of the lower genital tract. Their diagnosis is based on gynecological or colposcopical examination. Treatment depends on the type of the lesion and the progression of the disease.


Lin Y, Lin WY, Liang JA, et al.
Opportunities for 2-[(18)F] fluoro-2-deoxy-D-glucose PET/CT in cervical-vaginal neuroendocrine carcinoma: case series and literature review.
Korean J Radiol. 2012; 13(6):760-70 [PubMed] Article available free on PMC after 01/03/2014
OBJECTIVE: Neuroendocrine cervical carcinoma is a rare subtype of cervical cancer. These tumors exhibit an aggressive behavior with early regional lymph node and distant metastases. The purpose of our study was to describe five cases of neuroendocrine cervical-vaginal carcinoma and to discuss the potential of the 2-[(18)F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) scan for the detection of this rare malignancy.
MATERIALS AND METHODS: Five cases of cervical-vaginal neuroendocrine tumor were retrospectively collected, during a two year (from September 2009 to August 2011) period in our hospital. The clinical staging distributions were International Federation of Gynecology and Obstetrics (FIGO) stage IB2 (1 of 5), stage IIA (3 of 5) and stage IVA (1 of 5).
RESULTS: Two cases (cases 1 and 4) were restaged after (18)F-FDG PET/CT scan in the initial staging process. Post-treatment (18)F-FDG PET/CT scans, in three patients, revealed positive findings for tumor recurrence or lymph node metastases. Two patients (cases 2 and 3) died of tumor within two years.
CONCLUSION: (18)F-FDG PET/CT scan is a useful tool in cervical-vaginal neuroendocrine tumor. In its initial staging, the (18)F-FDG PET/CT scan may help assess the possible nodal involvement or early hematogeneous spreading. We can also use the (18)F-FDG PET/CT to detect local recurrence and to evaluate the treatment response after clinical manipulation.


Daniilidis A, Pantelis A, Lathouras K, et al.
A rare case of umbilical and vaginal metastasis from endometrial cancer--review of the literature.
Eur J Gynaecol Oncol. 2012; 33(4):436-7 [PubMed]
INTRODUCTION: Metastases from primary endometrial cancer to the umbilicus are extremely rare. This unusual site of metastases has been described as Sister Joseph's nodule.
MATERIAL AND METHOD: We present a case of a 73-year-old Caucasian woman with a BMI of 30, type II diabetes mellitus, hypertension, and umbilical and vaginal metastasis of endometroid endometrial adenocarcinoma (FIGO Stage IIIa, G2). Total abdominal hysterectomy and bilateral salpingo-oophorectomy by Pfannenstiel dissection, had been performed eight months before. The size of the umbilical mass was 2 x 2 cm. A second laparotomy including full recession of the umbilical ring, omentectomy, bilateral inguinal lymph nodes and excision of the upper one-third of the vagina was performed. Histological diagnosis revealed metastases of the same origin with her primary disease.
CONCLUSION: The exact mechanism of implantation of cancer cells at the site of the umbilical ring is still unclear. Perhaps malignant cells penetrated the thickness of the uterine wall and spread intraperitoneally to reach the umbilical ring. The exfoliation of cells from the primary tumor via the fallopian tubes could be another possible explanation. Unfortunately, the presence of umbilical metastasis is a poor prognostic feature and sign of advanced neoplastic disease. The survival rate of these patients is influenced by the type of treatment and time of the diagnosis.


