1/45. Anterolateral thigh fasciocutaneous flap in the difficult perineogenital reconstruction.A pedicled anterolateral thigh fasciocutaneous flap that was used to cover a complicated perineogenital defect after bilateral gracilis myocutaneous flap for perineal reconstruction is presented. The indications and advantages of this approach are outlined. This technique offers to the plastic surgeon and gynecologic oncologist a new option in the armamentarium for reconstruction of the perineum, and it offers the patient reduced donor-site morbidity.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
2/45. Metachronous carcinoma of the vulva and fallopian tube.BACKGROUND: Metachronous carcinoma of the vulva and fallopian tube is an unusual co-occurrence of gynecological malignancies. A report of such a case that developed and recurred over a 7-year period is presented. CASE: A 53-year-old G3P3 female presented with a verrucous carcinoma of the vulva and a serous papillary adenocarcinoma of the left fallopian tube metachronously. To investigate a possible association between the co-occurrence of the rare neoplasms and factors associated with multiple gynecological malignancies, we analyzed the status of human papillomavirus infection and dna mismatch repair deficiency as indicated by microsatellite instability. All samples analyzed were negative for these factors. CONCLUSION: The present results support the possibility that metachronous carcinomas of the vulva and fallopian tube involve unknown etiological factors or arise independently.- - - - - - - - - - ranking = 2keywords = gynecologic (Clic here for more details about this article) |
3/45. Microcystic adnexal carcinoma of the vulva.BACKGROUND: Microcystic adnexal carcinoma (MAC) is a subset of sweat gland carcinoma first described as a specific entity by D. J. Goldstein, R. J. Barr, and D. J. Santa Cruz (Cancer 1982;50:566-72). We report the first case of MAC occurring on the vulva and review the literature pertaining to this rare tumor. CASE: A 43-year-old multiparous black woman presented initially to Kings County Hospital Medical Center with a chief complaint of a vulvar lesion arising on the left labia majora which she had noted for 4 years prior to presentation. Aside from increasing paresthesia in the area, she denied any constitutional symptoms. Her past medical history was significant only for hyperthyroidism and mild hypertension and surgical history was noncontributory. Gynecologic history was unremarkable, with sporadic care over the last 20 years. physical examination revealed a 1.5 x 2.0-cm raised, well-circumscribed, firm mobile lesion on the left labia majora. It was noted to be yellow in color with the surrounding tissue being unremarkable in character. The remainder of her gynecologic examination and lymph node survey was unremarkable. Preoperative chest X ray was negative as was the CAT scan of the abdomen and pelvis. All laboratory values were within normal limits. A Pap smear done preoperatively was significant for atypical squamous and glandular cells of undetermined significance. Subsequent colposcopic examination of the cervix was remarkable for cervicitis and was adequate, with the entire transformation zone visualized. Both endocervical curettage and endometrial biopsy were normal. Initially, an excisional biopsy was performed with final pathology demonstrating microcystic adnexal carcinoma with positive surgical margins. She subsequently underwent a left radical hemivulvectomy with bilateral inguinal groin lymph node dissection. At the time of surgery, the left labia majora was noted to be well healed, with a residual surgical scar easily discernible. No areas of discoloration were noted and digital palpation of the area was unremarkable. Microscopic residual tumor was noted; however, all surgical margins and lymph nodes were negative for tumor. Her postoperative course was unremarkable. The patient has continued to do well since the time of her surgery and is being followed conservatively. CONCLUSION: Radical vulvectomy should be performed when MAC occurs in the vulva to secure negative margins of resection. groin dissection should be reserved for cases in which the inguinal lymph nodes are clinically suspicious or in cases of tumor recurrence.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
4/45. Malignant peripheral nerve sheath tumor of the vulva: a multimodal treatment approach.BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) are rare in the gynecological population and have a high risk for local and distant failures. Multimodal management of a patient with MPNST of the vulva and review of the literature are outlined. CASE: A 34-year-old woman presented with a complaint of a rapidly increasing pelvic mass, pain, and difficulty ambulating. A disfiguring 20 x 20-cm vulvar mass was identified and a recurrent MPNST diagnosed. Therapy included external-beam radiation, anterior pelvic exenteration with pelvic reconstruction, and adjuvant chemotherapy without complication. CONCLUSION: It is recommended that for malignant peripheral nerve sheath tumors of the vulva, complete surgical resection be performed with adjuvant radiation and chemotherapy in selected cases.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
