Pregnancy following vulvar squamous cell carcinoma: a report of two cases

Pregnancy following squamous cell carcinoma of the vulvar is rare. Its rarity is reflected by a paucity of cases reported in the literature. We report two cases of pregnancy following diagnosis and treatment for vulvar squamous cell carcinoma, and review eleven prior reported cases. In successfully treated vulvar cancer subsequent pregnancy is not shown to increase the risk of disease recurrence, and there appears to be no deleterious effects during the antenatal period. It is possible, when considering prior reports, that prior vulvectomy may increase the likelihood of delivery by caesarean section, though modifications in the surgical management of vulvar carcinoma may have decreased this risk.     

Management of Gynecological Cancers During Pregnancy

The diagnosis of a gynecological malignancy during pregnancy is rare but not uncommon. Cancer treatment during pregnancy is possible, but both maternal and fetal interests need to be respected. Different treatment plans may be justifiable and multidisciplinary treatment is advised. Clinical trials are virtually impossible, and current evidence is mainly based on small case series and expert opinion. Individualization of treatment is necessary and based on tumor type, stage, and gestational age at time of diagnosis. Termination of pregnancy is not necessary in most cases. Surgery and chemotherapy (second trimester and onwards) are possible types of treatment during pregnancy. Radiotherapy of the pelvic area is not compatible with an ongoing pregnancy. This article discusses the current recommendations for the management of gynecological malignancies (cervical, ovarian, and vulvar cancers) during pregnancy.     

Malignant mixed tumor of the skin: malignant chondroid syringoma

Malignant tumors of sweat gland origin are rare. Probably one of the rarest types, still poorly understood, is the so-called malignant chondroid syringoma or malignant mixed tumor of the skin. A case of malignant chondroid syringoma is presented. Ultrastructural study proves very useful for the differential diagnosis with other chondroid or chordoid tumors.     

Chondroid syringoma-scalp. A case report

A case of chondroid syringoma of scalp is reported. The case is of particular interest because of repeated recurrence with bone and dural infiltration.     

Management of precancerous lesions prior to conception and during pregnancy: a narrative review of the literature

TSENG J‐Y., BASTU E. & GUNGOR‐UGURLUCAN F. (2012) European Journal of Cancer Care Management of precancerous lesions prior to conception and during pregnancy: a narrative review of the literature Special considerations aiming at preserving reproductive function have to be implemented when treating young patients with precancerous lesions of the lower genital tract. These high‐grade lesions may progress into invasive cancer if left untreated. Currently, there are limited data on the impact of vulvar and vaginal precancerous lesions on fertility and its management during pregnancy. However, management and outcomes for cervical lesions have been extensively reported. The main approach for vulvar and vaginal lesions are maintaining anatomical function and cosmetics; whereas, treatment options for cervical precancerous lesions range from observation, cryotherapy or the more aggressive conisation. Gestational age is the most important factor in determining expectant management or surgical intervention. This narrative review draws attention to the relevant aspects of precancerous lesions of the lower genital tract, the potential effects and management prior to conception and during pregnancy.     

Subclinical syringoma coexisting with basal cell carcinoma

We report three cases of clinically unapparent syringoma found incidentally on horizontal frozen tissue sections from patients undergoing Mohs micrographic excision of basal cell carcinoma (BCC). In the first case, the syringoma and BCC were admixed; in the other two cases, they were seen in close approximation to one another. In all cases, the tumors were detected on the faces of elderly women. The potential existence of a benign syringoma in association with BCC should be borne in mind, particularly in connection with Mohs micrographic excision. These tumors must be distinguished from one another in order to avoid excessive surgery beyond adequate resection of the basal cell carcinoma.     

Pediatric vulvar squamous cell carcinoma in a liver transplantation recipient: a case report

Here we report the first Korean case of a girl who developed noninvasive squamous cell carcinoma of the vulva at the age of 16 years. She was taking tacrolimus, an immunosuppressive agent, after living-related liver transplantation. The vulvar masses were microscopically proved as vulvar intraepithelial neoplasm II and III, even squamous cell carcinoma in situ. Human papillomavirus subtypes (69 and 73) and human papillomavirus types (66, 70, 73, and 43) were detected in the vulvar mass and the cervicovaginal smear, respectively. The outcome of liver transplantation for children has been markedly improved during the last several decades. However, the present case highlights the need to perform periodic genital examinations for the adolescents after liver transplantation. In addition to the high risk and probable high subtypes, uncommonly found human papillomavirus subtypes were extracted from her vulvar cancer. The present case is the first to show the possible relationship between previously unknown and uncommon human papillomavirus subtypes and pediatric post-transplant vulvar squamous cell carcinoma. More attention should be paid to the vulvar and cervical surveillance of pediatric transplant recipients by both medical specialists and general physicians.     