Magné N, Chargari C, Levy A, et al.
Clear cell adenocarcinoma of the female genital tract: long-term outcome and fertility aspects after brachytherapy aimed at a conservative treatment.
Int J Gynecol Cancer. 2012; 22(8):1378-82 [PubMed]
OBJECTIVES: To assess the outcome and the fertility aspects in the particular population of cervical and/or vaginal clear cell adenocarcinoma (CCA) associated or not to previous in utero diethylstilbestrol exposure.
METHODS: From January 1970 to December 2003, data from 61 consecutive patients with cervical and/or vaginal histologically proven CCA treated with brachytherapy (BT) aimed at a conservative treatment at the Institut Gustave Roussy as a part of treatment were retrospectively analyzed.
RESULTS: The median follow-up was 9.4 years, ranging from 0.3 to 27.4 years. The 5-year specific overall survival rate was 79%. The median time of disease-free survival was 5.8 years. In the subgroup of 42 patients with a cervical CCA, 12 patients tried to be pregnant, 2 patients became pregnant and had miscarriages (P2M2 and P1M1). No pregnancy has been observed in 10 patients exclusively owing to anomalies of the reproductive tract: 6 patients had partial or total diaphragm, 2 patients had an anatomical alteration of the uterus, 1 patient had atrophic endometrium, and 1 patient had primary infertility. In the subgroup of 19 patients with a vaginal CCA, 7 patients tried to be pregnant. All of them had no morphological and/or functional anomalies of the genital tract. Three of 7 patients had delivered healthy babies (P1D1, P2D2, and P3M2D1), and another one had a miscarriage (P1M1). Moreover, all babies were delivered by cesarean section. The pregnancy rate was 10% (6 of 61 patients) with 3 healthy babies.
CONCLUSION: Conservative approach in patients with female genital tract CCA including BT gives good results with good survival rates and an interesting global pregnancy rate.


Vercellini P, Parazzini F, Pietropaolo G, et al.
Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study.
BJOG. 2012; 119(12):1538-43 [PubMed]
We retrospectively assessed pregnancy outcome in 419 women who achieved a first spontaneous singleton pregnancy after surgery for endometriosis. A miscarriage was observed in 87 of 419 women (20.8%) and an ectopic pregnancy in eight (1.9%). Among the remaining 324 women, 14 (4.3%) experienced gestational hypertension/pre-eclampsia, 38 (11.7%) had a preterm delivery, five (1.5%) had placental abruption and 12 (3.7%) had placenta praevia. The incidence of placenta praevia was 7.6% in 150 women with rectovaginal lesions, 2.1% in 69 with ovarian endometriomas plus peritoneal implants, and 2.4% in 100 women with peritoneal implants only, whereas no case was observed in 100 women with ovarian endometriomas only.


Thompson SR, Delaney GP, Gabriel GS, et al.
Estimation of the optimal brachytherapy utilisation rate in the treatment of vaginal cancer and comparison with patterns of care.
J Med Imaging Radiat Oncol. 2012; 56(4):483-9 [PubMed]
INTRODUCTION: Having previously modelled the optimal proportion of uterine cervix and corpus cancers that should be treated with brachytherapy (BT), we aimed to complete the assessment of the role of BT for gynaecological cancers by estimating the optimal proportion of vaginal cancer cases that should be treated with BT, the optimal BT utilisation (BTU) rate for vaginal cancer. We compared this with actual vaginal BTU and assessed quality of BT for vaginal cancer by a Patterns-of-Care Study (POCS).
METHODS: Evidence-based guidelines were used to construct an optimal BTU decision tree for vaginal cancer. Searches of the epidemiological literature to ascertain the proportion of patients who fulfilled the criteria for BT were conducted. The robustness of the model was tested by sensitivity analyses and by peer review. A retrospective POCS of BT in New South Wales (NSW) for 2003 was conducted, and actual BTU for vaginal cancer was determined. Differences between optimal and actual BTU were assessed. Quality of BT for vaginal cancer was compared with published benchmarks.
RESULTS: The optimal vaginal cancer BTU rate was estimated to be 85% (range 81-87%). In NSW in 2003, actual vaginal cancer BTU was only 42% (95% confidence interval 22-62%). In NSW, only nine patients were treated, all with intra-vaginal cylinders, and two of four to lower than recommended doses.
CONCLUSIONS: BT for vaginal cancers is underutilised in NSW compared with the proposed optimal models of care. BT quality may have been suboptimal and this may relate to the rarity of this disease.


