Pleomorphic rhabdomyosarcoma of the vagina: A case report

BACKGROUND Rhabdomyosarcoma(RMS)of the vagina in postmenopausal women is an extre-mely rare malignant tumor that was originally described as a unique group of soft tissue sarcomas originating from primitive mesenchymal cells.It was first re-ported in postmenopausal women in 1970,and fewer than 50 postmenopausal patients have been reported to date.CASE SUMMARY A 68-year-old multiparous female was admitted to the hospital on October 11,2023,with the chief complaint of a mass causing vaginal prolapse with incomplete urination that had persisted for 4 months.The vaginal mass was approximately the size of a pigeon egg;after lying down,the vaginal mass retracted.Complete resection was performed,and vaginal pleomorphic RMS was diagnosed based on pathology and immunohistochemical staining features.The patient is currently undergoing chemotherapy.The present study also reviewed the clinical,histolo-gical,and immunohistochemical features and latest treatment recommendations for vaginal RMS.Any abnormal vaginal mass should be promptly investigated through pelvic examination and appropriate imaging.The current initial treat-ment for vaginal RMS is biopsy and primary chemotherapy.CONCLUSION When surgery is planned for vaginal RMS,an organ-preserving approach should be considered.

Atopobium vaginae与细菌性阴道病关系的研究

目的:应用非培养方法研究Atopobium vaginae与细菌性阴道病的关系。方法:根据Nugent评分标准从15例健康妇女及17例BV患者的其阴道分泌物中提取细菌总DNA。分别选择健康妇女及BV患者样本各3例,构建16S rRNA基因克隆文库并进行测序分析。应用Atopobium vaginae16S rRNA基因的特异性引物对32例样本进行PCR扩增。结果:Atopobium vaginae是BV患者阴道菌群中的优势菌种,它存在于大部分(14/17)BV患者阴道中,健康妇女阴道中(1/15)则很罕见。结论:Atopobium vaginae与细菌性阴道病的发生有一定的相关性。

Vagina vasorum dissection during D2 lymphadenectomy for gastric carcinoma

AIM: To explore the relationship between metastasis and vagina vasorum in the progress of gastric carcinoma and to find some facts and references for gastric surgeons. METHODS: One hundred and seven specimens of left or right gastric arteries (55 left and 52 right) were gathered from 59 patients undergoing radical gastrectomy for gastric carcinoma. All the frozen specimens were cut into 3 μm-thick sections and stained with hematoxylin-eosin (HE) and immunohistochemical method separately. Cytokeratin (CK) and mesothelial cells (MC) were stained with immunohistochemical method. Cancer cells inside vagina vasorum were detected and the structure of artery wall was observed under microscope. RESULTS: Metastatic cancer cells or tubercles were found inside vagina vasorum in some stage Ⅲ or Ⅳ specimens, but not in stageⅠor Ⅱ specimens. Tumor cells in vagina vasorum were CK positive in 26 specimens of 14 tumors. Among them, stage Ⅲ was found in 4 specimens of 2 tumors, and stage Ⅳ in 22 specimens of 12 tumors. None of these specimens was positive for MC. The positive rate of CK increased with TNM staging. Compared with the lower part, tumors in the upper and middle parts of stomach were more likely to metastasize into vagina vasorum. CONCLUSION: Vagina vasorum dissection should be performed during D2 lymphadenectomy for TNM stage Ⅲ or Ⅳ gastric carcinoma.

Primary extragastrointestinal stromal tumor arising in the vaginal wall: significant clinicopathological characteristics of a rare aggressive soft tissue neoplasm

Gastrointestinal(GI)stromal tumor is the most common mesenchymal neoplasm of the GI tract but also occurs with a lower frequency in extragastrointestinal regions and is called extragastrointestinal stromal tumor(EGIST).We report an unusual case of EGIST presenting as a vaginal mass.A 41-year-old woman presented with a gradually enlarging vaginal mass for the last2 years.Physical examination revealed an elliptical,non-tender mass about 7.5 cm×7 cm in size in the posterior vaginal wall and was resected completely.Under histological examination,the tumor showed a spindle cell type with coagulation necrosis,hemorrhage and high mitotic count.Immunohistochemical analysis revealed tumor cells were positive for DOG1,CD117,CD34 and p53 protein.Ki-67 labeling was 8%.Genetic analysis showed a deletion of exon 11 of the c-kit gene at codons 557-558.EGISTs should be kept in mind in the differential diagnosis in patients presenting with solid mass of the vaginal wall.

