Verrucous carcinoma of the female genital tract

Verrucous carcinoma is a variant of epidermoid carcinoma with distinctive clinical and pathologic features. It is a warty, fungating or cauliflower-like tumor that gradually increases in size and usually invades into contiguous structures with a pushing margin rather than by infiltration. To date, 41 verrucous carcinomas involving the cervix, vagina, or vulva have been reported. Three recently observed cases of this rare and distinct entity are presented. The slow-growing insidious nature of verrucous carcinoma along with the great tendency of local recurrence, marked freedom from metastases and lymph node involvement, and poor response to radiation are the chief characteristics of the clinical course of this disease. Both gynecologists and pathologists should be alert to the fact that precise initial diagnosis may be difficult because of the close gross and microscopic similarity to benign squamous papillomas and condyloma acuminata.     

Verrucous carcinoma of the female genital tract: a review

The 102 cases of verrucous carcinoma of the female genital tract reported in the world literature have been reviewed. The difficulties in diagnosis of this tumor are discussed; correct diagnosis is heavily dependent on close collaboration between clinician and pathologist, and the provision to the latter of a sufficiently large biopsy specimen. Effective management requires surgical resection, which may at times need to be radical. Radiotherapy and chemotherapy are of doubtful value.     

Verrucous carcinoma of the female genital tract: Report of a case and review of the literature

Verrucous carcinoma (VC) of the female genital tract is a rare lesion, primarily affecting postmenopausal women. A case of VC of the vulva is reported, bringing the total number of VC of the female genital tract to 89. VC is a slowly growing, locally "pushing" tumor with a rather benign histologic appearance, and the clinical and histologic characteristics are described on the basis of the present report and a review of the literature. The treatment of VC is still a matter of discussion. It seems logical to treat the tumor by wide local excision, taking the lack of proof of spontaneous metastasis into consideration. Radiation therapy should be contraindicated, and local application of podophyllin, bleomycin therapy, and cryosurgery are ineffective methods in the treatment of VC.     

Verrucous squamous cell carcinoma of the female genital tract. Report of three cases and survey of the literature

Three new cases of gynecological verrucous squamous cell carcinomas are reported; one in the uterine cervix, and two in the vulva. The English literature covering the 49 cases reported previously is surveyed with special reference to the diagnostic and therapeutic aspects of these tumors, as well as with their clinical behavior and possible relationship to viral (HPV) lesions (Condylomas) of the genital tract.It was concluded that so far the exact relationship between the different verrucous squamous cell lesions in the genital tract remains obscure, all such lesions should be regarded as potentially malignant, and treated accordingly by radical surgery.     

Multicentric carcinoma of the female lower genital tract

Summary. The clinical history and treatment of 17 patients with multi-centric primary carcinomas of the cervix and vulva is presented. There is a significant association between vulval intraepithelial neoplasia and cervical neoplasia. The concept of multicentricity in relation to invasive and intraepithelial neoplasia of the cervix and vulva is critically reviewed.     

Physique of patients with carcinoma of the female genital tract

The authors carried out an investigation with a detailed anthropometric programme on 135 women suffering from different kinds of cancer: ovarian n = 35, endometrial n = 22, cervical n = 54, and vulvar/vagina n = 24. All patients were Hungarian and belonged to European ethnic groups. Their age varied between 25.6 and 85.0 years. Somatotype of the patients was estimated with the Heath-Carter anthropometric somatotyping method. Somatotype (endomorphy, mesomorphy, ectomorphy) of the patients with ovarian cancer was respectively: 6.8-5.3-1.0, patients with endometrial cancer 7.9-5.8-0.9, patients with cervical cancer 6.8-5.3-1.3, and patients with vulvar cancer 7.5-5.9-0.9. Based on variance analysis, there was no significant difference among subgroups at the p < 0.05 level. The patients in all four groups--in the overwhelming majority of cases--showed mesomorphic-endomorph forms, i.e., endomorphic elements dominated in their physique and mesomorphy (robusticity) was greater than ectomorphy (linearity).     

Microbiology of the female genital tract

Patients who contract genital tract infections are predominantly young, are otherwise healthy, and generally respond well to treatment for bacterial infections. These infections are most commonly polymicrobial in etiology, with several noteworthy exceptions. Often there is an inciting event such as childbirth, surgical intervention, pregnancy termination or intrauterine contraceptive device insertion. With treatment, prognosis for cure is excellent; however, sequelae such as recurrent infections, infertility, or ectopic pregnancy can be serious. Bacteria encountered in the female genital tract can be divided into aerobic and anaerobic organisms. Among the aerobic gram-positive organisms, several varieties of streptococci such as Group B streptococci and enterococci occur frequently. Staphylococcus aureus is an infrequent but important pathogen. Among the aerobic gram-negative organisms, the most common is Escherichia coli. Klebsiella sp. and Proteus sp. occur in about 5% of genital tract infections. Species that are more resistant to antibiotics, such as Pseudomonas aeruginosa and Enterobacter sp., occur in approximately 1% or 2% of these cases and are more likely to appear in patients who have previously received antibiotic therapy or who have been hospitalized for some time. Among the anaerobic organisms, the most common gram-positive isolates are Peptostreptococci and Peptococci. Clostridia sp. occurs less frequently. Among the anaerobic gram-negative organisms, the Bacteroides sp. most frequently encountered are Bacteroides bivius and Bacteroides disiens. Bacteroides fragilis is still a common problem but appears to be less predominant. Other organisms encountered are Chlamydia trachomatis, the genital mycoplasmas, yeasts, protozoa, and viruses.     