Recurrent malignant chondroid syringoma of the foot: a case report and review of the literature

Malignant chondroid syringoma, or mixed tumor of the skin, salivary gland type, is an uncommon neoplasm believed to originate in sweat glands. This neoplasm occurs mostly in women and is typically seen in the extremities and torso. A case of recurrent malignant chondroid syringoma of the right foot in a man aged 34 years is described with a review of pertinent literature. The surgically excised neoplasm was evaluated by routine histology, immunohistochemistry, and transmission electron microscopy. The malignant chondroid syringoma showed microscopic dermal satellite tumor nodules. Immunohistochemical staining was positive for keratin and S100 and negative for actin and p53. Ki-67 showed <10% positive staining. Ultrastructurally, the neoplasm was composed of epithelial cells with tonofilaments, cell junctions, and electron-dense amorphous keratin-like substance in the intercellular spaces. No evidence of myoepithelial differentiation was noted. Given the tumoral size, acral location, and histologic findings, the neoplasm was classified as a malignant chondroid syringoma. After reviewing the literature, it became apparent that wide surgical excision, adjuvant radiation therapy as well as patient education are critical in facilitating long-term survival.     

Hyaline Cell-rich Chondroid Syringoma: Epithelial Nature of the Hyaline Cells

We report a case of hyaline cell-rich chondroid syringoma arisingin the skin on the left side of the neck. The tumor was composedexclusively of hyaline cells arranged in a predominantly thicktrabecular pattern. Ductal structures of various sizes in thetumor were composed of eosinophilic cuboidal cells showing transitionto hyaline cells. Immunohistochemically, the hyaline cells werepositive for cytokeratin, S-100, and vimentin, although thebest marker for myoepithelial differentiation, alpha-smoothmuscle actin, was negative. As is the case with plasmacytoidmonomorphic adenomas of the salivary gland and some reportedcases of hyaline cell-rich chondroid syringoma, hyaline cellsin the present tumor similarly lacked any evidence of myoepithelialdifferentiation. These immunohistochemical findings reveal thatthe hyaline cells in the present tumor were epithelial.     

Breast metastasis from vulvar carcinoma: case report and review of literature]

The breast metastases resulting of vulvar carcinoma are very rare, and represent exceptionally the first manifestation of the disease. We report the case of a 42 year-old patient who underwent a treatment because of vulvar epidermoid carcinoma, right away metastatic at the level of the inguinal ganglia. The treatment consisted in a total vulvectomy with bilateral ganglial curretage, followed by external radiotherapy about the perineum and the inguinal ganglia. Three months after the end of her treatment, the patient presented with a nodula on the left outer breast with features of malignancy noticed by clinic and mammographic examination. The histologic study of the mammary biopsy showed epidermoid carcinoma of likely metastatic origin. A left Patey has been realized and confirmed the metastatic localization of epidermoid carcinoma with axillary ganglial metastasis (2N+/-7). Besides, this patient presented a right cervical ganglial parcel that the biopsy showed a metastatic localization of a vulvar carcinoma. A palliative chemotherapy type cyclophosphamid, adriblastin, cisplatine (CAP) has been admistrated during three cycles spaced out three weeks. The patient died 11 months after the supervene of the cerebral metastasis. We present this case because its rarety and to show the possibility of metastasis at the level of breast due to vulvar cancer. The clinicians must remember this possible tropism of the vulvar cancer for the breast, not only during the supervision and the complete examination as regards the disease spreading but also when the affection revealed unknown primary tumor. The diagnostic orientation is based on the mammography and the mammary biopsy. In this stage, the treatment is unfortunately palliative, the survival until a year is not more than 20%.     