Comparison of Electro Ejaculator and Artificial Vagina on Semen Collection from South African Indigenous Goat Following Assessment by Computer Aided Sperm Analysis

South African indigenous bucks are raised under extensive conditions and are more likely to reject artificial vagina (AV) due to their limited contact with human beings, as they are less handled. The purpose of the study was to compare goat semen collection techniques used for goats based on semen traits of South African indigenous bucks during the natural breeding season. A total of eight South African indigenous bucks were used, four bucks per semen collection technique due to their scarcity. Before semen collection with AV group, ten bucks were trained and exposed to AV. Semen was then collected from both groups over a period of six weeks per individual buck. Semen volume, pH and sperm concentration were evaluated immediately. The Computer Aided Sperm Analysis (CASA) assessed the sperm motility rates. Sperm morphology was evaluated using a fluorescence microscope with the aid of eosin-nigrosin staining. Analysis of variance was used to test the differences among the semen collection groups following assessment by CASA. Semen collected with EE resulted in higher semen volume (1.1 mL) compared with AV (0.5 mL) technique. However, AV technique resulted in higher total sperm motility and rapid movement (91.9% and 48.7%), live sperm (72%) and sperm concentration (635.6 × 106 sperm/mL) compared with EE (86.3% and 30.4%;69% and 463.7 × 106 sperm/mL, respectively). There were no significant differences observed in pH and sperm morphology characteristics between two semen collection techniques. Moreover, EE had higher sperm moving in a progressive (53.6%) and medium rate compared with AV (41.1% and 21.9%) technique. It was concluded that the AV yielded higher total sperm motility rate, sperm concentration and rapid sperm movement compared with EE. Therefore, AV was more suitable for semen collection of South African indigenous bucks, even though training was problematic to such indigenous bucks.

Supportive tissues of the vagina with special reference to a fibrous skeleton in the perineum: A review

With the aid of immunohistochemistry, the present review attempts to demonstrate the composite fibers and nerve topographical anatomy in the vaginal supportive tissues. Along the tendinous arch of the pelvic fasciae, distal parts of the pelvic plexus extend antero-inferiorly and issue nerves to the internal anal sphincter as well as the cavernous tissues. At the attachment of the levator ani muscle to the rectum, smooth muscles in the endopelvic fascia lining the levator ani merge with the longitudinal smooth muscle layer of the rectum to provide the conjoint longitudinal muscle coat or the longitudinal anal muscle (LAM: smooth muscle). However, at the rectovaginal interface, the longitudinal smooth muscle layer of the rectum continues to the LAM without any contribution of the endopelvic fascia. The bilateral masses of the perineal smooth muscles (PSMs) are connected by the perineal body, and the PSMs receive 1) the longitudinal anal muscle, 2) the internal and external anal sphincters and, 3) the perineal membrane lining the vestibular wall. Tensile stress from the levator ani seems to be transferred to the PSMs via the LAM. Because of their irregularly arrayed muscle fibers, instead of a synchronized contraction in response to nerve impulses, the PSMs are likely to act as a barrier, septum or protector against mechanical stress because, even without innervation, such smooth muscle fibers resist (not absorb) pressure, in accordance with Bayliss’ rule. The external anal sphincter, a strong striated muscle, inserts into the PSMs and seems to play a dynamic role in supporting the rectovaginal interface to maintain the antero-posterior length of the urogenital hiatus. However, we do not think that smooth muscles play an active traction role without cooperation from striated muscle. The fibrous skeleton composed of smooth muscle in the female perineum is explained in terms of a “catamaran” model.

