Vulvar Swelling in a 12-Year-Old Girl: An Early Manifestation of Crohn’s Disease

Vulvar Crohn’s disease (VCD) is a rare complication of Crohn’s disease, especially in pediatric population. An early diagnosis can result difficult if the complication does not present in conjunction with the classic gastrointestinal symptoms that characterize this disease. In this study we present the case of a 12-year-old girl whose initial symptom of Crohn’s disease was a symptomatic vulvar swelling promoted by a rectovaginal fistula. We also provide an overview of Crohn’s disease and the vulvar changes found in the course of this disease.

Evaluating the Association between Human Papillomavirus and Vulvar Cancer:A Comprehensive Analysis Using Bradford Hill Criteria

Background:The role of human papillomavirus(HPV)in the development of vulvar cancer(VC)has been widely studied,but findings have been inconsistent.Despite numerous meta-analyses exploring the potential link between HPV and VC,the association remains controversial due to inherent limitations in meta-analytic methods.Objectives:To address this controversy,the study aims to investigate the potential link between HPV and VC using the Bradford Hill criteria,which offer a more comprehensive framework for establishing causation.Methodology:The study began by extracting all relevant studies on the association between HPV and VC from the PubMed database.The potential links were then assessed by examining the data using the major postulates of the Bradford Hill criteria.To ensure the reliability of the findings,the methodologies of the identified studies were critically evaluated to account for possible false-negative and false-positive results.Results:The assessment of previous studies against the Bradford Hill criteria revealed that the major postulates were not fulfilled.Conclusion:Based on the findings,it can concluded that there is no causal association between HPV and VC.

Vulvar Contact Dermatitis: Effect of a Treatment with a Anti-Inflammatory, Moisturizing and Healing Product on the Course of the Disease

Background: Vulvar contact dermatitis is inflammatory disorders of genital skin causing itch, burning, and plaques with overlying excoriation and linear fissures. Objective: To assess the effectiveness of a soft foam based on Tiab&#174 system (TF), complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid, as a treatment of vulvar contact dermatitis. Method: 36 patients with the diagnosis of vulvar contact dermatitis received an 10-days treatment, during which the subjects applied TF, complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid on the affected vulvar surfaces, used once a day. Clinical symptoms (itching and burning) and signs (vulvar surface disruption) were documented at baseline and after 1 months of follow-up. Results: There was a significant reduction of symptoms between the basal scores and the symptoms complaints 1 months of follow-up. Moreover a significant reduction of excoriations and linear fissures was observed. Conclusion: The present study shows that application of TF can be an effective agents for the reduction of symptom and sign of vulvar contact dermatitis, and the medical device can be used as a preventive agent in predisposing condition of vulvar discomfort.

EXPRESSION OF MIDKINE IN BENIGN, PREMALIGNANT AND MALIGNANT VULVAR TUMORS

OBJECTIVE: To clarify the role of midkine (MK) in vulvar carcinogenesis though examination of its expression in vulvar lesions including vulvar condyloma acuminata (VCA), vulvar intraepithelial neoplasia (VIN) and vulvar squamous cell carcinomas (VSCC), and to analyze the relationship between MK expression and human papilloma virus (HPV) infection. METHODS: Thirty VSCC, 15 VIN and 10 VCA patients were studied by streptavidin-biotin-immunoperoxidase method. MK expression was compared with clinicopathologic features of vulvar tumors. RESULTS: MK was expressed in 26 of 30 VSCC (87%), 3 of 5 VIN III and all VCA samples, whereas no MK expression was detected in the VIN I-II samples or in normal epithelium. The difference of MK expression between VIN III and VSCC was statistically significant (P

Vulvar granular cell tumor

Granular cell tumors are rare,usually benign,soft tissue neoplasms of neural origin.They occur more often in females than males,the peak age incidence is in the fourth through fifth decades.They can occur anywhere in the body with up to 15% situated in the vulva.The commonest presentation is as an asymptomatic mass.Microscopic findings are usually sufficient,but immunohistochemistry can also be helpful in confirming the diagnosis.The vulvar tumors are benign in 98% of cases with 2% reported as malignant.In this case report we describe a woman with a granular cell tumor confirmed by biopsy who underwent excision of the mass but with focal extension to the resection margin on microscopy.Our recommendation of re-excision was declined.Since it is not uncommon with these tumors to find groups of tumor cells extending beyond the macroscopic limits of growth,we conclude that it is advisable to have margins assessed intraoperatively by frozen section such that further excision can be performed for positive margins.Our patient has been followed for 18 mo without recurrence,should the tumor recur,re-excision,with frozen section control,is indicated.Recurrence rates are reported as 2%-8% with clear margins and 20% with positive margins.