Boskovic V, Vrzic-Petronijevic S, Petronijevic M, et al.
Removal of a vaginal leiomyoma presenting as tumor previa allowing vaginal birth.
Eur J Gynaecol Oncol. 2012; 33(3):326-7 [PubMed]
Leiomyomas of the vagina are very rare tumors of the female genital tract with only 300 cases reported so far. A case of removal of the vaginal leiomyoma presenting as tumor previa in advanced pregnancy is described. Removal of the tumor allowed vaginal birth three weeks after surgery.


Sorbe BG, Horvath G, Andersson H, et al.
External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma: a prospective, randomized study--quality-of-life analysis.
Int J Gynecol Cancer. 2012; 22(7):1281-8 [PubMed]
BACKGROUND: A combination of vaginal brachytherapy and external beam radiotherapy was compared with brachytherapy alone in medium-risk endometrial carcinomas. Quality-of-life analysis is an important part of a randomized study to find out the optimal adjuvant treatment for this group of patients.
OBJECTIVE: To evaluate the value of adjuvant external beam pelvic radiotherapy in adjunct to vaginal brachytherapy in medium-risk endometrial carcinoma. Quality-of-life evaluation is the main topic of this report.
METHODS: A consecutive series of 527 evaluable patients were included in this randomized trial. Median follow-up for patients alive was 62 months. The primary study end points were locoregional recurrences and overall survival. Secondary end points were recurrence-free survival, toxicity, and quality-of-life. European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-OV28 modules were used to evaluate global health status, functional scales, and symptom scales.
RESULTS: Five-year locoregional relapse rates were 1.5% after external beam (ERT) plus vaginal irradiation (VBT) and 5% after vaginal irradiation alone (P = 0.013), and 5-year overall survival (OS) rates were 89% and 90%, respectively. External beam radiotherapy was associated with a higher rate of adverse effects from the intestine and the bladder, and quality-of-life parameters deteriorated at the end of radiotherapy but recovered to normal levels within a few months. There was a significant difference in favor of VBT alone with regard to adverse effects of the bowel and urinary tract, and quality-of-life.
CONCLUSIONS: Despite a significant locoregional control benefit with combined radiotherapy, no survival improvement was recorded; but increased late toxicity from the intestine and the bladder. External beam irradiation decreased global health status during and after treatment, and 3 functional scale items (physical, role, and social). Six of 11 symptom items showed a pattern favoring vaginal brachytherapy alone.


Höckel M, Horn LC, Einenkel J
(Laterally) extended endopelvic resection: surgical treatment of locally advanced and recurrent cancer of the uterine cervix and vagina based on ontogenetic anatomy.
Gynecol Oncol. 2012; 127(2):297-302 [PubMed]
OBJECTIVE: Pelvic exenteration is mainly applied as a salvage operation for a subset of patients with persistent and recurrent cervicovaginal cancer. The procedure can also cure locally advanced primary disease not suitable for radiotherapy. However, high operative abortion and intralesional tumor resection rates significantly limit its clinical benefit. To improve locoregional tumor control we have proposed to establish cancer surgery on ontogenetic anatomy and, consequently, we have developed the (Laterally) Extended Endopelvic Resection ((L)EER).
METHODS: (L)EER is clinically and histopathologically evaluated with a monocentric prospective observational study. Patients with advanced and recurrent cervicovaginal cancer are treatment candidates if distant metastases and tumor fixation at the region of the sciatic foramen can be excluded.
RESULTS: 91 patients with locally advanced primary (n=30) and recurrent or persistent (n=61) carcinoma of the cervix and vagina were treated with (L)EER. 74% of the tumors were fixed to the pelvic wall. No (L)EER treatment was aborted, R0 resection was histopathologically confirmed in all cases. (L)EER definitively controlled the locoregional cancer in 92% (95% CI: 85-99) of the patients. Five year overall survival probability was 61% (95% CI: 49-72).
CONCLUSIONS: The results of (L)EER treatment confirm the concept of cancer surgery based on ontogenetic anatomy. In patients with locally advanced and recurrent cervicovaginal cancer (L)EER achieves locoregional tumor control both with central disease and with tumors fixed to the pelvic side wall except at the region of the sciatic foramen.


