Acquired vulvar lymphangiomas: a sequela of radiation therapy

Lymphangiomas of the vulva are rare clinical entities. Acquired or secondary lymphangiomas have characteristically been reported after radiation therapy for cervical carcinoma and appear on the vulva years after this treatment. Local surgery, scrofuloderma, and Crohn's disease may also damage vulvar lymphatic flow and lead to the development of vulvar lymphangiomas. We report a case of acquired vulvar lymphangiomas that occurred in a patient 15 years after she received radiation therapy for squamous cell carcinoma of the uterine cervix.     

Acquired lymphangioma: report of four cases and a discussion of the pathogenesis

Four patients with acquired lymphangiomata arising after surgery for malignancy, both with and without subsequent radiotherapy, are reported.     

乳腺癌术后淋巴管瘤加重一例

患者，女，65岁。左肩背部包块65年。行“左乳腺癌改良根治术”4年后左肩背部包块明显增大，边界不清，质软，有触痛。行包块切除术，术后组织病理示：左肩背部淋巴管瘤。     

Metastatic Crohn's disease: a histopathologic study of 12 cases

Perhaps, the most intriguing cutaneous sequela of Crohn's disease (CD) is 'metastatic' CD, defined as sterile granulomatous skin lesions arising at sites discontinuous from the gastrointestinal tract. Though various histopathologic patterns have been described, a lack of a large series has precluded a comprehensive characterization and distinction from the pathologic differential diagnoses. The histopathology features of 12 new cases of metastatic CD were reviewed. Non-supperative granulomata with a slight cuff of lymphocytes in a nodular or diffuse pattern with an associated superficial and deep perivascular mixed inflammatory infiltrate was the most common pattern. Other common features included an accompanying infiltrate which was often rich in eosinophils, and ulceration of the overlying epidermis. These features are emphasized as potentially useful in distinguishing this entity from its greatest mimicker, cutaneous sarcoidosis.     

Acquired kinking of the hair associated with etretinate therapy

We describe three patients in whom dose-dependent, reversible kinking of the hair has occurred while receiving etretinate therapy. The morphological changes of the hair consist of incomplete twists, variation in bore and pigmentation. We propose that the changes may result from the drug's effect on the inner root sheath of the hair.     

Treatment of undifferentiated vulvar intraepithelial neoplasia with 5% imiquimod cream: a prospective study of 12 cases

OBJECTIVE: To assess the efficacy of 5% imiquimod cream on undifferentiated vulvar intraepithelial neoplasia (VIN), a disease caused by high-risk human papillomavirus. DESIGN: Prospective, uncontrolled study. SETTING: University hospital vulvar clinic.Patients Twelve consecutive patients treated with 5% imiquimod cream for undifferentiated VIN between March 1, 1999, and May 31, 2001. INTERVENTION: Self-application of 5% imiquimod cream, initially 3 times a week, then adjusted according to tolerance, for up to 7 months according to clinical response. MAIN OUTCOME MEASURES: Therapeutic response, clinically assessed by successive photographs and histologically confirmed for complete responders, was scored as complete, partial (> or =50% decrease in lesion size), or failure. Tolerance was evaluated at each visit. RESULTS: A total of 3, 4, and 5 patients achieved complete response, partial response (> or =75% reduction in lesion size for all such cases), and failure, respectively. Mean duration of treatment was 3.6 months (37.3 applications), 5.0 months (50.7 applications), and 3.4 months (25.2 applications) for complete responders, partial responders, and failures, respectively. Follow-up after treatment was 5 to 18, 14 to 32, and 2 to 28 months, respectively, with 1 partial responder lost to long-term follow-up. No patient developed invasive carcinoma. All but 2 patients experienced vulvar discomfort, resulting in treatment withdrawal for 3. Two patients had flulike symptoms. CONCLUSIONS: Imiquimod cream could be a therapeutic option for undifferentiated VIN. Although poorly tolerated, this self-applied treatment could spare patients, either totally or partially, the classic painful and sometimes mutilating treatments of VIN. Controlled, randomized studies are needed to evaluate its efficacy and tolerance.     

Secondary lymphangioma of vulva: a report of two cases

Secondary lymphangiomas or acquired lymphangiomas of vulva represent dilatation of upper dermal lymphatics following damage to previously normal deep lymphatics. They have been reported to occur following various infections, surgeries and radiotherapy which can cause damage to deep lymphatics.Treatment options in the management of secondary lymphangiomas include surgical resection, carbon dioxide laser vaporisation, sclerosing agents etc. We report two cases of secondary lymphangioma of vulva that followed radiotherapy for carcinoma of cervix. Both the patients were treated successfully by surgery.     

大疱性类天疱疮合并获得性血友病一例

获得性血友病A(acquired hemophilia A, AHA)死亡率为15%～42%,约50%左右的AHA为特发性,而另外50%与一些基础疾病有关,如系统性红斑狼疮、肿瘤、药物过敏、皮肤病(如银屑病,大疱性类天疱疮)等。本文报道一例大疱性类天疱疮合并获得性血友病,采用泼尼松、人凝血酶原复合物联合环孢素治疗后取得了显著疗效。     

Acquired vulvar smooth muscle hamartoma: a case report and review of the literature

A 36-year-old Korean woman had had a flesh-colored, indurated plaque with pruritus on the labium majora for five years. The lesion was not found in association with hyperpigmented or hypertrichotic patches. Results of biopsy specimens showed an excess of haphazardly oriented smooth-muscle bundles in the mid to lower dermis with an unremarkable overlying epidermis. Our diagnosis was an acquired smooth-muscle hamartoma in the vulva. Although there have been previously reported cases of acquired smooth-muscle hamartoma, this was the first reported case in the vulva. We also describe the characteristics differing between our case and the six previously reported ones.