PRIMARY MALIGNANT MELANOMA OF THE VAGINA:CLINICAL, PATHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDIES OF 9 CASES

Nine cases of vaginal primary malignant melanoma were diagnosed and treaed in Zhejiang Cancer Hospital from 1964 to 1990. The mean age of patients was 48. 6 years. Abnormal vaginal bleeding was the Incipient symptom in 6 patients. Five cases of malignant melanoma located in the lower one-third of the vagina. Five patients had the tumor in size larger than or equal to 4 cm In diameter. All of them were of the cauliflower-like, nodular configuration grossly. The surface of the mass demonstrated in a variable degree of black or grey- blackish in 7 patients. The htstological appearances were similar to those in the skin. Sections of 4 cases Indicated only few or no melanin under microscope. The covering epithelial changes of 3 vaginal primary malignant melanoma resembled that of malignant melanoma in situ. All sections of 9 cases showed positive reaction to S-100 protein and negative to CEA immunohistochemically. This article laid emphasis on the origin, diagnosis and treatment of this tumor, and make discussion in conjunction with the literature.

In Bangla There Is No Word for Vagina —Reflections on Language, Sexual Health, and Women’s Access to Healthcare in Resource-Limited Countries

Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.

Vulvovaginal myeloid sarcoma with massive pelvic floor infiltration: A case report and review of literature

BACKGROUND Myeloid sarcoma(MS),including isolated and leukaemic MS,is an extramedullary myeloid tumour.MS can involve any anatomical site,but MS of the female genital tract is rare,with the ovaries and uterine body and cervix being the most commonly seen sites.Involvement of the vagina and vulva is extremely rare.CASE SUMMARY We report a rare case of MS with involvement of the vulva and vagina and massive infiltration of the pelvic floor.A 26-year-old woman presented with a vulvar mass,irregular vaginal bleeding and night sweats.Magnetic resonance imaging demonstrated an ill-defined,irregular vulvovaginal mass with massive involvement of the paravaginal tissue,urethra,posterior wall of the bladder,and pelvic floor.The signal and enhancement of the huge mass was homogeneous without haemorrhage or necrosis.Positron emission tomography/computed tomography showed high fluorodeoxyglucose uptake by the mass.Peripheral blood count detected blast cells.Vulvovaginal mass and bone marrow biopsies were performed,and immunohistochemistry confirmed the diagnosis of acute myeloid leukaemia(M-2 type,FAB classification)and vulvovaginal MS.The patient was treated with induction chemotherapy followed by allogeneic haematopoietic stem cell transplantation,and achieved complete remission.A systemic review of the literature on vulvovaginal MS was conducted to explore this rare entity’s clinical and radiological features.CONCLUSION Vulvovaginal MS is extremely rare.Diagnosis of vulvovaginal MS can only be confirmed histopathologically.Even though its clinical and imaging presentations are nonspecific,MS should be considered in the differential diagnosis of a newly developed T2-hyperintense,homogeneously enhanced vulvovaginal mass,especially in a patient with suspected haematological malignancy.

Genistein improves the vaginal epithelium thickness in a rat model of vaginal atrophy through modulation of hormone and heat shock protein 70 levels

Objective: To investigate whether administration of genistein can improve hormonal changes [estradiol and follicle stimulating hormone (FSH)] , heat shock protein 70 (Hsp70) expression, and thickness of vaginal epithelial cells in a rat model of vaginal atrophy. Methods: Twenty-five multiparous female rats were divided into five groups, namely the control group (without ovariectomy), the ovariectomy only group, and the ovariectomy groups 1, 2 and 3 receiving genistein at the doses of 0.045, 0.090 and 0.180 mg/kg body weight/day, respectively. Estradiol, FSH, and Hsp70 expression were analyzed by using the immunoassay technique. Analysis of the thickness of the vaginal epithelium was performed by histology. Results: Ovariectomy significantly decreased estradiol levels compared to the control group (P<0.05). All doses of genistein significantly increased levels of estradiol in rats with vaginal atrophy compared to the ovariectomy only group (P<0.05). Ovariectomy significantly increased FSH levels compared to the control group (P<0.05). All three doses of genistein restored FSH levels comparable to those in the control group (P>0.05). Ovariectomy significantly increased parabasal cell Hsp70 expression compared to the control group (P<0.05). Of all the genistein doses, only the dose at 0.045 mg/kg body weight/day restored the expression of Hsp70 to levels in the control group (P>0.05). Conclusions: Genistein is able to increase the thickness of the vaginal epithelium through hormone modulation and cellular stress suppression. Genistein is beneficial in the form of a herbal or alternative food for improvement of vaginal atrophy due to menopause.

