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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied the outcome of patients undergoing radical local excision (modified radical vulvectomy) with inguinal-femoral lymphadenectomy through separate groin incisions for stage I and II invasive squamous carcinoma of the vulva. The purpose was to determine whether less radical and more individualized surgery is consistent with local control and cure. We have reported previously our experience using radical local excision and modified radical vulvectomy in stage I disease (Obstet. Gynecol. 63, 155 (1984)) and with separate groin incisions (Obstet. Gynecol. 58, 574 (1981)). This current report expands our experience with stage I and adds stage II patients treated over the past decade. Seventy-four patients were studied retrospectively over the 5-year period ending in January 1990. Reviews of both patient charts and histopathology reports were correlated with recurrence and survival. Factors analyzed included FIGO stage and grade, histology, lesion size and depth of invasion, surgical procedure, radiotherapy, lymph node status, interval to and site of recurrence, and survival. Thirty-nine patients had stage I disease and 35 had stage II. The primary operation was a radical local excision (modified radical vulvectomy) in 56 patients and radical vulvectomy in 18 patients; 13 underwent ipsilateral inguinal-femoral lymphadenectomy and 58 bilateral lymphadenectomy, each through separate groin incisions. The survival of those treated conservatively (97 and 90% for stages I and II, respectively) is the same as those undergoing a radical vulvectomy (100 and 75% for stages I and II, respectively) with only the presence of inguinal-femoral lymph node metastases impacting negatively on survival. In the entire group, the survival for negative and positive nodes was 98 and 45%, respectively. In conclusion, conservative, modified, and individualized vulvectomy in both stage I and II disease is associated with the same outcome and survival as radical vulvectomy, and lymph node status is the most important prognostic factor.
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PMID:Conservative and individualized surgery for early squamous carcinoma of the vulva: the treatment of choice for stage I and II (T1-2N0-1M0) disease. 817 23

Between 1981 and 1988, 58 patients with vulvar carcinoma underwent radical vulvectomy and unilateral inguinal lymphadenectomy. Sixteen patients with inguinal node metastases received complementary radiotherapy as an alternative to pelvic node dissection. They were treated with Co-60 therapy for bilateral inguinal and pelvic lymph nodes. The overall five-year actuarial survival rate in patients without node involvement was 84%; in patients with positive inguinal nodes treated with the combined radiosurgical approach, it was 64%. Patients with 1 node involved had a 74% rate of estimated survival, and those with 2 or more metastatic nodes, considered to be at high risk, had an estimated survival rate of 49%. Only mild to moderate side effects related to the radiation therapy were observed, and in no case was it necessary to interrupt the treatment. In terms of survival, the results obtained in the group of patients with postoperative radiotherapy were better than those normally expected after pelvic lymphadenectomy, and as suggested in recent literature, point to the promising role of irradiation as adjuvant management for vulvar cancer with node involvement.
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PMID:Radiotherapy for vulvar carcinoma with positive inguinal nodes. Adjunctive treatment. 833 21

Cancer of the vulva, the fourth most common malignancy of the female genital tract, accounts for approximately 4% of all gynecologic malignancies. Only one prior case of a cutaneous metastasis from a vulvar cancer has been previously reported and involved a FIGO Stage III (T2N1M0) lesion. We report a patient with Stage II (T2N0M0) vulvar carcinoma who developed cutaneous metastases. This case demonstrates the ability of vulvar carcinoma to disseminate hematogenously, despite complete surgical resection with negative skin margins, and negative lymph nodes. In addition, this case emphasizes the importance of careful and close follow-up of all patients with vulvar carcinoma.
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PMID:Cutaneous metastases from squamous cell carcinoma of the vulva. A case report and review of the literature. 854 4

Presented is a patient with advanced vulvar cancer involving the vagina, the perineum and the anus, with metastases to inguinal lymph nodes. The patient received irradiation and next, an artificial sigmoidal anus was made, with simultaneous vulvectomy performed with an electrosurgery. The patient's survival of 3 years and 3 months encourages to consider in such cases an attempt at applying aggressive surgical treatment combined with external radiotherapy.
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PMID:[A case of advanced vulvar cancer treated with combination therapy]. 867 77

