外阴硬化性苔癣合并外阴鳞状细胞癌一例

外阴硬化性苔藓(vulva lichen sclerosis,VLS)是女性慢性难治性皮肤病。主要发生于外阴及肛周皮肤,以外阴皮肤变白、瘙痒为主要特征,若伴有外阴疼痛及硬结明显者应警惕发展为外阴鳞状细胞癌(vulva squamous cell carcinoma,VSCC)。本文介绍了一例有40余年VLS病史的56岁女性,于大阴唇部位取材,组织病理示"外阴硬化性苔藓,轻度",后因阴蒂部位粘连,且疼痛明显,行外阴粘连分离术,见阴蒂色暗红,呈小菜花状,并分别用活检钳及冷刀两次病理取材后组织病理证实为VSCC,遂行扩大性外阴切除术+双侧腹股沟淋巴结切除术。术后进一步给予放疗+化疗。本例提示了对于VLS病史较长,且局部硬结,疼痛明显者,应警惕癌变,若阴蒂处疼痛且粘连者,应行粘连分解,暴露阴蒂,必要时重复取材,以免漏诊误诊。     

外阴硬化性苔藓的诊治现状及研究进展

外阴硬化性苔藓(vulvar lichen sclerosus,VLS)是一种常发生于女性外阴的淋巴细胞介导的慢性炎症性非瘤样皮肤病变。患者可有剧烈的瘙痒、疼痛、甚至外阴粘连,影响排尿、排便和性交。治疗方法首选外用糖皮质激素或钙磷酸酶抑制剂等保守治疗,对药物治疗无效或粘连严重者可选择外阴聚焦超声治疗或手术治疗。对于恶变风险较高的患者,应于外阴病变门诊密切随访。     

外阴硬化性苔癣的诊治

硬化性苔癣(lichen sclerosus，LS)是以皮肤萎缩变薄为主要特征的皮肤病。男女发病之比为1：10。女性硬化性苔癣主要发生于外阴及肛周皮肤，称为外阴硬化性苔癣(vulvar lichen sclerc,sus，VLS)。VLS病因不明，主要症状为外阴瘙痒，治疗较为困难，容易复发，给患者带来极大的痛苦。本文就VLS的临床诊治作一综述。     

女性外阴硬化性苔藓临床诊治专家共识（2021年版）

        女性外阴硬化性苔藓（vulvar lichen sclerosus,VLS）是一种常见的外阴慢性炎症性非瘤样皮肤病变。本病以外阴及肛周的皮肤和黏膜萎缩变薄为主要特征,呈慢性进展伴反复发作。不及时规范的治疗可导致外阴萎缩、粘连、瘢痕形成,甚至外阴丧失正常解剖及功能,局部发生癌变的风险亦有所升高。 浏览更多请关注本刊微信公众号及当期杂志。     

外阴鳞状细胞癌和癌前病变19例临床分析

外阴鳞状细胞癌（squamous cell carcinomas,SCC）占女性生殖道恶性肿瘤的5%,占外阴恶性肿瘤的90%[1]。常发生于老年女性。其发生外阴鳞状细胞癌之前,常有多年外阴病变病史,最常见者是外阴硬化性苔藓（LichenSclerosis,LS）,也称为外阴白斑。     

分化型外阴上皮内瘤变的诊治及相关问题

<正>分化型外阴上皮内瘤变(differentiated vulvar intraepithelial neoplasia,dVIN)是一种非人乳头瘤病毒(HPV)依赖性(HPV-independent)外阴鳞状细胞癌(vulvar squamous cell carcinoma,VSCC)的癌前病变,也是VSCC两种发病途径中的一种,主要来源于外阴硬化性苔藓(vulvar lichen sclerosus,VLS)等外阴慢性疾病,约占VSCC的70%^[1-2]。多项研究显示,近年来dVIN的发病明显增加,而且其进展为VSCC的风险明显高于HPV相关性(HPV-associated)外阴癌前病变——外阴高级别鳞状上皮内病变(HSIL)^[1-6]。据统计,     

外阴硬化性苔癣病因及治疗研究进展

外阴硬化性苔癣(VLS)以外阴搔痒、性交痛及外阴烧灼感为临床特点,晚期外阴多部位萎缩,有发展为外阴癌的趋势。近年国内外学者对VLS的病因及发病机制进行了大量深入的研究,认为外阴硬化性苔癣的发生与遗传、免疫、局部微环境及信号转导等多种因素有关,且对VLS的临床治疗包括药物治疗和物理治疗也进行了广泛的探索,取得了一定的进展。     

