1/34. Recurrent atypical myxoid fibroepithelial polyp associated with vulvar Crohn's disease.Fibroepithelial polyps of the lower female genital tract are common lesions that can rarely exhibit atypical features including increased and atypical mitoses, bizarre nuclei, and hypercellularity, a combination of findings that may suggest malignancy. Five recurrent cases have been published to date, two of which were in pregnant females; the other three followed incomplete excisions. Our case is that of a 25-year-old female with Crohn's disease who developed multiple recurrences of polypoid and domed lesions of the labium minus following surgical excision. Histologic findings in the initial and recurrent lesions were consistent with atypical myxoid fibroepithelial polyps with underlying vulvar Crohn's disease. The lesions subsequently improved with standard Crohn's treatment including 5-amino-salicylic acid (Pentasa) and prednisone. The present case represents the only example of this entity associated with Crohn's disease, and it is the only reported recurrent case not associated with pregnancy, tamoxifen administration, or positive excision margins. The clinical, microscopic, and immunohistochemical findings of this case suggest that atypical fibroepithelial polyps of the lower female genital tract, cutaneous pleomorphic fibroma, and lesions such as fibroepithelial polyps of the anus may represent variants of the same atypical reparative process.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
2/34. Crohn's disease of the vulva.Over the past 10 years, it has been well established that Crohn's disease may involve any segment of the gastrointestinal tract from the mouth to the anus and may also cause destructive extraintestinal lesions. Extensive cutaneous ulceration has recently been recognized as one of the rare extraintestinal complications. A case of chronic vulvar ulceration due to Crohn's disease is reported. The clinical manifestations and management of such a lesion are discussed.- - - - - - - - - - ranking = 1.1942829510565keywords = gastrointestinal tract, tract (Clic here for more details about this article) |
3/34. High-dose-rate brachytherapy for vaginal cancer: learning from treatment complications.Historically, early stage vaginal cancer has been treated with low-dose-rate (LDR) brachytherapy with or without external beam radiation therapy (EBRT). Complication rates have been low and treatment efficacious. Although high-dose-rate (HDR) brachytherapy has been used for cervical cancer in many countries for over a decade, only more recently has it been integrated into treatment plans for vaginal cancer. This paper describes three patients treated with HDR brachytherapy who experienced significant late effects. Given the very limited amount of literature regarding the use of HDR brachytherapy in vaginal cancer, this analysis potentially contributes to an understanding of treatment-related risk factors for complications among patients treated with this modality.A focused review of hospital and departmental treatment records was done on three patients treated with HDR brachytherapy. Abstracted information included clinical data, treatment parameters (technique, doses, volume, combinations with other treatments) and outcomes (local control, survival, early and late effects). A review of the available literature was also undertaken. All patients had significant complications. Although statistical correlations between treatment parameters and complications are impossible given the limited number of patients, this descriptive analysis suggests that vaginal length treated with HDR brachytherapy is a risk factor for early and late effects, that the distal vagina has a lower radiation tolerance than the upper vagina with HDR as in LDR, and that combining HDR with LDR as done in our experience carries a high risk of late toxicity. Integration of HDR brachytherapy techniques into treatment plans for early stage vaginal cancers must be done cautiously. The etiology of the significant side effects seen here is likely to be multifactorial. For users of HDR brachytherapy in vaginal cancer, there is a need to further refine and standardize treatment concepts and treatment delivery. Ideally this will be based on continued careful observation and reporting of both favorable and unfavorable outcomes and experiences.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
4/34. Postparacentesis bilateral massive vulvar edema in a patient with severe ovarian hyperstimulation syndrome.OBJECTIVE: To report a case of bilateral massive vulvar edema following lower abdominal paracentesis in a patient with ovarian hyperstimulation syndrome. DESIGN: Case report. SETTING: University teaching hospital. PATIENT(S): A 32-year-old woman with primary infertility. Intervention(S): The patient underwent ovarian stimulation with leuprolide acetate, highly purified FSH, and hCG. Because of the development of severe ovarian hyperstimulation syndrome, bilateral paracentesis through the lower abdominal quadrants was performed. MAIN OUTCOME MEASURE(S): Treatment of ovarian hyperstimulation syndrome. RESULT(S): Development of bilateral massive vulvar edema 24 hours after lower abdominal paracentesis. CONCLUSION: This case report suggests that lower abdominal paracentesis could be the cause of vulvar edema development in ovarian hyperstimulation syndrome, probably due to a fistulous tract created between the peritoneal cavity and the subcutaneous tissues.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
5/34. Postlaparoscopic vulvar edema, a rare complication.Two cases of unilateral labial edema occurred after laparoscopic presacral neurectomy and were associated with massive chylous ascites. One woman was cured by a second laparoscopy to repair the chylous leakage. In the other, vulvar edema subsided in 2 days and chyloperitoneum subsided spontaneously in 3 weeks. The mechanism of postlaparoscopic vulvar edema is believed to be similar to that of Conn's postparacentesis labial edema, in which the unhealed puncture tract permits ascites to travel through and accumulate in the labia majora.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