Unusual primary location of the malignant melanoma, the cervico-vaginal region: 3 cases and literature review

Introduction: Malignant melanoma (MM) represents 1% of all cancers and has an incidence of 3% - 7% in the female genital tract, the majority of cases being reported in the vulva. The cervico-vaginal region is an unsual primary location of the malignant mela-noma. Case report: The clinical and morphologic findings of 3 MM patients with cervico-vaginal tumours mimicking cervical polyp in third case. Histologically, the neoplasia was formed by nodules of broad cytoplasmic cells with poorly defined borders with pleomorphic nuclei with prominent nucleolae. Tumor cells were positive for S-100 protein, Melan A, HMB 45 and CD117. The authors discuss three cases of cervico-vaginal melanoma and analyze clinical and prognostic aspects of this disease. Conclusion: Primary MM of the cervix should be considered in the differential diagnosis of cervical malignancies. Early diagnosis is essential in order to warrant a better prognosis, although there are no cases of cure described.

Predictors of Outcome after Transvaginal Mesh for Pelvic Organ Prolapse

Introduction: We aim to report outcomes and predictors of outcome of transvaginal mesh (TVM) for pelvic organ prolapse (POP). We also report frequency, severity, risk factors, and management of mesh-related complications after TVM. Materials and methods: We performed retrospective chart review of TVM performed from 2005 to 2010. There were 67 patients followed for a mean duration of eighteen months. Complications were reported using the International Continence Society and International Urogynecological Association classification system for prosthesis/graft complication. Results: Success rate was 88% (97% for anterior repair, 100% for posterior repair and 71% for combined repair) and complications occurred in 13 patients (19%), including vaginal hematoma, pelvic pain, urinary retention, dyspareunia and vaginal mesh exposure (in 9 patients). On multivariable logistic regression, recurrence was significantly higher with combined repair (P = 0.021), overall complication was significantly associated with younger age (P = 0.019), and mesh exposure was significantly associated with age and combined repair. All mesh-related complications were vaginal exposures occurring at median of 6 months postoperatively. Two patients were managed conservatively with vaginal estrogen cream, while seven patients elected surgical excision of exposed mesh with primary re-approximation of the vaginal epithelium. There were no excision-related complications, and in no case was the defect large enough to require closure with graft or secondary material. Conclusion: Combined anterior and posterior repair using TVM is associated with failure, younger age is associated with higher rate of complication, and combined repair and younger age are associated with mesh-related complication specifically.

Primary Melanoma of the Vagina Treated by Imatinib: Case Report

Melanoma of the vagina is a rare lesion. It results from the malignant transformation of ectopic melanocytes occurring in post-menopause. The CKIT is expressed in 36% of cases in addition to melanoma markers. Prognosis is poor especially for inoperable and disseminated forms despite systemic therapy. Treatment with Imatinib is an option in cases of metastatic mucosal melanoma with CKIT mutation or amplification. We report the case of post-menopausal women, treated at Hassan II University Hospital, diagnosed with metastatic melanoma of the vagina, that didn’t respond to first line of chemotherapy, and received Imatinib as second line of treatment, with good clinical response and durable stability at radiological assessment.

