Cases reported "Vulvar Neoplasms"

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1/36. Metastatic melanoma of the vulva identified by peritoneal fluid cytology.

    Malignant melanoma of the vulva is an uncommon disease, with a significant portion of cases demonstrating metastasis to inguinal lymph nodes with potential distal spread. Identification of such metastases often requires fine-needle aspiration or biopsy. The cytologic diagnosis of metastatic vulvar melanoma from peritoneal effusions has not been previously described. We present the case of a 54-yr-old woman who underwent en bloc radical vulvectomy with bilateral inguinal lymphadenectomy for melanoma of the right labium minora. No evidence of metastatic disease was identified, and all surgical margins were free of tumor. Despite chemotherapy, the patient returned approximately 2 yr later with abdominal pain and distention. Computed tomography revealed marked ascites and three hepatic lesions. Cytologic examination of the ascites revealed recurrent, metastatic melanoma. Although very rare, metastatic melanoma of the vulva may present as a malignant effusion. In such an event, the diagnosis may be rendered by exfoliative cytology.
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ranking = 1
keywords = melanoma
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2/36. Malignant melanoma of the vulva: report of six cases and review of the literature.

    Six patients with vulvar malignant melanoma are reported. They accounted for 5.2% of all females with vulvar malignancies diagnosed in the south of israel between 1961 and 1997. Age ranged from 25 to 66 years. Presenting symptoms were pruritus, bleeding and ulcer. Lesion originated in the labia minora in four patients and the labia majora in two, and lesion size ranged from I to 8 cm. Five patients had nodular melanoma, and one had superficial spreading melanoma. Breslow depth ranged from 2.5 to 8 mm, Clark level was IV in four patients and III in two, and Chung level was IV in all patients. Two patients had radical vulvectomy and bilateral groin lymphadenectomy, one had wide local excision, and one refused surgery. The two patients who had radical hemivulvectomy and bilateral groin lymphadenectomy were given adjuvant active specific immunotherapy with allogeneic vaccine and have survived disease-free, whereas the remaining four patients died of disease. It is concluded that vulvar malignant melanoma is a rare and aggressive tumor. For patients who present with deep lesions (Breslow depth > 0.76 mm, Clark level > II, Chung level > II) the recommended treatment is wide radical local excision (or at the most, radical hemivulvectomy) and bilateral groin lymphadenectomy.
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ranking = 1.0123613244156
keywords = melanoma, malignant melanoma
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3/36. Fine-needle aspiration cytology of "proximal-type" epithelioid sarcoma.

    The cytologic and immunocytologic findings in a case of recurrent "proximal-type" epithelioid sarcoma (ES) of the vulva are presented. This is a recently described neoplasm that differs clinically and morphologically from conventional ES. Cytologic smears showed a dissociated population of large, atypical neoplastic cells with bi- and multinucleated cells, abundant cytoplasm, and rhabdoid-like morphology. Due to its different clinical management it must be differentiated from metastatic carcinoma and melanoma. From a practical perspective, its differentiation from other epithelial-like sarcomas is less important. In conclusion the cytopathologic findings of "proximal-type" ES show a good correlation with histopathology, permitting the diagnosis of recurrences and metastases. When accompanied by adequate clinical information and ancillary studies, a specific preoperative recognition seems possible.
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ranking = 0.11111111111111
keywords = melanoma
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4/36. Vulvar malignant melanoma associated with human papillomavirus dna: report of two cases and review of literature.

    Oncogenic human papillomavirus (HPV) types such as HPV 16 are known to play a crucial role in the development of anogenital carcinomas. The etiology of anogenital malignant melanoma is unknown. We report two case of vulvar malignant melanoma in which multiple HPV types including HPV 16 and putative novel HPV types (alb-1, alb-2, alb-7, and alb-10) were identified by degenerated nested polymerase chain techniques (polymerase chain reaction) in both the malignant melanoma and surrounding skin. One melanoma was associated with lichen sclerosus, and the other, with melanoma in situ and pigmented vulvar squamous papillomatosis. These melanomas harbored HPV types alb-7, and HPV 16 as well as alb-1, respectively. HPV types 16, 20, 21, 36, alb-2, and AJ001060 were detected in vulvar skin affected by lichen sclerosus. Vulvar squamous papillomatosis harbored HPV types 28 and alb-10. HPV 16 was physically integrated into the host genome in lichen sclerosus skin and possibly in the melanoma associated with pigmented vulvar squamous papillomatosis. Twenty-two percent (4 of 18) of normal control specimens from skin tumor excisions were found to harbor HPV dna (HPV types 3, 54, and alb-7); none of these control samples harbored multiple HPV dna. These findings of multiple HPV dna and integrated HPV 16 in skin associated with vulvar malignant melanoma indicate that HPV may play a role in the development of vulvar malignant melanoma. The role of HPV could be either direct through infection of melanocytes or indirect as a cofactor with free radicals in chronic fibroinflammatory vulvar disorders such as lichen sclerosus.
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ranking = 1.9383341865511
keywords = melanoma, malignant melanoma
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5/36. Melanocytic dysplasia and multiple melanoma of the vulva.