Malignant chondroid syringoma. Report of a case with widespread metastasis and review of pertinent literature

The authors report the autopsy case of a 73-year-old man with widespread, metastatic, malignant chondroid syringoma, with a long clinical history. Three years after resection of the primary tumor on the back, the tumor recurred at the same site, metastasized to the cervical lymph nodes 7 years later, and finally, after 13 years exhibited widespread metastases. Histologically, the tumor showed cords and nests of cuboidal or polygonal tumor cells with little cellular pleomorphism and few mitoses surrounded by a mucoid matrix. Histochemically, the matrix contained hyaluronic acid and sulfated acid mucopolysaccharides, such as chondroitin sulfate A and/or C. To the knowledge of the authors there have been nine reported cases of malignant chondroid syringoma in the English literature, four of which had distant metastasis. A review of the literature reveals that malignant chondroid syringoma is more common in women and occurs most often in trunk and extremities, which is in contrast to its benign counterpart, its histologic appearances vary greatly, and it may even have benign appearances.     

Gyn?kologische Krebserkrankungen in der Schwangerschaft

Gynecological cancer during pregnancy is a great challenge and a multidisciplinary treatment approach is necessary. Staging and treatment should follow the standard treatment of the respective type of cancer as much as possible. For cervical, ovarian and vulvar cancer a modified surgical approach should be considered. Chemotherapy during the second and third trimester probably does not increase the rate of fetal malformation. Delivery should be postponed preferably until 35 weeks of gestation are reached.     

Benign chondroid syringoma: report of a case clinically mimicking a malignant neoplasm

Chondroid syringoma, or mixed tumor of skin, is an uncommon sweat gland tumor most often seen in the head-and-neck region of patients in the sixth or seventh decade. Tumors usually present as asymptomatic, slowly growing masses. Histologically, there are both epithelial and stromal components. The treatment of choice is local excision. Rare malignant examples have been reported, commonly involving the extremities. We present a case of cutaneous chondroid syringoma arising in the thigh of a 28-year-old female. The tumor grew over a 4-year period, increasing rapidly in size over the last few months with fixation and pigmentation of the overlying skin clinically mimicking a malignant neoplasm. Such cutaneous appendage tumors are uncommon, and surgeons may be unfamiliar with them.     

Myelodysplastic syndrome and pregnancy: the Mayo Clinic experience

Although the myelodysplastic syndrome (MDS) is most common in the elderly, younger patients, including women of child-bearing age, may be affected. The association of MDS with pregnancy appears to be very rare: fewer than 25 cases have been reported. We report the outcomes of seven pregnancies in four women seen at the Mayo clinic between 1983 and 2000. Three of the women were found to have MDS when an abnormal complete blood count was detected during routine prenatal care. The fourth patient had an apparently congenital MDS, and suffered three spontaneous abortions before undergoing premature menopause as a result of pelvic irradiation for vulvar cancer. We discuss some of the unique concerns regarding pregnant patients with MDS. As women give birth at older ages and as more young persons survive cancer, MDS and pregnancy are likely to be seen together with increasing frequency.     

Treatment of gynecologic cancers in pregnancy

Gynecologic cancers are among the most common malignancies in reproductive-age women. Approximately 3% of women diagnosed with a malignancy of the reproductive tract will have a coexisting pregnancy. A pregnant woman with a gynecologic malignancy presents a significant challenge for the clinician for many reasons. Considerable diagnostic delay is common due to confusion of symptomatology with the physiologic changes associated with the pregnant state. The diagnostic options available for a patient suspected of having an invasive gynecologic malignancy may also be compromised by the pregnancy. In addition, difficult medical, ethical, and religious issues arise when the treatment of these malignancies is incompatible with continuation of the pregnancy. Unfortunately, a relatively limited experience with reproductive tract cancers in pregnancy has prevented the development of universally accepted management algorithms for many of the complex issues regarding their treatment. A literature review of diagnostic and treatment strategies for cervical, ovarian, endometrial, and vulvar carcinoma complicated by pregnancy is presented.     

Effects of the dietary phytoestrogens daidzein and genistein on the incidence of vulvar carcinomas in 129/J mice

