83 例外阴浸润性鳞癌的临床分析

目的分析外阴鳞癌的临床表现,总结治疗方法,评价手术和放化疗的疗效及愈后。方法对诊治的83例随访满1年的外阴鳞癌进行回顾性分析。结果83例外阴鳞癌患者中,95．2％有前驱疾患;Ⅰ期和Ⅱ期患者60例（72．3％）,Ⅲ期和Ⅳ期患者23例（27．7％）,平均发病年龄为56．2岁,其中55例患者绝经（66．3％）。手术78例,单纯放化疗5例。手术方式包括：外阴局部切除10例（12．8％）,单纯外阴切除4例（5．1％）,外阴局部根治37例（47．5％）,根治性外阴切除27例（34．6％）。51例（65．4％）合并单侧或双侧腹股沟股浅或深淋巴结的切除,术后辅以放化疗的有34例,其中1例术前行放化疗。完全缓解65例（78．3％）,未治愈并逐渐进展18例（21．7％）。复发11例（16．9％）。总体5年的缓解率为68．7％（57／83）。切缘或紧邻切缘阳性者即使术后辅予放射治疗,其复发率仍较高,为27．8％。肿瘤浸润超过5mm或累及真皮以下的患者,复发率高达34．6％。11例复发患者,1例手术,1例放疗,余9例均进行了手术联合放疗以及化疗的联合治疗,4例进展,7例缓解,但其中4例在5年内反复复发。结论外阴鳞癌早期病例占多数;主要治疗手段为手术治疗,术后放疗的意义待进一步观察;疾病分期与疗效相关;手术切缘不净和浸润较深的患者复发率高,复发病例总体疗效不佳。     

女阴鲍温样丘疹病的诊断(附五例报告)

报告５例鲍温样丘疹病的临床表现及病理特征。该病为良性病变，可自行消退。主要讨论其与Ｂｏｗｅｎ病及Ｐａｇｅｔ病的鉴别诊断，强调正确诊断须临床与病理标准相结合。建议采取保守治疗并进行随访。     

Lymphoepithelioma-like carcinoma of the vulvar region

A case of lymphoepithelioma-like carcinoma of the vulvar region is described. Histologically, the tumour was similar to lymphoepithelioma of the nasopharynx but was Epstein-Barr virus negative. Infiltrating lymphocytes were predominantly T-cells, but also included some B-cells. Immunohistochemical stains showed positivity in tumour cells for cytokeratins but negativity for neuroendocrine markers, the melanoma-associated antigen, HMB45 and leucocyte common antigen. We conclude that the tumour histologically resembles lymphoepithelioma of the nasopharynx and lymphoepithelioma-like carcinomas of the skin, and has no relation to prior infection with the Epstein-Barr virus.     

The role of ano-vulvectomy in locally advanced carcinoma of the vulva

Abstract. Between November 1978 and March 1990 319 patients with primary carcinoma of the vulva were treated at the Regional Department of Gynaecological Oncology at the Queen Elizabeth Hospital in Gateshead. Twenty-three of these had locally advanced disease which involved the anal and perianal skin, and were treated with radical ano-vulvectomy, bilateral inguinal-femoral lymphadenectomy, and in eight cases pelvic node dissection. Overall the 5-year survival rate was 62.1%. Survival in this group of patients with locally advanced disease was comparable to that reported in other series of similar patients treated with other modalities. Radical ano-vulvectomy has a valuable role to play in the treatment of this difficult problem.     

Benzyl alcohol allergy

A 63 year old woman presented with a 3 year history of vulval lichen sclerosus et alrophicus and vulval dermatitis resistant to multiple topical therapies. She was patch test positive to 5% benzyl alcohol which is a widely used preservative in topical creams and a component in balsam of Peru.     