Kishi K, Mabuchi Y, Sonomura T, et al.
Eradicative brachytherapy with hyaluronate gel injection into pararectal space in treatment of bulky vaginal stump recurrence of uterine cancer.
J Radiat Res. 2012; 53(4):601-7 [PubMed] Article available free on PMC after 01/07/2013
The purpose of this study is to develop a procedure for eradicative brachytherapy that can deliver a curative boost dose to bulky (>4 cm) vaginal stump recurrence of uterine cancer without risk of damaging surrounding organs. We separated risk organs (the rectum and sigmoid) from the target during brachytherapy, with a hyaluronate gel injection into the pararectal space via the percutaneous paraperineal approach under local anesthesia. The rectum anchored to the sacrum by native ligament was expected to shift posteriorly. We encountered a patient with bulky stump recurrence of uterine cancer, approximately 8 cm in maximum diameter. She was complaining of abdominal pain and constipation due to bowel encasement. Following 50 Gy of external beam radiotherapy, we applied a single fraction of brachytherapy under gel separation and delivered 14.5 Gy (50.8 GyE: equivalent dose in 2-Gy fraction calculated with linear quadratic model at α/β = 3) to the target. The gel injection procedure was completed in 30 min without complications. A total irradiation dose of 100.8 GyE was delivered to the target and the cumulative minimum dose to the most irradiated rectosigmoidal volume of 2 cc (cumulative D(2cc)) was calculated as 58.5 GyE with gel injection, and was estimated to be 96 GyE without. Over three years, the local stump tumor has completely disappeared, with no complications. Brachytherapy with a pararectal gel injection can be a safe and effective eradicative option for bulky vaginal stump recurrence.


Li Y, Chen Y, Xu H, et al.
Laparoscopic nerve-sparing radical vaginectomy in patients with vaginal carcinoma: surgical technique and operative outcomes.
J Minim Invasive Gynecol. 2012 Sep-Oct; 19(5):593-7 [PubMed]
STUDY OBJECTIVES: To describe our technique for laparoscopic nerve-sparing radical vaginectomy and to assess the feasibility and safety of the procedure via operative outcomes.
DESIGN: Retrospective study (Canadian Task Force classification II-2).
SETTING: Major university teaching hospital in Chongqing, China.
PATIENTS: Twelve consecutive patients with early stage vaginal carcinoma.
INTERVENTIONS: Laparoscopic radical parametrectomy/vaginectomy with pelvic/paraaortic lymphadenectomy.
MEASUREMENTS AND MAIN RESULTS: Nerve-sparing radical vaginectomy was completed laparoscopically without conversion to laparotomy in 12 patients with early stage vaginal cancer. Mean (SD) operative time was 158.5 (36.7) minutes, and estimated blood loss was 135.2 (62.8) mL. No intraoperative complications occurred, and no patients required blood transfusion. The number of pelvic nodes obtained was 21.2 (9.8), and of para-aortic nodes was 13. All nodes were negative for malignancy. Histologic analysis confirmed the absence of any residual cancer tissue in the margins of the parametrial tissue and vagina. The median (range) time before Foley catheter removal was 9.76 (3-14) days, and bladder void function recovery to grade 0-I was observed in 11 patients (91.7%). Neither long-term bladder voiding dysfunction nor any other long-term complications were reported. The median duration of follow-up was 28 months. One patient with stage II vaginal cancer received pelvic regional radiation therapy; the other patients did not require adjuvant therapy after the operation. All patients were included in the follow-up protocol, and there was no recurrence of disease in any patients.
CONCLUSIONS: Laparoscopic radical parametrectomy/vaginectomy with pelvic/para-aortic lymphadenectomy is a therapeutic option for early stage vaginal carcinoma. Nerve-sparing radical surgery in indicated patients may lead to optimal preservation of bladder function. The technique described in this preliminary study seems to be safe and feasible, and was relatively easy to perform in our study population.