Isolation and Screening of Lactic Acid Bacterial Strains with Antibacterial Properties from the Vaginas of Healthy Cows

In the present study, eight strains were isolated from 20 cow vagina samples and identified using phenotype, biochemical analysis, sugar fermentation tests, and 16S rRNA sequence analysis. Among eight strains, only SQ0048 was identified as Lactobacillus johnsonii based on a series of biochemical testing (including the adhesion test, catalase test, bacteriocin production test, antibacterial test, and pH value), suggesting that its biological activity was superior to the other seven strains. Furthermore, SQ0048 had the lowest pH value (4.32) and the shortest fermentation time (8 h) compared with the other strains. The adhesion rate of SQ0048 was significantly higher than that of Lactobacillus delbrueckii, with an average adhesion number of 304 ± 2.67. The hydrogen peroxide production testing in SQ0048 was positive;in addition, bacteriocin gene of SQ0048, encoding an approximately 10-kDa product, was successfully cloned, expressed, and detected using the SDS-PAGE method. Meanwhile, SQ0048 had a weak inhibitory effect on Staphylococcus aureus and Escherichia coli. However, the expression products of the bacteriocin gene of SQ0048 had a very strong inhibitory effect on S. aureus and E. coli, with inhibition zone sizes of 18 ± 0.45 mm and 15 ± 0.60 mm, respectively. These data showed that SQ0048 has excellent antibacterial properties compared with other isolated strains and is a potential probiotic candidate to improve the health of the vaginas of cows by inhibiting pathogenic microorganisms.

A Case Report of Aggressive Angiomyxoma of the Vagina

This is a case report of a woman with a vaginal aggressive angiomyxoma（AAM） which is a rare benign tumor. The woman was 51-years old who had a previous cesarean section. On July 3 2006, she was admitted because of an increase in vaginal excretions accompanying micturition over a period of 1 month. She had limitated activity of her left lower extremity from childhood because of inappropriate medication,

EXPERIENCE WITH VAGINAL RECONSTRUCTION USING PUDENDAL-THIGH FLAPS-REPORT OF 9 CASES

Objective To review our eoperience of vaginal reconstruction using pudendal- thigh flap.Methods In the past 4 years, 9 patients suffering from the congenital vaginal agenesis underwent vaginalreconstruction using the pudendal- thigh flaps. The modilications of the surgical technique were de-tailed. Results All patients recovered satisfactorily from surgery and have been lollowed - up for a mean of 1.5years. There were no instances of flap loss, penetration of rectum and urethra. On final examination, all patientswere recorded as having a satislactory result, complete flap take, adequate dimensions and depth of neovagina andthe external appearance of the perineum and vagina was satisfactory. All married patients reported a satisfactoryintercourse. Conclusion The result proves that neurovascular pudendal- thigh flaps provide excellent tissue forvaginal reconstruction with low complication rate and good results. This operation does not cause an ugly donorsite scar and can be completed in single stage, without need of loparotomy and postoperative daily dilation. It isbelieved that this method can serve as a reliable alternative in vaginal reconstruction, which is one of the mostchallenging subjects of plastic surgery.

Trichomonas vaginalis and human papillomavirus:Association with the microbiota and burden on the cervix

Trichomoniasis and HPV infection are common non-viral and viral sexually transmitted diseases worldwide.Emerging evidence shows that the female genital tract and its microbiota are greatly affected by these pathogens.However,the relationship between Trichomonas vaginalis,the vaginal microbiome,and High-risk(HR)-HPV infection is complex and multifaceted.Studies have proven that concurrent infections of HIV and HPV increase the risk of cervical cancer.With this basis,a question arises:How does the concurrent infection of trichomonas vaginalis and HPV affect genital tract health?Does this concurrent infection enhance or inhibit the development of cervical lesions?This review aims to bring light to these questions.This review also covers the association of trichomonas vaginalis and HPV with the microbiota of the genital tract.