股薄肌皮瓣转移修复女性外阴恶性肿瘤根治术后的组织缺损

利用带血管蒂股薄肌皮瓣转移修复女性外阴恶性肿瘤根治术后的组织缺损３例，缺损面积最大１４ｃｍ×７ｃｍ，肌皮瓣面积最大１６ｃｍ×９ｃｍ。肌皮瓣全部一期成活。讨论了带血管蒂股薄肌皮瓣转移或移植时应注意的问题。     

New monoclonal antibodies recognizing epidermal differentiation-associated keratins in formalin-fixed, paraffin-embedded tissue. Keratin 10 expression in carcinoma of the vulva

Two monoclonal antibodies (MAb) specific for differentiation-related epidermal keratins have been developed. They represent specific molecular probes for different stages of epidermal differentiation. Antibody DE-K10 is chain-specific for cytokeratin polypeptide no. 10 (56.5 kD) expressed in all suprabasal layers of the epidermis. Antibody DE-SCK is specific for modified stratum corneum keratins and thus represents a marker for the terminal step of epidermal differentiation. Since the epitopes identified by both antibodies are preserved in formalin-fixed, paraffin-embedded tissue sections, these antibodies can be used for retrospective studies of differentiation in various pathological processes. We have used antibody DE-K10 to study the cytokeratin 10 expression in 26 stage II or III vulvar squamous cell carcinomas. Preliminary data suggest an increased risk of recurrence in cytokeratin 10 negative tumours.     

An Adult Case of Histiocytosis X with a Vulvar Ulcer and Multiple Bone Lesions

A 62-year-old female with histiocytosis X presented with a vulvar ulcer. Multiple osteolytic lesions were later detected. Histological examination of the ulcerated skin showed diffuse proliferation of histiocytic cells with folded nuclei and pale eosinophilic cytoplasm. Immunohistochemistry revealed S100 protein and vimentin as well as CD1a, CD4, and HLA-DR antigens in the proliferating cells. Electron microscopy demonstrated Birbeck granules in the cytoplasm of the cells. The patient was successfully treated by complete surgical excision of the ulcer followed by radiotherapy for recurrent vulvar erythema.     

Chronic vulvitis in pre‐pubertal girls

Pre‐pubertal girls with inflammatory chronic vulval disease excluding lichen sclerosus are often described as having ‘non‐specific vulvovaginitis’. The aim of this retrospective case series was to determine the aetiology of chronic vulvovaginitis in pre‐pubertal (Tanner Stage 1) girls, with particular reference to candidiasis. A chart review recorded and compared the characteristics of 38 girls and 68 post‐menarchal adolescents and pre‐menopausal women with chronic vulvitis. Nineteen (50%) of the pre‐pubertal children had been previously diagnosed with candidiasis and 21 (55%) had been treated unsuccessfully with topical antifungal agents. Candida albicans was isolated in two (5%) of the children and 37 (54%) of the adults (P < 0.001). A positive Candida culture was causally associated with chronic vulvovaginitis in 50% of the adults but in none of the children (P < 0.001). In 28 (74%) of the children and 28 (41%) of the adults, no pathogens were isolated on microbiological testing. General skin examination of the girls revealed signs of psoriasis in 27 (71%) and atopic dermatitis in nine (24%). Symptoms were controlled with topical anti‐inflammatory treatment and environmental modification, including cessation of topical antifungals. Pre‐pubertal girls with chronic vulvitis are likely to have either psoriasis or atopic dermatitis. Chronic vulvovaginal candidiasis is not seen in Tanner Stage 1 girls.     

Treatment Outcome of Women with Vulvar Cancer Treated in Bangladesh

Vulvar cancer has not been well studied in Bangladesh. This retrospective review reports on the experience often women with vulvar cancer who were treated at the National Institute of Cancer Research Hospital and Delta Private Hospital from October 2010 through March 2011. Survival was analyzed by age, stage and grade of the cancers. The ages often women with vulvar cancer ranged from 45 years to 70 years with a median of 59 years. The majority of patients （nine） presented with stage If! disease. One patient had a stage II cancer. Nine women had squamous cell cancers and one had an adenocarcinoma of the Bartholin＇s gland, All patients underwent surgery and nine underwent either preoperative or postoperative radiation therapy. At 24 months of follow-up, eight patients are currently alive and disease free.