A case report of multicentric verrucous carcinoma of the female genital tract

BACKGROUND: Verrucous carcinoma is a variant of squamous cell carcinoma with distinct features including slow locally invasive growth and verrucous appearance. Verrucous carcinoma of the vagina is considered an extremely rare lesion because only 17 cases have been reported in the literature. CASE: We report a case of vaginal verrucous carcinoma with a second focus in the cervix. The patient was treated with surgery and adjuvant interferon therapy for local recurrence. Human papillomavirus was detected in both vaginal and cervical tumor tissue by immunohistochemistry. CONCLUSION: Diagnosis of verrucous carcinoma may be difficult, particularly if biopsy specimen involves only the surface epithelium. The role of human papillomavirus as an etiologic agent in verrucous carcinoma is still a matter of discussion. Effective management requires surgical resection. The efficiencies of radiotherapy and interferon therapy are discussed.     

Tamoxifen and the female genital tract

Ugwumadu AHN, Carmichael P, Neven P. Tamoxifen and the female genital tract. Int J Gynecol Cancer 1998; 8 : 6–15.
Tamoxifen was originally developed by Imperial Chemical Industries (England) (ICI) in 1966 as an anti-estrogenic contraceptive. Ironically, it found a role in the treatment of anovulatory infertility, but its most important application to date is in adjuvant hormonotherapy for breast cancer. Tamoxifen has a complex and poorly understood mix of estrogenic and anti-estrogenic properties with variable and contrasting effects on hormone-sensitive target tissues, such as the endometrium. This article reviews the gynecologic lesions associated with tamoxifen therapy and discusses the merits and acceptability of endometrial surveillance tests and the role of progestogens.     

Bleomycin-mitomycin C in advanced squamous cell carcinoma of the female genital tract

Bleomycin and mitomycin C have been reported to be active against advanced squamous cell carcinoma of the uterine cervix. Miyamoto et al reported a total response rate of 93% and complete response in 80% of the first 15 patients treated by sequential combination of bleomycin and mitomycin C. Updated results by Miyamoto reveal an 88.3% total response rate with a 65.3% complete response. However, others have reported poor results using the protocol outlined by Miyamoto. Using this protocol, 11 patients with advanced squamous cell carcinoma were treated at the authors' institution. There were no complete responses: one patient with partial response (9%), four with stable disease (36%), and six (55%) with progressive disease.     

Uterine serous papillary carcinoma: Histopathologic changes within the female genital tract

Abstract. Jordan LB, Abdul-Kader M, Al-Nafussi A. Uterine serous papillary carcinoma: Histopathologic changes within the female genital tract.
The histopathologic features of 25 patients with uterine serous papillary carcinoma (USPC) were presented, with particular emphasis on the changes seen in the remaining müllerian epithelium. The mean age at presentation was 68.9 years; 52% of patients were stage III at the time of presentation and 40% died of their disease within 24 months of diagnosis. Histologic assessment revealed: 1) pure serous carcinoma in 56% of patients and mixed differentiation of serous and endometrioid in the remainder; 2) malignant epithelium reminiscent of that of USPC and akin to carcinoma in situ , frequently seen in the remaining endometrium, cervix, and, less commonly, the fallopian tube; 3) residual endometrium that, when identified (11/25 cases), was atrophic in all cases; 4) various types of cervical involvement in 17 cases (68%) ; 5) tumor within the fallopian tube in three cases (12%); and 6) carcinoma with in situ -like features in five cases (20%). In conclusion, it appears that USPC is frequently associated with malignant epithelial changes (as with carcinoma in situ ) in the remaining müllerian epithelium. This finding suggests either a field change or, more likely, a transepithelial tumor spread. The latter theory is preferable, because this type of spread is frequently seen on serosal surfaces in cases of serous ovarian carcinoma. Uterine serous papillary carcinoma is, therefore, biologically more akin to its ovarian counterpart.     

Sarcoma botryoides of the female genital tract

Results of treating 14 patients with sarcoma botryoides of the female genital tract are reviewed. Nine patients were younger than four years old and five were older than 14. Primary tumors were in the vagina (eight), cervix (three), vulva (one), and cervicovaginal region (two). All but one patient underwent surgery, including wide local excision (one), vaginectomy (one), hysterectomy (one), hysterectomy and vaginectomy (two), anterior exenteration (two), and total pelvic exenteration (six). A combination of vincristine, actinomycin-D, and cyclophosphamide was the chemotherapy regimen most frequently administered. Only one of the nine patients receiving chemotherapy died from recurrence. One patient with disease too extensive for surgery received intraarterial vincristine and radiation therapy; 16 years later she developed an adenosquamous carcinoma of the uterus. Sarcoma recurred in three patients. This review of patients treated between 1956 and 1983 reflects the evolution of therapy over 30 years. Conservative surgery alone was inadequate; therefore, radical (exenterative) surgery was adopted; recently less extensive surgery has been combined with chemotherapy, producing satisfactory results.     

认识女性生殖道癌肉瘤

女性生殖道癌肉瘤是一类很少见、侵袭性强、易于复发转移、预后差的肿瘤。该类肿瘤包含癌和肉瘤两种恶性组织成分,目前的研究对此类肿瘤的起源更倾向于转化学说,即认为该类癌瘤为单克隆起源,其中肉瘤成分由癌细胞化生为肉瘤样成分。在治疗上,对癌肉瘤首选手术治疗,术后通常需采用辅助化疗和放疗等综合治疗。