Vulvar dystrophies: A long-term Brisbane study of 155 cases

Objective: To review the long-term outcomes for 155 women with a vulvar dystrophy (VD) who attended the Royal Brisbane Hospital Vulvar Clinic between 1976 and 1988. Methods: VD data from Vulvar Diseases Clinic were reviewed and analysed using the computer software Statistical package for the Social Sciences (SPSS) 11.0. Results: Of 155 patients 94 had Lichen Sclerosus (LS), 41 Lichen Simplex Chronicus (LSC) and 20 Mixed Dystrophy (MD). Three patients developed squamous cell carcinomas of the vulva between 10 and 26 years after presentation with a VD. To date only one of these three patients remains alive following treatment. Conclusion: The need for long term follow up is stressed and any of the three types of VD may become malignant. Time from diagnosis to malignant change is not predictive. VD treatments seem to go through phases with the application of potent steroid creams having stood the test of time.

The use of traditional Chinese medicine internally and externally combined with auricular acupuncture point bloodletting in the treatment of vulvar leukoplakia

Vulvar leukoplakia refers to the chronic disease of degeneration and hypopigmentation of the skin and mucous membrane of the vulva with unbearable itching in women, seriously affecting the quality of life. The main treatment of western medicine for vulvar leukoplakia is the external use of glucocorticoids or estrogen, resulting to the high recurrence rate and side effects. Traditional Chinese medicine (TCM) has the characteristics of the overall concept and dialectical treatment with a variety of ways. Literature review in recent years found that the treatment of TCM decoction combined with external therapies, such as external fumigation, acupuncture and other treatments, or the combination of TCM decoction and external western medicine hormone ointment, can obtain good effects in vulvar leukoplakia. During the clinical practice, we found that the use of TCM internally and externally combined with auricular acupuncture point bloodletting was highly effective with unique advantages in the treatment of vulvar leukoplakia, providing the ideas guidance for clinicians.

Detection and Identification of Human Papiliomavirus in Vulvar Intraepithelial Neoplasia

Objective： To evaluate the rate and types of human papillomavirus infection in vulvar intraepithelial neoplasia. Methods： We detected and identified HPV in 40 VIN cases with 67 lesions using PCR based reverse line blot hybridization and DNA sequencing. Among the 40 patients, 13 were diagnosed as VIN Ⅲ, 11 as VIN Ⅱ, and 16 as VIN Ⅰ. 31 patients had multifocal disease. First a fragment of 150 bp was amplified from the L1 region of HPV with GPS/GP6 primers. If the result was negative, a short fragment of 65 bp was amplified also from the LI region with SPFI/SPF2 primers. Results： Using general primer GPS/GP6, the positive rate was 52.2% （35167）. Using a short PCR fragment （SPF PCR）, the positive rate of the rest 32 lesions was 81.2% （26132）. The total positive rate was 91.0% （61/67）. 90% of the HPV types found in VIN were high risk types. All 35 GP PCR products were analyzed by sequencing. The gene types of 31 mono-infection lesions were in accordance with the reverse line blot results, while sequence results of the 4 multi-infection samples could not be analyzed. The SPF PCR products were also sequenced, 24 of the 26 SPF PCR products could be analyzed and 2 samples failed. 80.6% （25/31） cases with multifocal VIN displayed the identical type of HPV, suggesting monoclonality in different lesions from the same patient. Conclusion： The high risk type of HPV is associated with vulvar intraepithelial neoplasia and may be necessary for development of HPV-associated invasive vulvar carcinoma.

CLINICAL OBSERVATION ON ELECTROTHERMAL ACUPUNCTURE IN TREATMENT OF 16 CASES OF VULVAR DYSTROPHY

Electrothermal acupuncture,amodification of the traditional“hot-red”puncturing technique, is generally adopted forsoftening and resolving hard mass,

Vulvar Rejuvenation Using High-Intensity Focused Ultrasound (HIFU): Fundamentals and Technique

