1/7. melanosis of the vagina. A case report.BACKGROUND: melanosis is a term given to lesions in which melanin pigment is confined to the basal layer of squamous epithelium and on visual inspection may have an appearance similar to that of malignant melanoma. Although relatively common in the oral and gastrointestinal tract, melanosis is an uncommon finding in the female genital tract and especially rare in the vagina; most reported cases have been vulvar. CASE: A 43-year-old, nulliparous woman was noted to have a pigmented lesion at the vaginal cuff during a routine annual examination one year after a hysterectomy. On physical examination, the lesion appeared as a coalescence of several small, pigmented areas at the cuff. On palpation the lesion was flat, having the contour of normal vaginal mucosa, and was not indurated or tender. A biopsy revealed vaginal melanosis. The patient was followed conservatively, with annual examinations, which documented no change in color, size or contour of the lesion. At this writing the patient is six years from presentation and doing well. CONCLUSION: Vaginal melanosis may be difficult to distinguish clinically from malignant melanoma but carries a much different prognosis. A biopsy of any pigmented lesion is always indicated prior to determining the need for therapy versus observation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/7. Differences in the integration pattern and episomal forms of human papillomavirus type 16 dna found within an invasive cervical neoplasm and its metastasis.Human papillomavirus (HPV) type 16 dna was found in three separate neoplastic lesions within a female patient. The physical state of the viral dna in each lesion was determined by two-dimensional agarose gel electrophoresis. The primary cervical tumor contained large amounts of several distinct episomal forms as well as integrated HPV dna. Metastatic tumor tissue found in the vagina had greatly reduced levels of episomal dna and a viral dna integration pattern that was different from that of the primary tumor. The vulvar carcinoma in situ had what appears to be free and integrated forms of viral dna. The results show that although metastatic tissue retained HPV dna, further rearrangements of the integrated viral dna pattern found in the primary tumor may occur with a dramatic decrease of episomal forms during malignant progression.- - - - - - - - - - ranking = 0.060587691683509keywords = physical (Clic here for more details about this article) |
3/7. recurrence of vaginal implantation of transitional cell carcinoma of the urinary tract.BACKGROUND: Vaginal recurrence of bladder carcinoma is extremely rare, with only two cases already reported. We have experienced a third case with the same characteristics of the first one, which was a vaginal recurrence with a prior resected urothelial vaginal tumor. CASE: An 82-year-old woman first presented in 1994 with frequency and gross hematuria. Cystoscopic evaluation revealed a single superficial tumor of the bladder which was treated by endoscopic resection. During the following 7 years, she underwent endoscopic procedures to remove recurrent Ta G2 tumor. In 2002, a cystoscopy revealed a papillary lesion, and a physical examination demonstrated multiple papillary lesion on the vaginal wall. histology of excised genital lesions showed a Grade 2 transitional cell carcinoma. Two years later, the patient presented with a 1-cm solitary lesion on the right vaginal wall, which was then excised. Histological examination showed high-grade transitional cell carcinoma, infiltrating the chorion of the vagina. CONCLUSION: Implantation of shed tumor cells in tissues during micturition or resection seems the only plausible cause of the first implantation. For the second recurrence in the vagina, the possibility is of an incomplete locally excision or a relapse, tied to lymphatic micro metastasis, due to involvement of its own lamina propia.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/7. Paraurethral leiomyoma in a female causing urinary obstruction.We report a case of paraurethral leiomyoma in a female patient, in which the first symptoms were dysuria and sensation of incomplete voiding. The physical examination revealed a mass in the anterior vaginal wall. The diagnosis was made through ultrasonography and pelvic MRI and confirmed by transvaginal ultrasound-guided needle biopsy. The surgical excision was accomplished without opening the urinary tract. A review of the relevant published studies and a suggestion for the appropriate management of these cases are included.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/7. Xanthogranulomatous pseudotumor of the vagina: evidence of a local response to an unusual bacterium (mucoid escherichia coli).Utilization of nonconventional bacterial strains and electron microscopy occasionally may aid in the recognition of unusual microorganisms which fail to be demonstrated by more conventional bacterial stains. We report an unusual case of recurrent vaginal polyps, initially thought by physical examination to represent a malignant neoplasm and histologically to represent a granular cell tumor. The lesions were comprised microscopically of sheets of large, polygonal, histiocytic-like cells with abundant eosinophilic granular cytoplasm. With the Dieterle silver stain, the cytoplasm of these cells contained large numbers of intracellular rod-shaped bacilliform bodies thought to be microorganisms. These organisms stained not at all or very poorly with more conventional bacterial stains, such as Gram and Giemsa stains. Electron microscopy was employed to confirm the presence of intra- and extracellular bacilliform bodies and the absence of large numbers of cytosegresomes, the latter characteristically seen in typical granular cell tumors. Cultures of tissue from the biopsy documented a pure strain of a mucoid form of escherichia coli. We were unable to identify any prior report describing a similar recurrent inflammatory vaginal lesion in which mucoid E. coli was demonstrated. We discuss possible pathogenesis of this case, and relate it to morphologically similar diseases, such as Whipple's disease and malakoplakia, in which there appears to be defective clearance of bacteria from a variety of tissues.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/7. radiation recall reaction to idarubicin resulting in vaginal necrosis.radiation recall reactions are uncommon delayed tissue reactions seen in previously irradiated sites following treatment with cytotoxic agents. We evaluated a 64-year-old who developed two episodes of acute vulvitis and vaginal necrosis after receiving idarubicin therapy for acute myelogenous leukemia. Three years earlier she had undergone successful radiotherapeutic treatment of a stage I squamous cell carcinoma of the vagina. Her symptoms and examination findings resolved with local therapy and discontinuation of idarubicin. Recall reactions have been associated with the antitumor antibiotics actinomycin D and doxorubicin and, more recently, the mitotic inhibitors vinblastine and Taxol. The mechanism of this phenomenon is poorly understood but may be related to sequential stem cell injury or depletion. Because physical and biopsy findings are nonspecific, the diagnosis must be suspected on the basis of the patient's history and the location of the reaction within the prior treatment field.- - - - - - - - - - ranking = 0.060587691683509keywords = physical (Clic here for more details about this article) |
7/7. Malignant vaginal melanoma. Usefulness of fat-saturation MRI.We present a case of malignant vaginal melanoma studied by magnetic resonance imaging (MRI). A dark irregular mass was noted in the anterior wall of the vaginal cavity on physical examination. On fat-saturated T1-weighted MRI, the vaginal lesion was demonstrated more clearly than by conventional T1- and T2-weighted images. Furthermore, the fat-saturated image detected the bladder metastasis from the vaginal lesion.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |