<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The incidence of cancer vulva is increasing. 50% of cases are occurring at y...<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The incidence of cancer vulva is increasing. 50% of cases are occurring at younger age especially the type related to Human Papilloma Virus infection. Cancer vulva can be prevented. Awareness of cancer vulva is deficient among women and healthcare providers. In this study we looked for a correlation between the most significant vulval symptoms to be associated with cancer vulva in order to educate women and to provide guidance for the health care providers. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> 569 women were enrolled in this observational cohort study. The patients were stratified according to their symptoms </span><span style="font-family:Verdana;">into 5 groups. Biopsy from the vulva, unless the lesion is obviously benign.</span> <b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Vulvar lesion, as a symptom (mass-ulcer), was significantly associat</span><span style="font-family:Verdana;">ed with detection of vulvar cancer (</span><i><span style="font-family:Verdana;">P</span></i><span> </span></span><span style="font-family:""><span style="font-family:Verdana;">≤ </span><span><span style="font-family:Verdana;">0.001). 100% of those women presented </span><span style="font-family:Verdana;">with vulvar lesions (mass or ulcer) had cancer. Positive predictive value (PPV)</span><span style="font-family:Verdana;"> of vulvar lesion alone was 1.25% but the probability of detection of a cancer dramatically increased when the lesion was accompanied with bleeding 35.2% or pain 26.9% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Presenting symptoms other than a lesion in the vulva as for example, soreness, irritation or bleeding was rarely associated with detection of cancer.</span></span></span>展开更多
Vulva Basal Cell Carcinoma (BCC) is a rare tumor. It usually occurs in Caucasians at an advanced age. We present a case of vulvar BCC in an African patient under 40 years old with HIV infection successfully treated su...Vulva Basal Cell Carcinoma (BCC) is a rare tumor. It usually occurs in Caucasians at an advanced age. We present a case of vulvar BCC in an African patient under 40 years old with HIV infection successfully treated surgically. This presentation is exceptional because of age, race, and the immune status of the patient.展开更多
Background: Radiation-induced pelvic insufficiency fracture (PIF) is an important complication associated with pelvic radiation therapy (RT) for patients with gynecologic malignancies. Despite known risk factors and r...Background: Radiation-induced pelvic insufficiency fracture (PIF) is an important complication associated with pelvic radiation therapy (RT) for patients with gynecologic malignancies. Despite known risk factors and recent reports describing the incidence on the order of 30 percent, there has been a dearth of translational research or consensus statements to guide clinical management. Objective: The aim of this study is to describe seven cases of PIF diagnosed and managed at the Massachusetts General Hospital during a 5-year period and to perform a focused review of the literature to inform several clinical questions that remain unanswered. A secondary aim of this study is to highlight the need for additional research related to screening, prophylaxis, diagnostics, and treatment of PIF in patients with gynecologic malignancy. Methods: In the current retrospective review, we report 10 cases of PIF diagnosed over a 5-year period in 7 patients with vulvar (4), vaginal (2), and cervical (1) cancer following chemoradiation therapy at a single institution. Data were collected from the medical records by a single investigator and all diagnostic imaging was reviewed by a single radiologist to confirm the presence or absence of PIF. Results: All 7 patients were post-menopausal and received concurrent chemoradiation, 3 were over the age of 65 years old (42.8%), 3 had BMI kg/m2 (42.8%), 2 had a history of osteoporosis (28.6%), and 1 had a history of hormone replacement therapy use (14.3%). No patients underwent standard screening for PIF and no patients were started on prophylaxis prior to diagnosis. The plain film was the most common initial imaging performed while MRI was the most common overall study used to diagnose PIF. Median time to the development of fracture was 16 months (range 4-114) with femoral neck fracture being the most common (40%) and sacral fractures trailing close behind (30%). 7 of 10 fractures were initially managed expectantly with 1 ultimately failing expectant management and requiring surgical intervention. 4 of 10 fractures required surgical intervention. All patients had resolution of symptoms by 12 months after diagnosis. Conclusion: Radiation-induced PIF remains an important complication associated with pelvic RT. Significant risk factors have been identified and studies have compared various diagnostic imaging modalities. Future studies are needed to compare screening algorithms and evaluate the comparative effectiveness of prophylactic pharmacotherapies. Future studies are also needed to determine the cost-effectiveness of PET/CT versus MRI and compare the morbidity associated with expectant management versus surgical intervention in patients with symptomatic fractures.展开更多