Background: The unaesthetic appearance of the female intimate area (vulva, “mound of venus” and perianal region) is a triggering factor of negative psychological responses, embarrassment, anxiety and insecurity in many women. Using rejuvenating equipment for vaginal structure or for the intimate area as a whole is already widespread in the literature, and High-Intensity Focused Ultrasound (HIFU) has proven to be very effective in the clinical practice of many professionals. This study, therefore, aims to describe the fundamentals and applicability that guide the use of HIFU in vulvar rejuvenation. Materials and Methods: Exploratory research was carried out, presented in a narrative review, to highlight the action of HIFU in female intimate rejuvenation. The review explored scientific articles published and available in the following databases: MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed (National Library of Medicine), SCIELO (Scientific Electronic Library Online), and LILACS (Latin Literature American and the Caribbean in Health Sciences). In addition, some clinical findings obtained through a retrospective analysis of medical records were added to describe the authors’ clinical experience in the use of Focused Ultrasound (HIFU) for vulvar rejuvenation. Results: We verified that the tissues of female external genitalia respond very well to the stimuli of the focused sound waves of the HIFU, being able to produce immediate and lasting results through isolated applications or in association with intradermotherapy or other therapeutic resources. Conclusion: We conclude that using High Intensity Focused Ultrasound aimed at vulvar rejuvenation is safely indicated and assures excellent aesthetic results at the end of the treatment because similarly to other treatment techniques, the thermal stimuli of HIFU are also able to produce an excellent therapeutic response in the dermal tissue of the female intimate area, promoting intense neocollagenesis and generating great aesthetic improvement.

Vulvar sarcomas: A 25 plus-year experience from Queensland

Objective: To review the characteristics of cases of vulvar sarcomas (VS) referred to the Queensland Centre for Gynaecological Cancer (QCGC) between mid 1984 and mid 2012. Methods: VS case data from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences (SPSS) 11.0. Results: Of the nine cases three died of their disease, one died of ovarian cancer and five are still alive and disease free. The mean age at diagnosis was 54.8 years. Time from onset of symptoms to diagnosis averaged one month. All diagnoses were confirmed histologically. The most common presenting complaint was a lump. Treatment in all but one case involved surgical excision, one case had chemotherapy alone and two cases had surgery followed by radiotherapy. Conclusions: To talk of five year survival for patients with such a rare cancer, so many histological types with variable cell differentiation plus the unknown of when sarcomatous cells metastasize from even early FIGO staged lesions is in our opinion taking generalisation to far. A multidisciplinary approach to management achieves the best results for each individual and pooling multicentre data will improve our understanding of this rare disease and benefit future patients.

Vulvar basal cell carcinoma: A retrospective study of 29 cases from Queensland

Objective: Review the clinical features, diagnosis, management and outcomes for 29 cases of Basal Cell Carcinoma (BCC) of the Vulva referred to Queensland Centre for Gynaecological Cancer (QCGC) between 1986 and 2010. Methods: Vulvar BCC cases from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences (SPSS) 11.0. Results: BCC of the vulva is uncommon with an incidence from the QCGC vulvar cancer registry of 3.2%. Of the 29 patients one died of their BCC and seven died of unrelated causes. The mean age at diagnosis was 69.5 years (range 40 to 91). All cases were Caucasian. Time from onset of symptoms to diagnosis averaged 22.6 months (range 0 - 120 months). Not until a biopsy was performed was the diagnosis made. The most common presenting complaints were pruritis and a lump. Initial treatment was surgical. Conclusions: The prognosis for vulvar BCC is excellent. Histological diagnosis and long term follow-up are important management issues. The status of disease at the margins of surgical specimens does not reliably equate to patient long term outcomes. Follow up should be supervised via a gynecological oncology register to reduce the risk of patient loss to follow up.

Prevention and Reduction of Complications in Women with Vulvar Cancer: Development of an Algorithm for Safer Multidisciplinary Care

Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks for complications and by planned post-surgical interventions. Therefore, the aim of this study was to develop a clinical care algorithm for vulvar cancer to assess risk for complications and prevent and control post-surgical complications. Methods: Key elements of the algorithm were identified via a literature review, structured chart review, a survey of care team members and interviews with stakeholders including healthcare team, patients and their family. Results: An algorithm for the management of wound and psychosocial complications was developed, based on internal and external evidence and was vetted by expert reviewers. Conclusion: Describing the process and defining the roles of health care professionals contributes to purposeful, systematic prevention and treatment of post-surgical complications. The care algorithm provides structured reference points for healthcare professionals with regard to multidisciplinary post-surgical management of vulvar cancer patients.

Influences on the study of Vulvar Anatomy and Disease

The study of Gynaecology over the years has been influenced by the culture and social attitudes of society to the body as a whole and to the genital organs in particular. Variations in these attitudes between different cultures and at different times have influenced the subsequent rate of progress in the study of the vulva and its diseases.

