Squamous cell carcinoma of the cervix: HPV 16 and DNA ploidy as predictors of survival

In this study, the hypothesis that DNA ploidy and the presence of HPV 16 and HPV 18 DNA affects survival of patients with squamous cell carcinoma of the cervix was tested. Archival paraffin blocks from biopsy and surgical specimens were obtained from 127 women diagnosed in 1977-1984. Determination of DNA ploidy was by flow cytometry and HPV 16 and HPV 18 DNA status by polymerase chain reaction with subsequent dot-blot hybridization. For each patient, age, stage, treatment modality, and 5-year survival were correlated with ploidy and HPV status. HPV 16 DNA was present in 53% of the tumors. HPV 18 was not detected in this population. HPV 16 DNA was found twice as often in Stages IB and IIA than in advanced-stage disease (III and IV). These advanced-stage tumors were more commonly aneuploid. Neither HPV status nor DNA ploidy were predictive of survival for any stage of disease or therapeutic modality.     

Squamous cell carcinoma of the vulva: prognostic factors influencing survival.

One hundred seventy-two cases of patients with squamous cell cancer of the vulva treated at the University of Michigan Medical Center from 1975 to 1988 are reported. The mean age was 66 years with a range of 21 to 101 years. The distribution by stage included Stage I, 65; Stage II, 44; Stage III, 50; and Stage IV, 13 patients. Groin node dissections performed on 145 patients showed negative nodes, 58%; unilateral positive nodes, 28%; and bilateral positive nodes, 14%. The distribution of patients with positive nodes was influenced by stage: Stage I, 14%; Stage II, 23%; Stage III, 72%; Stage IV, 92%. The overall cumulative 5-year survival was 71% and this was significantly influenced by stage of disease: Stage I, 94%; Stage II, 91%; Stage III, 36%; Stage IV, 26%. Stages I/II and III/IV were combined for analysis. In Stages I/II, survival was significantly influenced by tumor grade while size, patient age, and lymph node status did not influence survival. In Stage III/IV, survival was significantly influenced by tumor size, node status, and number of positive nodes while grade, patient age, and tumor location did not influence survival. Squamous cell cancer of the vulva is effectively treated with radical surgery but advanced-stage disease with regional metastases significantly alters survival.     

Squamous cell carcinoma of the vulva and Fanconi anemia

Malignant neoplasia frequently occurs with Fanconi anemia. Generally this represents hematologic disease; however, solid tumors may also appear. The woman described here developed squamous cell carcinoma of the vulva at age 28, and is the third such case in a patient with Fanconi anemia that has been reported. It is a diagnosis to be considered for the young patient with this type of carcinoma. Increased chromosomal breakage in this syndrome may be important in the pathogenesis of these neoplastic changes.     

Squamous cell carcinoma of the vulva with cutaneous metastases

Cutaneous metastases from squamous cell carcinoma of the vulva are extremely uncommon. A 72-year old woman had undergone vulvectomy with bilateral inguinal lymphadenectomy. The operative specimen showed tumor infiltration in the resection borders to a considerable depth. Thereafter she received radiotherapy. Seven months after the primary operation, multiple non-tender tumor metastases appeared on the lower abdomen. These metastases result from cross-section and obstruction of lymphatic channels.     

Squamous cell carcinoma of the vulva stage IA: long-term results

OBJECTIVE: The aim of this study was to evaluate the risk of metastases to lymph nodes and long-term results of radical and modified radical surgery in patients with a T1 squamous cell carcinoma of the vulva and 相似文献   

HPV changes and their significance in patients with invasive squamous cell carcinoma of the vulva: a clinicopathologic study.

Records of 28 patients with invasive squamous cell carcinoma of the vulva were analyzed with regard to age-specific incidence rate, associated human papillomavirus (HPV) changes, multifocal and unifocal distribution of the lesions, and incidence of nodal metastasis. The presence of HPV changes (koilocytosis and condyloma) around the neoplastic epithelium correlated with a mean age group younger than that of those without HPV changes (47 vs 77 years). All multifocal cancers were associated with HPV changes while only 35% of unifocal lesions were so associated. Patients with multifocal disease were found to have a mean age younger than that of those with unifocal disease (44 vs. 67). When patients with microinvasion were excluded, no patients with multifocal invasive cancer and HPV changes were found to have nodal metastases. In contrast, nodal metastases were present in 59% of patients with unifocal invasive cancer.     

Squamous carcinoma of the vulva: results of treatment, 1938 to 1976.

Clinical data on 264 patients with squamous cell carcinoma of the vulva seen between 1938 and 1976 are reported. Two hundred and four patients were "eligible" for 5 year assessment for a 55% survival rate. Patients treated with radical vulvectomy and bilateral lymphadenectomy had a corrected 5 year survival rate of 86% if the lymph nodes failed to show metastatic disease. Twenty-eight percent of the patients treated with lymphadenectomy had lymph node metastasis at the time of surgery. The presence of lymphatic metastasis appeared to be the most significant prognostic factor. The results obtained have led to a degree of individualization in current treatment policies, together with a re-evaluation of the possible role of radiotherapy.     