Darragh TM, Colgan TJ, Cox JT, et al.
The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology.
J Low Genit Tract Dis. 2012; 16(3):205-42 [PubMed]
The terminology for human papillomavirus (HPV)-associated squamous lesions of the lower anogenital tract has a long history marked by disparate diagnostic terms derived from multiple specialties. It often does not reflect current knowledge of HPV biology and pathogenesis. A consensus process was convened to recommend terminology unified across lower anogenital sites. The goal was to create a histopathologic nomenclature system that reflects current knowledge of HPV biology, optimally uses available biomarkers, and facilitates clear communication across different medical specialties. The Lower Anogenital Squamous Terminology (LAST) Project was cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology and included 5 working groups; 3 work groups performed comprehensive literature reviews and developed draft recommendations. Another work group provided the historical background and the fifth will continue to foster implementation of the LAST recommendations. After an open comment period, the draft recommendations were presented at a consensus conference attended by LAST work group members, advisors, and representatives from 35 stakeholder organizations including professional societies and government agencies. Recommendations were finalized and voted on at the consensus meeting. The final, approved recommendations standardize biologically relevant histopathologic terminology for HPV-associated squamous intraepithelial lesions and superficially invasive squamous carcinomas across all lower anogenital tract sites and detail the appropriate use of specific biomarkers to clarify histologic interpretations and enhance diagnostic accuracy. A plan for disseminating and monitoring recommendation implementation in the practicing community was also developed. The implemented recommendations will facilitate communication between pathologists and their clinical colleagues and improve accuracy of histologic diagnosis with the ultimate goal of providing optimal patient care.


Vassallo L, Lio R, Vestri M, Miracco C
Tubulo-squamous polyp of the vagina. A case with cellular, "angiomyofibroblastic-like" stroma.
Pathologica. 2012; 104(1):38-41 [PubMed]
Tubulo-squamous polyp is an infrequent, apparently benign lesion which has recently been described in the vagina. Histologically, it is characterized by an epithelial component, consisting of squamous nests and tubules, embedded in a hypocellular fibrous stroma. Here, we report an unusual histological variant showing a cellular stroma, as an additional histologic feature, which could lead to confusion with other site-specific lesions of the vagina. A brief review of the literature on this entity is also provided.


Wallenfels I, Chlumská A
Vaginal myofibroblastoma with glands expressing mammary and prostatic antigens.
Cesk Patol. 2012; 48(1):40-3 [PubMed]
A case of unusual vaginal myofibroblastoma containing glands which expressed mammary and prostatic markers is described. The tumor occurred in 70-year-old woman in the proximal third of the vagina. It showed morphology and immunophenotype typical of so-called cervicovaginal myofibroblastoma. The peripheral zone of the lesion contained a few groups of glands suggesting vaginal adenosis or prostatic-type glands on initial examination. The glands showed a surprising simultaneous expression of mammary markers mammaglobin and GCDFP-15 and prostatic markers prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP). Immunostains for alpha-smooth muscle actin, p63 and CD10 highlighted the myoepithelial cell layer of the glands. The finding indicates that simultaneous use of both mammary and prostatic markers for examination of unusual glandular lesions in the vulvovaginal location can be helpful for an exact diagnosis, and can contribute to better understanding of prostatic and mammary differentiations in the female lower genital tract.


Ansari DO, Horowitz IR, Katzenstein HM, et al.
Successful treatment of an adolescent with locally advanced cervicovaginal clear cell adenocarcinoma using definitive chemotherapy and radiotherapy.
J Pediatr Hematol Oncol. 2012; 34(5):e174-6 [PubMed]
Pediatric cervicovaginal clear cell adenocarcinoma (CCA) is rare but continues to occur in the postdiethylstilbestrol era. Ideal management is unclear. We report a case of locally advanced, node-negative CCA in a 14-year-old girl without a history of diethylstilbestrol exposure. The patient's disease was FIGO stage IIIA, involving the cervix, vagina, and parametrium. She was treated with concurrent cisplatin and external beam radiation, followed by interstitial low-dose rate brachytherapy. The patient has no evidence of disease after 2 years of follow-up. These findings support the use of definitive chemoradiation as a treatment option for adolescents with locally advanced CCA.