CD34在外阴病变组织中的表达

目的探讨外阴真皮组织内血管形成及密度改变与外阴皮肤黏膜上皮内非瘤样病变(NNEDV)及外阴上皮内瘤变(VIN)的关系。方法2000年1月至2005年1月对沈阳市妇婴医院等采用免疫组织化学链菌素抗生物素———过氧化物酶(SP)法,检测人原始造血细胞抗原(CD34)在外阴病变组织中的表达。结果在外阴硬化性苔藓(VLS)组织中微血管密度(MVD)值为10.10,在VIN组织中MVD值为32.70,两者与正常皮肤(NS)比较差异均有显著性意义(P<0.05)。在外阴鳞状上皮增生(VSH)组织中MVD值为22.84,3种病变中任意两组比较差异均有显著性意义(P<0.05)。结论MVD在VLS真皮中表达较NS、VSH和VIN低,提示VLS组织存在真皮微循环障碍。在VIN中MVD值较VSH高,提示MVD增加加速了异型细胞的增殖。     

点阵CO2激光治疗外阴硬化性苔藓的疗效分析

目的 评估点阵CO₂激光治疗外阴硬化性苔藓(vulvar lichen sclerosus,VLS)的临床疗效及不良反应，为临床提供指导。方法 收集2018年9月至2021年6月因组织学证实为VLS并于郑州大学第二附属医院妇产科行点阵CO₂激光治疗≥3次的125例患者的基本资料，于治疗前、第1次治疗后1个月、第3次治疗后1个月及疗程结束后3个月，通过视觉模拟评分法(visual analogue score,VAS)评估患者的外阴瘙痒、外阴灼痛、性交疼痛、性生活不满意度、生活质量、皮肤颜色及皮肤弹性情况，进而评估点阵CO₂激光治疗VLS的临床疗效。结果 在随访过程中，有14例患者失访，最终111例患者纳入分析。与治疗前相比，VLS患者的外阴瘙痒、外阴灼痛、生活质量、皮肤颜色、皮肤弹性、病损面积及性生活满意度在激光治疗后均有好转，差异具有统计学意义(P<0.05)，且随着治疗的进行，外阴瘙痒、生活质量、皮肤颜色、皮肤弹性及病损面积逐渐改善，差异具有统计学意义(P<0.05)。点阵CO₂激光...     

外阴硬化性苔藓345例临床病理分析及维持治疗频率的初步探讨

目的探讨外阴硬化性苔藓(VLS)的临床病理特征及治疗, 并初步探讨其维持治疗频率。方法收集2018年至2021年于复旦大学附属妇产科医院诊断为VLS的患者共345例, 回顾性分析其临床病理特征、治疗方法及效果, 对病情稳定的患者进行维持治疗并定期随访, 探究维持治疗的最低用药频率。结果 (1)一般情况:345例VLS患者的确诊年龄为(50.4±14.7)岁(范围:8～84岁), 其中50～59岁年龄段的占比最高(30.1%, 104/345)。177例有合并疾病和相关家族史记录的患者中, 18.6%(33/177)合并自身免疫性疾病, 24.3%(43/177)合并过敏性皮肤疾病, 5.6%(10/177)患者的女性直系亲属有长期外阴瘙痒或皮肤色素减退病史。(2)临床特征:204例有症状记录的患者中, 最常见的症状为外阴瘙痒(96.1%, 196/204);214例有体征记录的患者中, 最常见体征为外阴色素减退(96.3%, 206/214);202例有病变累及部位记录的患者中, 常见累及部位依次为小阴唇(70.3%, 142/202)、大阴唇(67.8%, 137/202)、阴唇沟(...     

Increased osteopontin expression is associated with progression from vulvar precancerous lesions to vulvar squamous cell carcinoma

Purpose

Vulvar squamous cell carcinoma (VSCC) contributes to about 3–5 % of all gynecological cancers. Vulvar intraepithelial neoplasia (VIN) and vulvar lichen sclerosus (VLS) are regarded as precancerous lesions. Early detection and treatment of precancerous lesions may prevent development of VSCC. Osteopontin (OPN) has been shown to be involved in many physiological and pathological processes, such as tumor progression, by promoting cancer cell invasion and metastasis. As a result of these findings, OPN has been described as a potential marker for tumor progression in some malignancies. In this study, we investigated the expression of OPN in vulvar tissue specimens and compared its expression between different histopathological grades.