5/45. Liposomal doxorubicin for treatment of metastatic chemorefractory vulvar adenocarcinoma.BACKGROUND: Primaryadenocarcinoma of the vulva is a rare entity, and for widely metastatic vulvar adenocarcinoma, no effective treatment has been established. CASE: A 65-year-old woman was diagnosed with regionally advanced vulvar adenocarcinoma, with bulky involvement of bilateral groin lymph nodes, and associated extramammary Paget's disease. Initial therapy consisted of multiagent chemotherapy and vulvar and groin irradiation, followed by radical vulvectomy with groin and pelvic lymph node dissection. She subsequently developed widely metastatic disease including brain, pulmonary, hepatic, osseus, and subcutaneous lesions. Treatment with liposomal doxorubicin (Doxil) resulted in dramatic regression of metastatic lesions and marked improvement in quality-of-life. She remains clinically well, greater than 1 year since initiating Doxil treatment for widely metastatic vulvar adenocarcinoma, and has surpassed 5 years of survival since her initial diagnosis. CONCLUSIONS: We report the first case of Doxil used for the treatment of metastatic chemorefractory vulvar adenocarcinoma. We observed that Doxil was a well-tolerated and effective agent for this gynecologic malignancy, and warrants further investigation.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
6/45. neuroma of the clitoris after female genital cutting.BACKGROUND: Nerve tumors of the clitoris and particularly neuromas are extremely rare. CASE: A 27-year-old infibulated African woman suffering from chronic vulvar pain increasing with sexual intercourse presented for gynecologic care. Examination revealed a painful clitoral tumor. The tumor was surgically excised. The diagnosis of amputation neuroma of the clitoris was made by microscopic examination. CONCLUSION: This is the first well-documented case of clitoral amputation neuroma occurring after female genital cutting. Considering the high number of genital cuttings practiced, these tumors are probably under-reported in the literature.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
7/45. Vulvar pseudolymphoma.We report a 31-year-old patient with longstanding complaints of vulvar itching and painful intercourse treated with many antimycotic drugs. On examination a small tumor, clinically not differentiable from a malignant lymphoma, on and near the clitoris was found. After excision biopsy the lesion proved to be a pseudolymphoma. Six months after excision of this rare vulvar tumor the patient was completely free of complaints. Although pseudolymphomas are small benign tumors they may case diagnostic problems and major complaints. To our knowledge this very rare disorder has not been reported in the gynecological literature until now.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
8/45. Vulvar cancer with Fanconi's anemia and neutropenic fever: a case report.BACKGROUND: Fanconi's anemia (FA), an autosomal-recessive aplastic anemia, was first described in 1927. patients usually die from complications of pancytopenia. The longer patients survive the underlying anemia, the higher the risk of other cancers, particularly leukemias, hepatocellular cancer and squamous cell tumors. This report is the sixth reported case of vulvar cancer in a young woman with FA since 1966. CASE: A 25-year-old woman with FA was admitted with neutropenic fever; a rapidly growing, suppurative vulvar mass; and trichomonas vaginalis. The patient had maintained routine, preventive gynecologic care, and 4 months prior to admission she had complete removal of a benign vulvar condyloma and no evidence of genital tract cancer. We removed the vulvar mass to relieve discomfort and eliminate an infectious source. The mass was an invasive squamous cell carcinoma of the vulva arising in a vulvar condyloma. Within 2 months of the diagnosis, the patient developed bulky disease metastatic to the lungs and inguinal lymph nodes. CONCLUSION: FA patients are at high risk of squamous cell tumors, and gynecologic examinations should begin at menarche. However, despite adequate screening, rapidly progressing solid tumors of the genital tract can develop in these immunosuppressed patients, who have a defect in dna repair genes.- - - - - - - - - - ranking = 2keywords = gynecologic (Clic here for more details about this article) |
9/45. Pitfalls in the sentinel lymph node procedure in vulvar cancer.OBJECTIVES: There is an increasing interest among gynecologic oncologists to implement the sentinel lymph node (SLN) procedure in vulvar cancer patients in clinical practice. However, the safety of this promising method of staging still has to be proven in a randomized trial. MATERIALS AND methods: Two vulvar cancer patients are reported to illustrate pitfalls in the sentinel lymph node procedure. RESULTS: The phenomena of bypassing the sentinel lymph node and confusion about the number of removed sentinel lymph nodes are presented and discussed. CONCLUSION: Gynecological oncologists who perform the sentinel lymph node procedure in vulvar cancer patients should perform this technique by following a strict protocol and within the protection of a clinical trial.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
10/45. breast cancer metastatic to the vulva.BACKGROUND: Primary cancer of the vulva is not common, constituting only 3-5% of all gynecologic malignancies and <1% of all cancer in the female. Metastatic tumors of the vulva are even more unusual, constituting only 5-8% of all vulvar cancers. CASE: A 32-year-old female underwent total mastectomy with axillary lymph node dissection for left breast cancer. The patient was well with a postoperative follow-up period of 40 months till a 1.2-cm lump was noted in her left labium majus. Excisional biopsy was performed and histologic examination was done. Pathologic examination of the breast cancer revealed coexistence of intraductal carcinoma and invasive lobular carcinoma. The histologic feature of the invasive lobular carcinoma was consistent with that of the vulvar lesion. The vulvar cancer was consistent with a metastatic lobular carcinoma from the breast. CONCLUSION: Only with careful gynecologic surveillance in women with breast cancer can the unusual sites of metastasis be detected earlier and appropriately treated.- - - - - - - - - - ranking = 2keywords = gynecologic (Clic here for more details about this article) |
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