文摘<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The incidence of cancer vulva is increasing. 50% of cases are occurring at younger age especially the type related to Human Papilloma Virus infection. Cancer vulva can be prevented. Awareness of cancer vulva is deficient among women and healthcare providers. In this study we looked for a correlation between the most significant vulval symptoms to be associated with cancer vulva in order to educate women and to provide guidance for the health care providers. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> 569 women were enrolled in this observational cohort study. The patients were stratified according to their symptoms </span><span style="font-family:Verdana;">into 5 groups. Biopsy from the vulva, unless the lesion is obviously benign.</span> <b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Vulvar lesion, as a symptom (mass-ulcer), was significantly associat</span><span style="font-family:Verdana;">ed with detection of vulvar cancer (</span><i><span style="font-family:Verdana;">P</span></i><span> </span></span><span style="font-family:""><span style="font-family:Verdana;">≤ </span><span><span style="font-family:Verdana;">0.001). 100% of those women presented </span><span style="font-family:Verdana;">with vulvar lesions (mass or ulcer) had cancer. Positive predictive value (PPV)</span><span style="font-family:Verdana;"> of vulvar lesion alone was 1.25% but the probability of detection of a cancer dramatically increased when the lesion was accompanied with bleeding 35.2% or pain 26.9% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Presenting symptoms other than a lesion in the vulva as for example, soreness, irritation or bleeding was rarely associated with detection of cancer.</span></span></span>
文摘Vulva Basal Cell Carcinoma (BCC) is a rare tumor. It usually occurs in Caucasians at an advanced age. We present a case of vulvar BCC in an African patient under 40 years old with HIV infection successfully treated surgically. This presentation is exceptional because of age, race, and the immune status of the patient.
文摘Background: Radiation-induced pelvic insufficiency fracture (PIF) is an important complication associated with pelvic radiation therapy (RT) for patients with gynecologic malignancies. Despite known risk factors and recent reports describing the incidence on the order of 30 percent, there has been a dearth of translational research or consensus statements to guide clinical management. Objective: The aim of this study is to describe seven cases of PIF diagnosed and managed at the Massachusetts General Hospital during a 5-year period and to perform a focused review of the literature to inform several clinical questions that remain unanswered. A secondary aim of this study is to highlight the need for additional research related to screening, prophylaxis, diagnostics, and treatment of PIF in patients with gynecologic malignancy. Methods: In the current retrospective review, we report 10 cases of PIF diagnosed over a 5-year period in 7 patients with vulvar (4), vaginal (2), and cervical (1) cancer following chemoradiation therapy at a single institution. Data were collected from the medical records by a single investigator and all diagnostic imaging was reviewed by a single radiologist to confirm the presence or absence of PIF. Results: All 7 patients were post-menopausal and received concurrent chemoradiation, 3 were over the age of 65 years old (42.8%), 3 had BMI kg/m2 (42.8%), 2 had a history of osteoporosis (28.6%), and 1 had a history of hormone replacement therapy use (14.3%). No patients underwent standard screening for PIF and no patients were started on prophylaxis prior to diagnosis. The plain film was the most common initial imaging performed while MRI was the most common overall study used to diagnose PIF. Median time to the development of fracture was 16 months (range 4-114) with femoral neck fracture being the most common (40%) and sacral fractures trailing close behind (30%). 7 of 10 fractures were initially managed expectantly with 1 ultimately failing expectant management and requiring surgical intervention. 4 of 10 fractures required surgical intervention. All patients had resolution of symptoms by 12 months after diagnosis. Conclusion: Radiation-induced PIF remains an important complication associated with pelvic RT. Significant risk factors have been identified and studies have compared various diagnostic imaging modalities. Future studies are needed to compare screening algorithms and evaluate the comparative effectiveness of prophylactic pharmacotherapies. Future studies are also needed to determine the cost-effectiveness of PET/CT versus MRI and compare the morbidity associated with expectant management versus surgical intervention in patients with symptomatic fractures.