6/34. Vulvar syringoma: a clinicopathologic and immunohistologic study of 18 patients and results of treatment.BACKGROUND: syringoma of the vulva has been rarely reported. No effective treatment modality has been documented. OBJECTIVE: The purpose of this study was to describe the clinicopathologic features of vulvar syringoma, to investigate the hormonal influence on its growth, and to establish an effective treatment modality. methods: A total of 18 cases of vulvar syringoma were selected from the surgical pathologic file at Chang Gung Memorial Hospital. In all, 15 formalin-fixed, paraffin-embedded specimens were examined by immunohistochemical staining for estrogen receptor and progesterone receptor. RESULTS: The age of first presentation at our vulvar clinic ranged from 21 to 60 years with a median age of 29.5 years. Of patients, 13 (72%) had vulvar pruritus and 7 noticed aggravation during summer or during menstruation. The most common clinical appearance was multiple flesh-colored or brownish papules on bilateral sides of the vulva (9 of 18). One third of our series was found to have coexisting eyelid syringoma and 4 of them also had a family history of periorbital syringoma. Immunohistochemical stainings for estrogen receptor and progesterone receptor were all negative on the 15 cases studied. Of our patients, 7 with intense pruritus were treated with carbon dioxide laser vaporization. Their lesions resolved and pruritus subsided. CONCLUSION: Vulvar syringoma is not very rare and should be considered in the differential diagnosis of vulvar pruritus. In our study, estrogen receptor and progesterone receptor were not detected in vulvar syringoma. carbon dioxide laser was an effective therapeutic modality in treating patients with intractable symptoms.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
7/34. Vulvar Langerhans cell histiocytosis: a case report and review of the literature.BACKGROUND: Langerhans cell histiocytosis (LCH) of the female genital tract is rare. Only, seven cases of primary vulvar LCH have been previously reported in the medical literature. We describe an additional case of LCH in which the disease was confined to the vulva. CASE: A 33-year-old gravida 0, para 0 Ethiopian woman presented with a nodular lesion on her left vulva. The lesion was biopsied, and the results were consistent with LCH. A metastatic workup did not reveal any evidence of disease beyond the vulva. The patient was initially treated with radiotherapy to the vulva. She was diagnosed with recurrent disease in the vulva 21 months after the completion of radiotherapy. At that time, she underwent a wide local excision. Five months later, we found a lesion on her right labium majus that was consistent with a recurrence. The patient's vulva was treated with a higher dose of radiotherapy than it had been the first time. Six months later the patient again experienced a local recurrence. She underwent a wide radical vulvar excision of diffuse bilateral lesions and was free of disease for approximately 3 months, after which she experienced another recurrence and underwent treatment with thalidomide. Within 2 months of starting thalidomide therapy, the patient experienced resolution of her symptoms and of her vulvar lesions. CONCLUSIONS: Primary LCH of the vulva is very rare. Its etiology and pathophysiology, as well as the most effective modes of therapy, remain elusive. We propose that thalidomide is a useful alternative for patients with this disease.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
8/34. spinal cord stimulation for intractable vulvar pain. A case report.BACKGROUND: vulvodynia is a complex pain syndrome with few effective treatments. We present a case of complex persistent vulvar pain effectively managed with spinal cord stimulation. CASE: A 21-year-old woman had a long history of burning vulvar pain exacerbated by exercise and sexual intercourse. Her symptoms began after termination of pregnancy and were not improved by diet changes or medical therapy. A partial vulvar vestibulectomy with Bartholin gland excision was performed, without an improvement. After referral to a pain management specialist, the patient had temporary relief of symptoms following bilateral hypogastric plexus blocks. With these favorable but temporary results, a permanent spinal cord stimulator was implanted, with sustained symptom relief. CONCLUSION: spinal cord stimulation may offer a new treatment for women with intractable neuropathic vulvar pain.- - - - - - - - - - ranking = 2.5keywords = tract (Clic here for more details about this article) |
9/34. Bladder perforation presenting as vulvar edema after the tension-free vaginal tape procedure. A case report.BACKGROUND: Bladder perforation during the tension-free vaginal tape (TVT) procedure is a common complication. CASE: Vulvar edema was noted 4 hours after application of TVT, and cystoscopy revealed bladder perforation. The patient had a history of a previous vaginal hysterectomy with anterior colporrhaphy. CONCLUSION: To our knowledge, this is the first case report of vulvar edema following TVT. Bladder filling to 250 mL, 70 degrees cystoscopy, good skills in cystoscopy and familiarity with retropubic anatomy are key issues for the TVT procedure. A cystoscopic examination before the TVT procedure should be considered for patients with previous pelvic surgery.- - - - - - - - - - ranking = 0.061613664038451keywords = anatomy (Clic here for more details about this article) |
10/34. Transitional cell carcinoma presenting as clitoral priapism.BACKGROUND: Clitoral priapism is an uncommon cause of clitoromegaly. It should be suspected in the absence of hirsuitism and the presence of clitoral engorgement, pain, and local irritation. CASE: A 48-year-old female had a straight catheterization of her bladder for a history of frequent urinary tract infections. She was noted to have a clitoral size of 5 x 2.5 cm along with the classic findings of priapism. She had an 8 x 10 cm pelvic mass that was biopsied and revealed transitional cell carcinoma with papillary squamous component. CONCLUSION: Clitoral priapism presents with clitoral engorgement in the absence of sexual stimulation. The most common etiologies include medications, pelvic tumors, blood dyscrasias, or retroperitoneal fibrosis. A thorough investigation is warranted to identify potential pelvic venous or lymphatic obstruction.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
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