Mahe E, Bishara M, El Demellawy D, et al.
The vaginal spindle cell epithelioma: a case report, review of the literature and discussion of potential histogenesis.
Pathol Res Pract. 2012; 208(7):424-32 [PubMed]
The so-called mixed tumors occur in a variety of sites throughout the body. While most cases are encountered in the salivary glands, several cases have been described in the female genital tract. A variety of monikers have been applied to this lesion including "spindle cell epithelioma." As in other locations, the vaginal spindle cell epithelioma (VSE) consists of a proliferation of both epithelial and mesenchymal components. Based on our extensive review of the literature, we present the 53rd reported case of VSE. More significantly, we present the most up-to-date review of this lesion, including its immunohistochemical and electron microscopic features. We also review the theories pertaining to its histogenesis incorporating current embryologic data, which together suggest a Müllerian derivation.


Laronda MM, Unno K, Butler LM, Kurita T
The development of cervical and vaginal adenosis as a result of diethylstilbestrol exposure in utero.
Differentiation. 2012; 84(3):252-60 [PubMed] Article available free on PMC after 01/10/2013
Exposure to exogenous hormones during development can result in permanent health problems. In utero exposure to diethylstilbestrol (DES) is probably the most well documented case in human history. DES, an orally active synthetic estrogen, was believed to prevent adverse pregnancy outcome and thus was routinely given to selected pregnant women from the 1940s to the 1960s. It has been estimated that 5 million pregnant women worldwide were prescribed DES during this period. In the early 1970s, vaginal clear cell adenocarcinomas (CCACs) were diagnosed in daughters whose mother took DES during pregnancy (known as DES daughters). Follow-up studies demonstrated that exposure to DES in utero causes a spectrum of congenital anomalies in female reproductive tracts and CCACs. Among those, cervical and vaginal adenoses are most commonly found, which are believed to be the precursors of CCACs. Transformation related protein 63 (TRP63/p63) marks the cell fate decision of Müllerian duct epithelium (MDE) to become squamous epithelium in the cervix and vagina. DES disrupts the TRP63 expression in mice and induces adenosis lesions in the cervix and vagina. This review describes mouse models that can be used to study the development of DES-induced anomalies, focusing on cervical and vaginal adenoses, and discusses their molecular pathogenesis.


Zanfagnin V, Tripodi E, Perotto S, et al.
Aggressive clinical course of primary invasive vaginal carcinoma associated with type 61 HPV: a case report.
Tumori. 2012 Mar-Apr; 98(2):57e-58e [PubMed]
Primary invasive vaginal cancer is one of the rarest malignant processes in the female genital tract. The etiology has not been identified, but the strongest association is with HPV infection and subtypes 16 and 18 have the highest oncogenic potential. We present the case of a young woman diagnosed with metastatic squamous cell carcinoma of the vagina associated with HPV type 61, a non-oncogenic HPV type. We report the propensity of a primary vaginal neoplasm to spread to lymphatic vessels early and the unresponsive aggressive behavior to multimodal therapy.


Postow MA, Hamid O, Carvajal RD
Mucosal melanoma: pathogenesis, clinical behavior, and management.
Curr Oncol Rep. 2012; 14(5):441-8 [PubMed]
Mucosal melanoma represents a rare subtype of melanoma with distinct biological, clinical, and management considerations. Knowledge regarding optimal treatment strategies for mucosal melanoma is limited and based primarily upon small case series and single-institution, retrospective analyses. Surgery remains the standard of care for loco-regional management, but the common presence of multifocal disease and the high rate of distant recurrence should be considered before pursuing aggressive surgical interventions associated with inherent significant morbidity. The role of sentinel lymph node biopsy and lymph node dissection remains unclear. Radiotherapy has not been shown to improve overall survival but may reduce the rate of local recurrence. Significant advances in the treatment of metastatic disease have been made with novel immunotherapeutic agents, the discovery of KIT and BRAF mutations and the development of targeted agents that inhibit these oncogenic pathways.