Squamous cell carcinoma of the vulva in Brazil: prognostic importance of host and viral variables.

BACKGROUND: Certain clinicopathologic features of vulvar squamous cell carcinoma have been correlated with adverse prognosis. However, few large-scale studies have addressed their role in patient survival. This study examined the relationship between multiple variables and prognosis in a large group of vulvar cancers in Brazil. METHODS: One hundred eighty-four Brazilian women with vulvar carcinoma were studied and the following variables recorded: age, pathologic TNM stage, survival, histologic grade, tumor histologic pattern, invasion pattern, tumor thickness, and tissue stromal and inflammatory response. Human papillomavirus (HPV) was detected by polymerase chain reaction amplification of extracted archival DNA. Data were analyzed using Cox proportional hazards modeling. RESULTS: After controlling for age, the probability of cancer survival decreased with increasing age, stage, grade, and tumor thickness, a fibromyxoid stromal response, infiltrative growth pattern, and basaloid histologic pattern. With the exception of fibromyxoid stromal response, each of these variables remained prognostically significant after adjustment for several other predictors in a multivariate model. Women whose tumors displayed a basaloid pattern were 3.5 times as likely to die from cancer than those with keratinizing tumors [hazard ratio (HR) = 3.5, 95% CI(1.3-9.2)]. An infiltrative invasion pattern strongly increased the probability of cancer death [HR = 4.6, 95% CI(1.9,11.4)]. HPV status did not influence survival, despite its association with basaloid histology. CONCLUSIONS: Previously reported associations of negative HPV status and fibromyxoid response with adverse prognosis in vulvar cancer were not confirmed by multivariate analysis. Basaloid variants, and particularly diffusely infiltrative tumors, carry an adverse prognosis.     

HPV and p53 expression in epithelial ovarian carcinoma

OBJECTIVES: Human papillomavirus is the causal factor for cervical cancer. However, the role of HPV infection in ovarian cancer is unclear. This study aimed to determine the presence of human papillomavirus (HPV) in ovarian cancer tissues along with the expression of tumor suppressor gene p53. We also investigated any possible association of HPV with p53 gene mutations in ovarian carcinoma. METHODS: Archived human ovarian cancer tissues (n = 40 cases of epithelial ovarian cancer) embedded in paraffin blocks were used. Controls were 32 non-malignant ovarian tumor tissue blocks. In situ hybridization (ISH) and immunohistochemistry (IHC) were used to detect the presence of HPV and p53 expression, respectively. RESULTS: Of the total, 37.5% (n = 15) of malignant and 28.1% (n = 9) of benign ovarian tumors were positive for HPV (OR: 1.5 CI: 0.5-4.1, p = 0.4). The difference was not statistically significant. However, p53 was detected in 72.5% (n = 29) of malignant cases compared to 37.5% (n = 12) of benign cases (OR: 4.3 CI: 1.6-11.9, p = 0.003). Furthermore, a positive correlation between HPV and p53 expressions in ovarian cancer tissue samples was detected (r = 0.47, p = 0.001). CONCLUSIONS: HPV does not seem to be a major component in the development of ovarian carcinoma, nevertheless HPV positivity seems to contribute to the pathogenesis in at least some ovarian carcinoma cases by way of interaction with tumor suppressor p53.     

Squamous cell carcinoma of the vulva: A review of 424 patients, 1956–1974

A total of 424 patients with squamous cell carcinoma of the vulva have been followed 3–21 years. The cases were reviewed according to the FIGO, TNM, and the Friedrich staging systems. The FIGO system seemed to be the most useful in predicting prognosis. There was also a good correlation between the FIGO stages and the occurrence of metastases. In stage I 10.5% lymph node metastases were found as compared to 29.8% in stage II, 66.0% in stage III, and 100% in stage IV. The 5-year actuarial survival rate for the total series was 67.0%, 93.0% in stage I, 75.0% in stage II, and 50.0% in stage III. Radical vulvectomy with bilateral inguinal lymphadenectomy was the standard primary treatment during the study period. In stage I lesions less radical procedures are recommended. If metastases to the lacunar and/or Cloquet glands are found, the patient may benefit from high-voltage irradiation against the inguinal region and the pelvic lymph nodes.     

Basal cell carcinoma of the vulva.

A clinical and histopathologic study of material from a series of 17 patients with basal cell carcinoma of the vulva are reviewed. The tumors occurred primarily in elderly patients (average age, 59 years), the majority of whom were Causasian. Presenting symptomatology consisted primarily of pruritis vulvae and/or the presence of a vulvar mass (79%) of long duration (average, 6 years, 7 months). The lesions were described grossly as ulcerations or masses located on the anterior labium majus. Etiologies were indeterminate although 2 patients had previously received vulvar irradiation. Therapy consisted primarily of wide local excision and was effective in that follow-up studies in 16 patients revealed no deaths attributable to basal cell carcinoma. These data indicate that basal cell carcinoma is a locally invasive nonmetastasizing tumor best treated by wide local excision providing the tumor edge does not extend to the margin of excision.     