阴道卷曲乳杆菌S层蛋白多样性研究

目的:分析比较西安市女性阴道卷曲乳杆菌S层蛋白的多样性及NCBI数据库中阴道来源卷曲乳杆菌S层蛋白的多样性。方法:选取100例妇科患者的阴道分泌物标本作为研究对象,从其中10例标本中分离得到480株卷曲乳杆菌,其中两株卷曲乳杆菌S层蛋白有明显差异,对其进行全基因组测序;并从NCBI数据库中下载人阴道源的卷曲乳杆菌全基因组数据,分析并比较西安市来源与数据库来源的卷曲乳杆菌S层蛋白的多样性。结果:S层蛋白注释基因具有菌株内和菌株间的多样性,同一套基因组中有多个S层蛋白注释基因,菌株间的相似性偏差较大,通过系统发育分析发现,中国人阴道卷曲乳杆菌的S层蛋白基因与其他人种的具有系统发育相似性。结论:阴道卷曲乳杆菌S层蛋白具有菌种间和菌株间多样性的特征,不同人种的卷曲乳杆菌具有相似性。

女性生殖道中肾腺癌临床病理及分子特征分析

目的:探讨女性生殖道中肾腺癌的临床特点、组织病理学形态及免疫表型和分子特征。方法:收集2014年1月至2023年12月于首都医科大学附属北京妇产医院确诊的女性生殖道中肾腺癌5例(宫颈中肾腺癌4例及阴道中肾腺癌1例),回顾分析其临床病理资料。结果:5例患者平均年龄55岁(49~63岁)。主要临床表现为异常阴道出血。4例宫颈中肾腺癌均在术前行宫颈活检,但未明确诊断为中肾腺癌。患者均行根治性全子宫切除+双侧附件切除+盆腔淋巴结清扫±腹主动脉旁淋巴结切除术,术前和(或)术后行以铂类为基础的化疗±放疗±抗血管生成治疗。4例宫颈中肾腺癌诊断为FIGOⅠb1~Ⅱb期,1例阴道中肾腺癌诊断为Ⅲ期。宫颈中肾腺癌肿瘤主体位于宫颈管壁深层,肿瘤周边存在中肾管残余/中肾管增生。5例中肾腺癌的免疫组化染色结果基本一致,阳性表达PAX8、GATA3、CD10,并阴性表达TTF-1、ER及PR,且4例为TP53野生型。1例宫颈中肾腺癌和1例阴道中肾腺癌均存在KRAS基因突变,突变位点分别为p.G12D及p.G12A。平均随访51个月(18~115月),1例阴道中肾腺癌患者在随访13个月时发生肺转移。结论:女性生殖道中肾腺癌是起源于中肾管残留或增生的罕见恶性肿瘤。中肾腺癌极易误诊,结合PAX8、GATA-3、CD10、ER、PR及TTF-1等免疫组化特征有助于明确诊断。中肾腺癌常与KRAS/NRAS的分子改变有关,为疾病的分子靶向治疗提供了依据。

腹腔镜腹膜阴道成形术治疗MRKH综合征的临床疗效

目的探讨腹腔镜腹膜阴道成形术(罗湖二式)治疗苗勒管发育不全(MRKH)综合征的临床疗效。方法回顾性分析2020年1月-2024年4月深圳大学附属第三医院(深圳市罗湖区人民医院)诊治的221例MRKH综合征患者的临床资料。患者年龄17~35岁,平均22±8岁,所有患者均采用腹腔镜腹膜阴道成形术(罗湖二式)治疗,分析患者的手术时间、住院时间、术中出血量和术后临床疗效。结果本组221例患者均成功完成腹腔镜腹膜阴道成形术,手术时间25-100 min,平均35±23 min,住院时间15-29 d,平均20±5 d,术中出血量10~100 mL。术前阴道压迹0.5~3.0 cm,术后患者阴道深度10±2 cm,两者差异有统计学意义(P<0.05)。221例患者均顺利完成手术,术后恢复良好,其中1例患者出现膀胱损伤,1例出现直肠损伤,均全部一期缝合修复。所有患者均获得随访,随访时间1-37个月。结论腹腔镜腹膜阴道成形术(罗湖二式)治疗MRKH综合征所致先天性无阴道具有创伤小、恢复快、疗效确切和并发症少等优点,是一种可靠有效的手术方式。