    We report a case of a 24-year-old woman with multiple pigmented lesions on her vulva. Histologically the lesions showed a heterogeneous pattern: the majority consisted of melanoma in situ and invasive melanoma; in a few lesions a much less clear-cut picture was found with only melanocytic dysplasia of various degrees. Our case shows the relationship between anomalous melanocytic proliferation of the vulva and vulvar melanoma and underlines the necessity of a thorough check of all melanocytic vulvar lesions also in young patients.
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ranking = 0.77777777777778
keywords = melanoma
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6/36. Pagetoid squamous cell carcinoma in situ (pagetoid bowen's disease) of the external genitalia.

    Approximately 5% of cutaneous squamous cell carcinomas in situ (SCCIS) have a nested pattern, referred to as pagetoid SCCIS, or pagetoid bowen's disease. This growth pattern may simulate extramammary Paget's disease (EPD) when the external genitalia are involved. We report two cases of genital pagetoid SCCIS, including the first example affecting the vulva. Using several known cases each of classic (bowenoid) SCCIS of the vulva, primary cutaneous vulvar EPD, and cutaneous melanoma in situ as controls, we performed a battery of immunohistochemical and mucin stains to study the phenotype of pagetoid SCCIS. Both cases of pagetoid SCCIS were strongly positive for cytokeratin (CK) 7, a highly sensitive and popular marker for EPD. Stains with the high molecular weight cytokeratin marker Keratin-903 (34betaE12) showed 4 immunoreactivity, although not with the intensity seen in the juxtaposed normal keratinocytes or in the cells of classic SCCIS. Immunoreactivity scores were 2 for CK5/6, 2 for CK19, and 1 to 3 for CK 13. Unlike the Paget's cells of EPD, the nested cells of pagetoid SCCIS were devoid of mucin and were nonimmunoreactive with GCDFP-15, CEA, CAM5.2, and c-erbB2. Stains for CK20, S-100, and Melan A also were negative. Although CK7 is a sensitive marker for the Paget's cells of EPD, this study corroborates the unexpected CK7 positivity in pagetoid SCCIS, precluding its usefulness in distinguishing these two diseases. Combined with mucin stains, a limited immunohistochemical panel may be of diagnostic value in particularly difficult cases.
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ranking = 0.11111111111111
keywords = melanoma
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7/36. Malignant vulvar melanoma: colposcopic evaluation and review of the literature. A case report.

    Because of the rarity of this kind of vulvar neoplasia, the diagnostic difficulties (clinical and histopathological) conditioning the therapeutic approach and the missing iconographical material, we report a case of vulvar melanoma seen at the Department of obstetrics and gynecology of the University of L'Aquila in April 2001, together with a review of the literature. Owing to radical vulvectomy and bilateral inguinal lymphadenectomy with the Byron three-incision approach the histological report was: epithelioid cell apigmented melanoma radially spreading (MMSS), a tumor-free margin of at least 1.7 cm with sufficient lympholitic infiltration.
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ranking = 0.66666666666667
keywords = melanoma
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8/36. Vulvar melanoma: diffuse melanosis and metastasis to the placenta.

    Mucocutaneous melanoma, including vulvar melanoma, is rare and has a worse prognosis and higher recurrence rate than traditional cutaneous melanoma. Diffuse cutaneous melanosis is another rare clinical presentation of metastatic melanoma. It is essential for dermatologists to be alerted to rare presentations of melanoma, to facilitate early detection. We present the first case to our knowledge of metastatic vulvar melanoma with diffuse cutaneous melanosis in a pregnant young woman. Despite the occurrence of placental metastasis, a healthy, unaffected baby was born. This case exemplifies the aggressiveness of vulvar melanoma. The genitalia should be included in routine total body skin examinations. pregnant women with generalized melanosis may be at increased risk for placental metastasis of melanoma. Pregnancy does not alter the incidence or prognosis of melanoma; however, patients with a poor prognosis or high recurrence risk should be informed of potential pregnancy complications associated with melanoma recurrence or metastasis.
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ranking = 1.5555555555556
keywords = melanoma
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9/36. angiokeratoma of the clitoris.

    A 25-year-old woman, multigravida, presented with a dark ulcerated tumor of the clitoris. Histologic examination demonstrated an angiokeratoma, a benign telangiectatic vascular tumor. To our knowledge, this is the first report of angiokeratoma of the clitoris and only the fifth describing vascular tumor of this organ. The clinical differential diagnosis of angiokeratoma and of clitoral tumors includes malignant neoplasms such as melanoma. biopsy with histologic examination is, therefore, recommended to ensure appropriate treatment of these unusual tumors.
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ranking = 0.11111111111111
keywords = melanoma
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10/36. Primary vulvar melanoma with satellite metastasis: dermoscopic findings.

    A 79-year-old woman presented with a 1-year history of a pigmented nodular lesion on the left labium minor. Histopathology of the nodule led to a diagnosis of metastatic melanoma. A pigmented flat lesion on the inner side of the left labium major was also biopsied and was found to be a superficial spreading melanoma. The dermoscopic findings of primary and metastatic vulvar melanoma which simultaneously occurred in the same patient are described. dermoscopy revealed a homogeneous pattern associated with linear irregular vessels in the metastatic nodule, while irregular globules and streaks were seen in the primary melanoma.
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ranking = 0.88888888888889
keywords = melanoma
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