Clinical study about endoscopic inguinal lymphadenectomy for patients with vulvar carcinoma

Objective： The aim of this study was to explore the new method of inguinal lymphadenectomy in order to reduce side effects of conventional method for patients with vulvar carcinoma. Methods： Lipolysis and liposuction were performed to subcutaneous fat on inguinal region. We inserted endoscope and filled with C02 gases to this field and then resected inguinal lymph nodes with ultrasonic scalpel. The operative field was placed with the vacuum sealing drainage and pressured with soft saline bag after the operation. Results： Many lymphatic vessel, small blood vessels and hanging lymph nodes in the subcutaneous tissues of inguinal region were revealed after lipolysis and liposuction and lymph nodes can be easily removed. The follow-up so far showed that healing of the incision was good and there was no lymphedema of patient＇s lower limb and inguinal region. Conclusion： Endoscopic inguinal lymphadenectomy can resect the lymph nodes and keep most of the lym- phatic vessels. So this technique has less influence on the lymph backflow of lower limb and inguinal region and can avoid the huge incision of conventional method. This method is worthy of further study.

Study on the effect of Baiban Ointment on the whole gene expression profile of vulvar sclerosing lichen

Objective:To study the effect of Baiban Ointment on gene expression profile of vulvar lichen sclerosus before and after treatment,and to provide theoretical basis for the early diagnosis and clinical treatment of vulvar lichen sclerosus.Methods:Nine patients with vulvar lichen sclerosus diagnosed pathologically were selected as the study object,and the Baiban ointment was applied locally for 3 months.Gene chip technology was used to detect the vulva skin tissue in the same area before and after treatment,and the peripheral normal skin was used as the normal control group to analyze the change of gene expression profile.FC and P values were used as research indicators,and the standard of differential expression was FC value≥1.5,P value<0.05.The differentially expressed genes were screened,and GO analysis and KEGG database gene pathway analysis were carried out.Results:Compared with the normal control group,there were 22 differentially expressed genes in Group A before treatment,of which 21 were up-regulated and 1 was down regulated;compared with Group B before treatment,there were 23 differentially expressed genes,all of which were up regulated.The differentially expressed genes related to Baiban ointment treatment included TBK1、STAT1、ITGAM、VCAN、PRKACB、PROM1、PLAT、SERPINA1.Go analysis showed that the up-regulated differential genes were mainly concentrated in the extracellular exosome,cytosol,extracellular space,Golgi apparatus and other cellular component,using the biological process such as positive regulation of cell metabolism,signal transduction regulation,cell adhesion,etc.,to play a role in protein binding,enzyme activity regulation and other molecular functions.KEGG signaling pathway showed that the differentially expressed genes were significantly enriched in Toll like receptor signaling pathway,Nod like receptor signaling pathway and Fc RI signaling pathway,all of which were up-regulated signaling pathways.Among them,Toll like receptor signaling pathway and Nod like receptor signaling pathway are most closely related to the disease.Conclusion:Baiban ointment may play a role in regulating metabolism,inflammation and immune response by regulating the expression of related genes,affecting the signal transduction such as Toll like receptor signal pathway.The pathway and the genes screened in this study will provide a direction for the future study of this disease.

Relationship between FHIT Expression and HPV Status in Vulvar Squamous Cell Carcinomas

OBJECTIVE To investigate the relationship between fragilehistidine triad (FHIT) depletion and human papillomavirus (HPV)status in the vulvar squamous cell carcinomas (VSCC).METHODS Immunohistochemical method was used to detectthe expression of FHIT protein in 42 cases of VSCC and 10 casesof normal vulvar tissues. PCR was used to detect HPV infectionstatus. We analyzed the relationship of the expression of FHITprotein between the 2 groups: HPV positive and HPV negative, aswell as the clinically pathological characteristics.RESULTS The expression of FHIT was positive in all normal vul-var tissues, and 71.4% was depletion in VSCC (P < 0.01). Abnormalexpression of FHIT was significantly correlated with pathologicalgrade (P < 0.05). There was a significant difference between FHITdepletion and HPV infection based on the statistial analysis (P <0.05).CONCLUSION The FHIT depletion is related to occurrenceand development of VSCC, and the abnormal expression of FHITsignificantly correlates with HPV infection.