Squamous cell carcinoma of the vulva is a rare disease, mainly seen in elderly women. Risk factors are advanced age, an immunocompromised status, longstanding vulvar dystrophy, VIN, a history of vulvar human papillomavirus infection, and a history of cervical cancer. Vulvar cancer should be considered as a skin tumor and detection is possible in an early stage. However, because of patients' and doctors' delay, one in three vulvar cancers is not treated before an advanced stage. The tumor metastasizes mainly lymphatogenic. Spread starts in the inguinal lymph nodes. In the middle of this century, standard treatment, consisting of an en bloc dissection of the vulva and inguinal lymph nodes has been developed and applied. As a result, considerably improved survival rates were achieved: up to 90% 5-year survival rates for patients without lymph node metastases. However, complication rates were high. In recent years, a more individualized approach has replaced standard treatment. Surgical treatment now depends on the localization, size and extent of the tumor, and is followed or preceded by radiotherapy in selected cases. The role of chemotherapy in advanced disease is currently being studied in several referral centers. The most important success in the treatment of vulvar cancer in recent years is the maintenance of high survival rates despite considerably less extensive surgical treatment, resulting in lower complications rates. An important challenge for the near future will be the improvement of the management of advanced disease. However, an even more difficult issue may be the prevention of such large lesions. The reduction of treatment delays requires a considerable effort in education of both health care workers and the general public.
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PMID:Vulvar squamous cell carcinoma. 872 25

The frequency, distribution, and significance of a prominent fibromyxoid stromal response to tumor was examined in 51 consecutive cases of invasive squamous carcinoma of the vulva in which the lesion was totally excised and follow-up information available. The stromal response consisted of an admixture of myxoid change and immature collagen with fibroblasts at the tumor-stromal junction and was focally (< 25% of tumor) in 11 of the 51 cases (21%), regionally (26-50% of tumor) in seven cases (14%), diffusely (> 50% of tumor) in eight cases (16%), and not at all in 25 cases (49%). Tumors showing a prominent fibromyxoid stromal response (> 25% of the tumor) were typically flat or elevated ulcerative lesions, whereas carcinomas without a prominent fibromyxoid stromal response were more commonly exophytic. Sixty percent of the tumors with a prominent fibromyxoid stromal response involved the clitoris, compared with clitoral involvement in only 14% of carcinomas without a prominent response. Case showing prominent fibromyxoid stromal response were associated with a significantly older age group, poorer survival rate, and more extensive lymph node metastases than when fibromyxoid stromal response was not prominent. This behavior was manifested despite the fact that these tumors were not larger, more deeply invading, of higher grade, or more likely to show infiltrating patterns of invasion than when fibromyxoid stromal response was not prominent. Because the ability of a tumor to invade is believed to be related in a large part to changes in the relationship of tumor to stroma, a correlation between fibromyxoid stromal response and aggressive tumor behavior would suggest that a specific pattern of alteration in the interaction of tumor cells with stroma occurs in a subset of vulvar squamous carcinomas. The current findings may reflect the diverse etiology of vulvar carcinoma. If the characteristic features of vulvar carcinomas showing a prominent fibromyxoid stromal reaction as shown in this study can be confirmed on larger study populations, "squamous cell carcinomas with prominent fibromyxoid stromal reaction" may be a useful designation for these tumors.
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PMID:Clinicopathologic features of vulvar squamous cell carcinomas exhibiting prominent fibromyxoid stromal response. 878 3

In spite of efforts to reduce complications associated with inguinal-femoral lymphadenectomy (IFL), morbidity continues to be substantial. We sought to assess the efficacy of sartorius transposition (ST) in reducing groin wound complications following IFL, in patients with vulvar malignancy. The records of 101 patients with vulvar cancer undergoing IFL through separate incisions between March 1975 and December 1994 were examined. Sixty-two patients undergoing ST (group 1) were compared to 38 who did not (group 2). The groups were similar with respect to age, weight, tobacco/alcohol use, prior abdominal/vulvar surgery, prevalence of diabetes, hypertension, or peripheral vascular disease, and previous exposure to irradiation or chemotherapy. Additionally, there was no significant difference with respect to extent of disease, incidence of macro-/microscopic groin metastases, use of groin drains, and use of perioperative antibiotics or deep venous thrombosis prophylaxis. Groin wound complications were less frequent in patients undergoing ST (group 1). The incidence of groin cellulitis was 30% in group 1 compared with an incidence of 58% in group 2 (P = 0.011). Significant groin wound morbidity, defined as either wound breakdown or cellulitis, was seen less frequently in group 1 (41% vs 66%; P = 0.029). Employing a multivariate analysis, only patient weight < 150 lbs and performance of ST were established as independently associated with a reduction in groin morbidity following IFL (P = 0.0281 and P = 0.0075, respectively). In conclusion, despite waning enthusiasm for its performance, ST appeared to significantly reduce the incidence of wound morbidity after IFL. Our data confirmed that separate incisions, and improved perioperative antibiotics, have not eliminated the value inherent in this surgical modification. We suggest a prospective trial to further establish the benefit of sartorius transposition during IFL.
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PMID:The effect of sartorius transposition on wound morbidity following inguinal-femoral lymphadenectomy. 903 69