Methods

In the present study, the expression patterns of OPN in 80 paraffin-embedded tissue specimens, including 25 VSCC samples, 21 VIN lesions and 21 VLS, in addition to 13 normal vulvar samples, were examined by the immunohistochemical method and chromogenic in situ hybridization.

Results

The intensity of OPN expression steadily increased according to the pathological grades. In addition, OPN staining was found in the extracellular matrix in VSCC.

Conclusions

Expression levels of OPN increased from VLS and VIN to VSCC, and steadily increased with the pathological stage of VSCC. Our results suggest that OPN may be associated with the progression of VSCC.     

A case of a pT3, HPV 52-positive vulvar carcinoma in an 18-year-old woman

BACKGROUND: Vulvar carcinoma in young women is rare; so far, no case of an 18-year-old woman has been described. Here, we report a case with a T3 HPV 52-induced tumor 3 years after primary HPV contamination. CASE: An 18-year-old woman without risk factors complaining of dysuria and vulvar pain was treated several months for fungal infection before referred and diagnosed with a vulvar carcinoma located between clitoris and urethra. She underwent operation with partial urethral resection and external radiation. The tumor tested positive for HPV type 52, the time between primary sexual contact and tumor development was less than 3 years. CONCLUSION: Also in very young women, an ulcer and vulvar pain have to be biopsied to exclude malignancy despite an unusual short time interval between possible HPV contamination and symptoms.     

Effectual surgical perineal reconstruction of malignant mucosal vulvar melanoma

ObjectiveTo demonstrate a successful surgical treatment and reconstruction in a case of malignant mucosal vulvar melanoma.Case reportA 52-year-old woman had stage II bulky malignant mucosal vulvar melanoma and received wide surgical excision with partial vulvectomy. She underwent 2-steps reconstructive vulvoplasty and vaginoplasty with skin grafting 1 year after initial surgical treatment. There was no evidence of recurrence after 3 years of follow-up.ConclusionVulvar melanoma is a rare malignant neoplasm. Wide local excision with reconstruction can relieve pelvic discomfort and restore local function after the surgery.     

Unilateral vulvar edema after operative laparoscopy: a case report and literature review

OBJECTIVE: To report a case of unilateral vulvar edema occurring after operative laparoscopy and to review the relevant literature. DESIGN: Case report. SETTING: University hospital. PATIENT(S): An 18-year-old woman with a single ovarian cyst. INTERVENTION(S): The patient underwent laparoscopic ovarian cystectomy and 1,000 mL of adhesion barrier solution was instilled in the peritoneal cavity at the end of the procedure. MAIN OUTCOME MEASURE(S): Treatment of ovarian cyst and prevention of adhesion formation with adhesion barrier solution. RESULT(S): Development of unilateral vulvar edema 3 hours postoperatively. CONCLUSION(S): Vulvar edema after operative laparoscopy is an uncommon complication, the mechanism of which remains unclear. The condition is self-limited and resolves with conservative management.     

Successful management of vulvar adhesions with potent topical corticosteroids: a case report

BACKGROUND: Vulvar adhesions are a rarely reported but clinically recognized complication of severe ulcerations following herpes genitalis. The condition is avoidable with adequate pharmacologic treatment, hygiene, separation of the labia and topical application of skin emollients. CASE: Vulvar agglutination was diagnosed in a 23-year-old woman following hospitalization for severe herpetic vulvar ulcerations. Manual attempts to separate the labia under local anesthesia were unsuccessful. Topical application of a potent cortico- steroid led to separation with no residual effects. CONCLUSION: Preventive and proactive management of extensive herpetic vulvar ulcerations should be the first line of care. There will always be patients who will present at a later stage of the disease, with established vulvar agglutination; there potent topical corticosteriods could prove valuable. There is no literature on the use of topical corticosteroids as the primary treatment for vulvar adhesions, and further studies are essential.     