The objective of this study was to determine the effect of dietary phytoestrogens on the incidence of spontaneous vulvar carcinomas in 129/J mice using three natural ingredient diets and two purified diets containing predetermined levels of daidzein and genistein. Eighty weanling female mice without clinical evidence of vulvar carcinomas were randomly assigned 16 per diet to each of 5 test diets. Mice were clinically examined for vulvar masses weekly for 3 months and at monthly intervals thereafter. Vulvar carcinomas in representative groups of mice were confirmed using routine histological procedures. The incidence of vulvar carcinomas increased sharply in mice on all test diets during the first 2 months with minor changes during the remainder of the study. Within one month, the incidence of vulvar carcinomas in mice fed the AIN-76A modified soy protein diet was significantly (P < .05) increased over those of mice fed the AIN-76A modified casein diet, the #5K96, or the # 5058 diet. At three months, the incidence of vulvar carcinomas in mice fed the soy protein diet was significantly (P < .05) increased over those of mice fed the NIH-31 diet or the PMI #5K96 diet. There was a marginally significant (P < .10) correlation between the total daidzein and genistein levels in the five test diets and the incidence of vulvar carcinomas in mice as determined by clinical examination. We concluded that dietary levels of daidzein and genistein were associated with an increase in the incidence of vulvar carcinomas in mice and that the 129/J mouse may provide an animal model for studying the development of vulvar carcinomas.     

外阴和阴道良性肿瘤236例临床分析

目的 探讨该类肿瘤的临床特点、病理特征及治疗预后,总结外阴、阴道良性肿瘤的临床诊治经验.方法 回顾性分析236例外阴、阴道良性实性肿瘤患者的临床及病理资料.结果 外阴良性肿瘤177例,阴道良性肿瘤59例,所有患者均为单发,外阴良性肿瘤平均发病年龄为41.1 （1～73）岁,阴道良性肿瘤平均发病年龄为45.7（24 ～71）岁;97.2％ （172/177）外阴良性肿瘤初发患者表现为外阴肿物,71.2％ （42/59）阴道良性肿瘤患者在妇科检查时发现阴道肿物;外阴、阴道良性实质性肿瘤以平滑肌瘤、乳头状瘤、纤维瘤、色素痣等常见.61.6％（109/177）外阴良性肿瘤患者为色素痣,而在59例阴道良性肿瘤中,平滑肌瘤占71.2％ （42/59）.患者均采用局部病灶切除术,术后随访1～5年,外阴良性肿瘤未见复发,阴道良性肿瘤有3例（5.1％）出现术后复发.结论 外阴、阴道良性实性肿瘤术后预后较好,但仍有复发、恶变风险,提倡早日手术切除,术后需加强随访.     

Rising serum values of beta-subunit human chorionic gonadotrophin (hCG) in patients with progressive vulvar carcinomas.

Elevated serum levels of the beta-subunit of human chorionic gonadotrophin (hCG) were measured in 50% of patients with locoregional recurrences or progressive vulvar carcinoma (n = 14). At diagnosis of vulvar cancer, however, the incidence of elevated serum levels was low (5%) in 104 patients. The rising serum levels during progression of disease indicate that the synthesis of the beta-subunit hCG can be increased in vulvar carcinoma.     

Genetic variation in the TLR and NF‐κB pathways and cervical and vulvar cancer risk: A population‐based case–control study

Genital infection with the oncogenic human papillomavirus is the necessary cause of cervical cancer and of a large fraction of vulvar cancers. The toll‐like receptor and the nuclear factor κB (NF‐κB) signaling pathways have been implicated in inflammation, autoimmune disease and cancer, but whether common nucleotide variation in these pathways is associated with the risk of cervical and vulvar cancers has received little study. Using data from a population‐based case–control study of cervical and vulvar cancers, we genotyped 205 single nucleotide polymorphisms (SNPs) in and around 32 candidate gene regions within these pathways. Gene‐based analyses were used to estimate the associations between individual gene regions and the risk of cervical and vulvar cancers. Odds ratio (OR) and 95% confidence intervals (CI) were calculated to assess the risk of cervical and vulvar cancers for each SNP. p‐Values were adjusted for multiple testing. A total of 876 cervical cancer cases, 517 vulvar cancer cases and 1,100 controls were included in the analysis. The TNF region was significantly associated with the risks of cervical cancer (gene‐based p‐value: 2.0 × 10^?4) and vulvar cancer (gene‐based p‐value: 1.0 × 10^?4). The rare allele (A) of SNP rs2239704 in the 5′ UTR of the LTA gene was significantly associated with increased risks of cervical cancer (OR = 1.31, 95% CI: 1.15–1.50; adjusted p‐value: 0.013) and vulvar cancer (OR = 1.51, 95% CI: 1.30–1.75; adjusted p‐value: 1.9 × 10^?5). These findings add to the evidence of the importance of the immune system in the etiology of cervical and vulvar cancers.