Evaluation of sentinel lymph nodes in vulvar, endometrial and cervical cancers

Sentinel lymph node （SLN） biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic malignancies has been studied extensively over the past decade. We review the current literature on SLN dissection in vulvar, endometrial and cervical cancers. Large, well-designed trials in each of the three types of cancer have demonstrated high sensitivity and low false-negative rates when SLN biopsy is performed in the correct patients and with an appropriate technical approach. In all of these cases the addition of ultra-staging to conventional pathology yields increased detection of micrometastatic disease. Biopsy of the sentinel nodes is feasible and safe in early vulvar malignancies, with multiple studies describing low recurrence rates in those women who have with negative SLNs. There does not appear to be a survival benefit to lymphadenectomy over SLN biopsy and quality of life is improved in women undergoing SLN biopsy. Optimal treatment strategies for women with positive nodal biopsies, particularly in cases with micrometastatic disease, remain unclear. Multiple large studies investigating the utility of SLN biopsy in endometrial malignancy have found that sentinel nodal status is a reliable predictor of metastases in women with low-risk disease. Prospective studies are ongoing and suggest sentinel nodal detection may soon become widely accepted as an alternative standard of care for select cases of endometrial cancer. In cervical cancer, SLN biopsy is accurate for diagnosing metastatic disease in early stage tumors （≤ 2 cm diameter or stage ≤ IB2） where the risk of metastasis is low. It is unknown if women who undergo SLN biopsy alone will have different survival outcomes than women who undergo complete lymphadenectomy in these cases. In a specific population of women with vulvar cancer, SLN dissection is an effective and safe alternative to complete dissection. It can be offered as an alternative management strategy in these women. In women who do undergo SLN biopsy, it is associated with improved quality of life. Promising evidence supporting the utility of SLN dissection in endometrial and cervical cancer continues to emerge, and it may soon become a reasonable option for select patients. However, continued research and refnement of appropriate patient selection and long-term follow-up are necessary.

Management of Giant Ano-Vulvar Condyloma in a Structure with Limited Resources

Buschke-Lowenstein Tumor (BLT) or Giant Acuminate Condyloma (GAC) is an uncommon clinical entity rarely published in Cote d’Ivoire and Africa. It is a viral infection with increasing sexual transmission due to the resurgence of HIV infection. This observation is the first case recorded in our service in three decades. The treatment is resolutely surgical, in our context of sub-medicalization, in the absence of other therapeutic means. Most of the time the progression is favorable, but the prognosis can be aggravated by the HIV coinfection. Through this observation, the authors insist on the prevention of all sexually transmitted infections, particularly, with HPV and HIV, by sexual education (abstinence, fidelity, port of condom) and the systematic vaccination before any sexual activity.

Major Clinical Features and Epidemic Characteristics of Erosive Vulvar Lichen Planus:A Retrospective Analysis

Objective:Vulvar lichen planus(VLP),especially erosive VLP(EVLP),seriously affects women’s physiological function and quality of life.A retrospective analysis of erosive vulvar lichen planus(EVLP)was performed to raise awareness on this chronic,deforming,and painful vulvar disease.Methods:This observational retrospective study involved 40 patients with EVLP among 1,368 patients with vulvar disease from 2017 to 2020.The patients’vulvar clinical features and extravulvar mucosal involvement were investigated.The patients’pain and quality of life were evaluated with the numeric rating scale and the Dermatology Life Quality Index(DLQI),respectively.Clinical characteristics were reported using frequencies and proportions for categorical variables.Continuous variables are expressed as mean±standard deviation.The association between NRS score for pain and DLQI score was analyzed by Pearson’s correlation test.Results:EVLP accounted for 2.9%(40/1,368)of all cases of vulvar disease,and the median age at onset was 42 years.Erosion mostly occurred on the labia minora and introitus.Half(20/40)of the patients had extravulvar mucosal involvement.Seventeen(42.5%)patients had oral lichen planus,and seven(17.5%)patients were diagnosed with vulvovaginal-gingival syndrome.The numeric rating scale score showed that 47.5%(19/40)of patients experienced mild pain,whereas 12.5%(5/40)described the pain as severe.Thirty-one patients(77.5%,31/40)had dyspareunia,and nine patients had aggravated pain after sexual intercourse.The mean DLQI score was 9.1±6.0,with 37.5%(15/40)of patients indicating that EVLP had severely affected their lives.The numeric rating scale score for pain was significantly correlated with the DLQI score(P=0.007).Conclusion:EVLP can affect the quality of women’s lives and cause severe deformations and painful architectural changes.The description of the characteristics of EVLP in this report will benefit the diagnosis and early treatment of this disease.