Squamous cell carcinoma with sarcomatoid features of the vulva: a case report and review of literature

BACKGROUND: A squamous cell carcinoma with sarcomatoid features of the vulva is an extremely rare malignancy of the female genital tract. This type of tumor is known to grow rapidly and associated with poorer clinical outcomes than those of squamous cell carcinoma of the vulva. CASES: A 43-year-old woman presented to our institute with a 4-month history of an aggravated vulvar mass. A radical local excision, bilateral inguinal lymph node dissection and laparoscopic assisted vaginal hysterectomy were performed. The FIGO stage of the vulvar cancer was stage II (T(2)N(0)M(0)) and the pathologic finding was consistent with a poorly differentiated squamous cell carcinoma with extensive sarcomatoid features. No further treatment was given and there was no clinical evidence of recurrence during the 2 years of follow-up. CONCLUSION: A squamous cell carcinoma with sarcomatoid features of the vulva is a tumor with aggressive biological behavior. To date, there have been only 15 cases of this disease reported in the literature. So, a collection and close study of these cases would be extremely useful in singling out and identifying the best treatment possible for this type of tumor.     

p16, p14, p53, and cyclin D1 expression and HPV analysis in small cell carcinomas of the uterine cervix.

Small cell carcinomas (SmCCs) of the uterine cervix are rare tumors. The knowledge regarding protein expression of several checkpoint candidates of cell cycle regulation is limited. Surgically treated SmCCs were selected from our files for immunohistochemical staining (neuroendocrine markers, p53, p16, p14, and cyclin D1). Polymerase chain reaction analysis, using general primers, was performed for human papillomavirus analysis. Nine of 677 tumors (1.3%) were classified as SmCCs after Grimelius staining (8/9 tumors positive) and immunohistochemical reaction against neurone-specific enolase, chromogranin A, synaptophysin (7/9 positive tumors), and CD 56 (8/9 positive tumors). All specimens were positive for at least two of the above. Two SmCCs were p53 positive and one case was p14 positive. Cyclin D1 staining was completely negative. All cases showed strong nuclear and/or cytoplasmic p16-immunostaining. Seven tumors represented human papillomavirus positivity for high-risk types. Four patients died of the tumor after a median time of 36.7 months (range, 15-56 months), representing a 5-year survival rate of 56%. The results suggest that p16 is up-regulated or accumulated in the SmCCs of the uterine cervix, probably caused by infection with human papillomavirus. p14 inactivation is of high prevalence in SmCCs and detection rate of p53 is similar to other histologic types of cervical carcinomas.     

卵巢的子宫内膜样癌临床情况及DNA倍体分析与p~(53)基因蛋白增殖细胞核抗原表达测定的研究

目的：研究卵巢的子宫内膜样癌ｐ５３基因蛋白、增殖细胞核抗原（ＰＣＮＡ）的表达与ＤＮＡ倍体分析之间的相互关系，并对其与临床分期、病理学分级与残存瘤的关系等进行分析、比较。方法：应用流式细胞技术及ｐ５３、ＰＣＮＡ单克隆抗体免疫组化技术对卵巢的子宫内膜样癌１３例进行倍体分析及基因、抗原测定。结果：ＤＮＡ异倍体率为７８％，ｐ５３基因蛋白表达率为４６％，ＰＣＮＡ表达率为９２％。ＤＮＡ倍体分析与临床Ⅱ～Ⅳ期、病理２～３级及残存瘤＞２ｃｍ者有关，异倍体阳性率分别为９０．９％、８８．８％、８７．５％，明显高于临床Ⅰ期、病理１级及无残存瘤者。ｐ５３在临床Ⅱ～Ⅳ期、病理２～３级表达率分别为６８．６％和５５．５％，均高于临床Ⅰ期及病理１级者，并对ＤＮＡ倍体水平与ｐ５３表达之间的关系进行了探讨。结论：ＤＮＡ异倍体与ｐ５３基因蛋白表达阳性可作为卵巢的子宫内膜样癌恶性程度的重要指标。     

Basal cell carcinoma of the vulva

Four cases of basal cell carcinoma of the vulva are presented with case histories and treatment. One death is recorded due to postoperative cardiac failure and pulmonary edema following a Basset operation two years after the preliminary vulvectomy. At the time of the gland removal there was no evidence of any local recurrence. The other 3 patients are alive and well, eight years, nine years, and six months, respectively. All were treated by surgical extirpation without radiation. Three patients had a regional lymph gland removal, but in no case was there any evidence of any metastasis.     

Basal cell carcinoma of the vulva

A clinical and histopathologic study of material from a series of 21 patients with basal cell carcinoma treated from 1960 until 1979 are reviewed. In 3 patients 'mixed' tumor was recorded. The histopathologic diagnosis: basosquamous carcinoma and the behavior of this carcinoma are discussed. The mean age of the patients was 76 years. Presenting symptomatology consisted primarily of bleeding, burning or itching, and ulcerations. No case of pure basal cell carcinoma gave metastasis to the regional lymph nodes, in no case could the cause of death be attributed directly to this kind of lesion. A conservative approach consisting of wide local excision is suggested.