Conway EL, Farmer KC, Lynch WJ, et al.
Quality of life valuations of HPV-associated cancer health states by the general population.
Sex Transm Infect. 2012; 88(7):517-21 [PubMed] Article available free on PMC after 01/10/2013
OBJECTIVES: To obtain health-related quality of life valuations (ie, utilities) for human papillomavirus (HPV)-related cancer health states of vulval, vaginal, penile, anal and oropharyngeal cancers for use in modelling cost-effectiveness of prophylactic HPV vaccination.
METHODS: Written case descriptions of each HPV-associated cancer describing the 'average' patient surviving after the initial cancer diagnosis and treatment were developed in consultation with oncology clinicians. A general overview, standard gamble questionnaire for each health state and a quiz was conducted in 120 participants recruited from the general population.
RESULTS: In the included population sample (n=99), the average age was 43 years (range = 18-70 years) with 54% men, 44% never married/43% married, 76% education beyond year 12 and 39% employed full-time. The utility values for the five health states were 0.57 (95% CI 0.52 to 0.62) for anal cancer, 0.58 (0.53 to 0.63) for oropharyngeal cancer, 0.59 (0.54 to 0.64) for vaginal cancer, 0.65 (0.60 to 0.70) for vulval cancer and 0.79 (0.74 to 0.84) for penile cancer. Participants demonstrated a very good understanding of the symptoms, diagnosis and treatment of these cancers with a mean score of 9 (SD=1.1) on a 10-item quiz.
CONCLUSIONS: This study provides utility estimates for the specific HPV-related cancers of vulval, vaginal, penile, anal and oropharyngeal cancers valued by a general population sample using standard gamble. The results demonstrate considerable quality of life impact associated with surviving these cancers that will be important to incorporate into modelling cost-effectiveness of prophylactic HPV vaccination in different populations.


Carter JS, Downs LS
Vulvar and vaginal cancer.
Obstet Gynecol Clin North Am. 2012; 39(2):213-31 [PubMed]
Vulvar cancer is becoming more common as the population ages and is primarily a disease of the elderly. Most vulvar cancers are diagnosed at a localized stage and can be cured with surgery and adjuvant radiotherapy. More conservative therapy has been the mainstay in vulvar cancer treatment, which has lessened short-term and long-term morbidity without sacrificing efficacy. Recent national and international studies continue to prove the value of sentinel lymph node technology, which is moving toward a new standard of care for women with early stage vulvar cancer. Vaginal cancer is a rare cancer that also affects elderly women. Prognosis is poor; however, adequate treatment can be delivered with a combination of external beam radiotherapy and brachytherapy, and with surgical resection for a select group of patients.


Li H, Guo YL, Zhang JX, et al.
Risk factors for the development of vaginal intraepithelial neoplasia.
Chin Med J (Engl). 2012; 125(7):1219-23 [PubMed]
BACKGROUND: Vaginal intraepithelial neoplasia (VAIN), as a precursor of vaginal cancer, is a rare disease. Its prevalence has not been well analyzed. This research is to ascertain the risk factors for VAIN in a Chinese population.
METHODS: A case-control study was conducted, including 63 VAIN cases and 64 healthy controls. In all subjects Pap smear and HPV tests were performed. A questionnaire survey was distributed, covering information on socio-demographic characteristics, smoking, past history, reproductive and sexual histories. The clinical pathological data were collected from medical records including symptoms, Pap smear results, grade of lesions, and human papillomavirus (HPV) status.
RESULTS: Postmenopausal women had a 2.09 times higher risk for VAIN than pre-menopausal women (95%CI: 1.10 - 3.85; P = 0.024). The patients with previous hysterectomy had an increased risk of VAIN (OR = 4.69; P = 0.003). Patients with a history of cervical cancer or CIN were predisposed to VAIN (OR = 78.75; P < 0.0001). The rate of HPV infection in VAIN was significantly higher than in controls, and an increased risk of VAIN was observed in patients with higher viral load (OR = 126.00; P = 0.000). Multivariate analysis showed that HPV infection and a history of CIN or cervical cancer were still found to be significant in patients.
CONCLUSION: HPV infection and a history of CIN or cervical cancer are the main risk factors for the development of VAIN.


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