Recommendations for the Study of Vulvar Pain in Women,Part 1: Review of Assessment Tools

IntroductionThe etiology and consequences of chronic vulvar pain are multidimensional, resulting in highly variable clinical presentations and no established treatment algorithm. Inconsistent use of measurement tools across studies is a significant barrier to drawing conclusions regarding etiology and treatment. In a companion paper, we review additional methodological challenges to the study of chronic vulvar pain and potential solutions.AimTo review and recommend assessment and measurement tools for vulvar pain and associated key outcomes.MethodsThe authors reviewed the scientific evidence related to measurement of vulvar pain and made decisions regarding recommendations via discussion and consensus.Main Outcome MeasureWe assessed measurement tools for vulvar pain and related outcomes and considered advantages and disadvantages of their use.ResultsEmpirically validated measurement tools are available and should be used uniformly across studies to support comparisons and pooling of results. There is, at times, a trade-off between advantages and disadvantages when selecting a particular tool, and researchers should be guided by their specific research aims, feasibility, and potential to gain further knowledge in the field. Researchers should incorporate a biopsychosocial assessment of vulvar pain and its consequences.Clinical ImplicationsThis review provides a comprehensive list of measurement tool recommendations for use in clinical research, and in some cases, clinical practice.Strengths & LimitationsThis expert review can guide study design and decision-making for those researching vulvar pain and its consequences. The review content and recommendations are based on expert knowledge of the literature rather than a formal systematic review.ConclusionA thorough consideration of vulvar pain assessment tools is essential for continued progress toward identifying factors involved in the development and maintenance of vulvar pain and developing empirically supported treatments.Rosen NO, Bergeron S, Pukall CF. Recommendations for the Study of Vulvar Pain in Women, Part 1: Review of Assessment Tools. J Sex Med 2020; 17:180–194.     

Benign vulvar dermatoses

Vulvar pruritus and pain are common indications for consultation with a gynecologist. Contact dermatitis, lichen sclerosus, lichen planus, and vulvar intraepithelial neoplasia are vulvar dermatoses that are often associated with both pruritus and pain. Because these skin conditions are frequently misdiagnosed by providers and incorrectly self-treated by patients, vulvar biopsy is considered the gold standard for diagnosis. The etiology of these vulvar skin conditions is multifactorial; therefore, patient education, behavior modification, and regular follow-up with an experienced clinician are essential to ensure effective control of patient symptoms and management of the skin condition. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After completing this CME activity physicians should be better able to evaluate common vulvar skin conditions and identify these conditions as a source of significant morbidity for women, diagnose vulvar dermatoses using vulvar biopsy as the gold standard, create a differential diagnosis of vulvar skin disorders.     

Vulvar Lesions in an 8-Year-Old Girl: Cutaneous Manifestations of Multisystem Langerhans Cell Histiocytosis

Background

Langerhans cell histiocytosis (LCH) is a rare localized or systemic disease characterized by proliferation of myeloid-derived dendritic cells. Vulvar lesions might be the herald symptom of LCH and might mimic other cutaneous lesions. Prognosis varies widely on the basis of the extent and spread of disease.

Outcomes of Therapy for Vulvar Manifestation of Inflammatory Bowel Disease in Adolescents

Background

Vulvar manifestations of inflammatory bowel disease (IBD) are variable in presentation and challenging to treat. We describe vulvar manifestations and treatment response in female adolescents with IBD.

EGF与外阴癌发生发展的关系

目的:通过检测表皮生长因子(EGF)在正常外阴皮肤、外阴上皮内瘤变(VIN)和外阴鳞状细胞癌(VSCC)中的表达,探讨其在外阴癌变中的作用。方法:应用免疫组化SP法进行检测。EGF的表达与外阴肿瘤的临床病理特征相比较。结果:正常外阴组织、低级别VINs、高级别VINs、外阴癌中EGF蛋白阳性表达率分别为0(0/20)、18.2%(2/11)、82.8%(9/11)、100%(60/60),P<0.05。在高、中、低分化的浸润性外阴癌中,EGF的细胞阳性表达率分别为36.2%、42.7%、47.1%,P>0.05。有淋巴结转移者EGF蛋白阳性表达率为30.2%明显低于无淋巴结转移者的49.8%。结论:EGF蛋白的异常表达在外阴癌的发生发展中起着重要的作用,而且可为外阴癌的预后提供重要的信息。