Thrombocytosis (platelet count >400 x 10(9)/L) is frequently found in association with malignant disease. Although the pathogenesis of thrombocytosis in malignancy is currently unclear, it appears to be a poor prognostic factor in patients with lung, colon, breast, and cervical carcinoma. The current study was initiated to assess the incidence of thrombocytosis in vulvar carcinoma and to evaluate its prognostic significance for patients with vulvar carcinoma. The pretreatment platelet counts of 201 women treated for vulvar cancer were reviewed and correlated to the patient's age, stage of disease, node status, histologic type, and outcome. Differences between categories were analyzed by means of the ANOVA test, and survival was compared using the log-rank test on the Kaplan-Meier life table. Thrombocytosis was presented in 14.92% of patients with vulvar malignancies and in 15.46% of patients with squamous cell carcinoma of the vulva. No correlation was found between thrombocytosis and tumor size, incidence of lymph node metastases, or stage of the disease. The 5-year survival rate for patients with thrombocytosis was 89.29%, which was not significantly different from the 76.47% 5-year survival of patients with normal platelet counts (P = 0.586). When adjusted for age, histological differentiation, number of tumors, staging, incidence of nodal metastases, platelet count, hemoglobin, and white blood count, only the staging, number of tumors, and histological differentiation were associated with an unfavorable prognosis (P = 0.0001, P = 0.003, P = 0.03, respectively). Thrombocytosis was not found to be a prognostic factor in patients with carcinoma of the vulva in this series of 201 patients.
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PMID:Thrombocytosis in women with vulvar carcinoma. 988 35

Lymph node pathologic status is the most important prognostic factor in vulvar cancer; however, complete inguinofemoral node dissection is associated with significant morbidity. Lymphoscintigraphy associated with gamma-probe guided surgery reliably detects sentinel nodes in melanoma and breast cancer patients. This study evaluates the feasibility of the surgical identification of sentinel groin nodes using lymphoscintigraphy and a gamma-detecting probe in patients with early vulvar cancer. Technetium-99m-labelled colloid human albumin was administered perilesionally in 37 patients with invasive epidermoid vulvar cancer (T1-T2) and lymphoscintigraphy performed the day before surgery. An intraoperative gamma-detecting probe was used to identify sentinel nodes during surgery. A complete inguinofemoral node dissection was then performed. Sentinel nodes were submitted separately to pathologic evaluation. A total of 55 groins were dissected in 37 patients. Localization of the SN was successful in all cases. Eight cases had positive nodes: in all the sentinel node was positive; the sentinel node was the only positive node in five cases. Twenty-nine patients showed negative sentinel nodes: all of them were negative for lymph node metastases. Lymphoscintigraphy and sentinel-node biopsy under gamma-detecting probe guidance proved to be an easy and reliable method for the detection of sentinel node in early vulvar cancer. This technique may represent a true advance in the direction of less aggressive treatments in patients with vulvar cancer.
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PMID:Sentinel node biopsy in early vulvar cancer. 1064 80

The status of regional lymph nodes is a powerful predictor of survival in patients with early cancers of the vulva, cervix, and uterus. Radical resection of vulvar and cervix cancers along with extensive lymphadenectomy remains the standard of care for these cancers. Intraoperative lymphatic mapping and sentinel node identification has the potential to improve the treatment of patients with gynecologic cancer with improved detection of lymph node metastases and reduced morbidity. This chapter will focus primarily on vulvar cancer and include a review of previous innovations in treatment and current experience with intraoperative lymphatic mapping in these patients.
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PMID:Intraoperative lymphatic mapping and sentinel node identification: gynecologic applications. 1085 69


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