RESUMEN
OBJECTIVE: To investigate the efficacy, safety, and influencing factors of secondary focused ultrasound (FU) therapy for recurrence of non-neoplastic epithelial disorders of the vulva (NNEDV). METHODS: Patients with NNEDV who have relapsed after initial FU treatment were included in this study. They were treated with secondary FU therapy between July 2015 and July 2021. Outcome measures included the degree of symptom severity and operative complications. We further analyzed the relationships between age, course, time between relapse and initial treatment, menopause status, lesion size, pathological types, severity of symptoms, and curative rate. RESULTS: There were 98 patients enrolled in this study, with a mean age of 47.4 ± 11.4 years. All patients successfully underwent secondary FU therapy. Blisters developed among 16 (16.3%) patients, of whom 6 (6.1%) developed superficial skin ulcers. A curative response was observed among 46 (46.9%) patients, while an effective response was observed among 44 (44.9%) patients. Only 8 (8.2%) patients showed no improvement. The total response rate was 91.8%. A total of 12 (12.2%) cases recurred among all effective cases. Patients with a recurrence of NNEDV after more than 1.5 years following their first FU therapy demonstrated a higher response rate than those with a recurrence after less than 1.5 years. CONCLUSIONS: A second FU therapy remains effective for patients with recurrent NNEDV with no obvious side effects. The response rate, however, is higher for patients who experience recurrence of NNDEDV after more than 1.5 years.
Asunto(s)
Ultrasonido Enfocado de Alta Intensidad de Ablación , Enfermedades de la Vulva , Adulto , Femenino , Humanos , Persona de Mediana Edad , Recurrencia , Resultado del Tratamiento , Vulva/patología , Enfermedades de la Vulva/diagnóstico por imagen , Enfermedades de la Vulva/patología , Enfermedades de la Vulva/terapiaRESUMEN
This case image demonstrates the usefulness of vulvar ultrasound in the diagnosis of vulvar abscess.
Asunto(s)
Absceso , Enfermedades de la Vulva , Femenino , Humanos , Absceso/diagnóstico por imagen , Enfermedades de la Vulva/diagnóstico por imagen , Vulva/diagnóstico por imagen , UltrasonografíaRESUMEN
In this study, a prospective study was conducted by using optical coherence tomography (OCT) in the in vivo detection of vulvar diseases. The clinical efficacy of the OCT we investigated in the detection of vulvar diseases, and the characteristics of the OCT images were defined. Overall, this study recruited 63 patients undergoing the colposcopy for vulvar lesions in three Chinese hospitals from December 20th, 2018 and September 24th, 2019. The colposcopy and the OCT examination were performed successively, and the OCT images were compared with the relevant tissue sections to characterize different lesions. The OCT diagnoses where categorized into 7 types, including normal and inflammatory vulva, condyloma acuminata, papilloma, lichen sclerosus, atrophic sclerosing lichen, fibrous epithelial polyp as well as cysts. The structural characteristics of the vulva tissue can be clearly observed in the OCT image, which are consistent with the characteristics of the tissue section. Compared with the pathological results, the sensitivity, specificity and accuracy of the OCT examination reached 83.82% (95% confidence interval, CI 72.5%-91.3%), 57.89% (95% CI 34.0%-78.9%) and 78.16%, respectively. The OCT is found with the advantages of being noninvasive, real-time and sensitive and with high resolution. It is of high significance to screening vulva diseases, and it is expected as one of the methods to clinically diagnose vulva diseases.
Asunto(s)
Tomografía de Coherencia Óptica , Enfermedades de la Vulva , Colposcopía , Femenino , Humanos , Embarazo , Estudios Prospectivos , Tomografía de Coherencia Óptica/métodos , Vulva/diagnóstico por imagen , Enfermedades de la Vulva/diagnóstico por imagen , Enfermedades de la Vulva/patologíaRESUMEN
BACKGROUND: High-intensity focused ultrasound (HIFU) is an important method for treating non-neoplastic epithelial disorders of the vulva (NNEDV), but the factors affecting the efficacy of HIFU for NNEDV treatment remain unclear. OBJECTIVE: To determine the factors influencing the clinical efficacy of HIFU in the treatment of NNEDV. METHODS: A retrospective observational study of 186 NNEDV patients treated with HIFU was performed to evaluate the therapeutic effect, and the relationship between treatment efficacy and clinicopathological factors was analyzed. RESULTS: NNEDV signs and symptoms were effectively improved and relieved after HIFU treatment. The total effective and recurrent rates were 95.16% and 4.52%, respectively. Younger patients with shorter disease courses, mild itching, or peri-vulvar lesions had better therapeutic effects, and patients with anxiety and/or depression had worse treatment outcomes. CONCLUSION: The therapeutic effect of HIFU on NNEDV is not only related to the itching degree, age, or disease course but is also closely related to lesion location as well as anxiety and depression in patients.
Asunto(s)
Ultrasonido Enfocado de Alta Intensidad de Ablación , Enfermedades de la Vulva , Femenino , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , Enfermedades de la Vulva/diagnóstico por imagen , Enfermedades de la Vulva/terapiaRESUMEN
BACKGROUND: In this case report, we presented a rare case of maternal death with massive vulvar edema and Covid-19 diagnosis. CASE PRESENTATION: The case was a 20-year-old woman who was referred to with pain and massive vulvar edema by passing 7 days from her labor. The laboratory tests showed leukocytosis, lymphopenia, and elevated C-reactive protein levels. The high-resolution computed tomography was in favor of Covid-19 changes. Finally, she died because of respiratory distress, ON the 8th day postpartum. CONCLUSION: Given the increasing prevalence of Covid-19, it is important and vital to be aware of its potential complications and then to try prevent and manage them, especially during high-risk periods such as pregnancy and postpartum.
Asunto(s)
COVID-19/complicaciones , Edema/complicaciones , Edema/diagnóstico por imagen , Muerte Materna , Periodo Posparto , SARS-CoV-2/genética , Enfermedades de la Vulva/complicaciones , Enfermedades de la Vulva/diagnóstico por imagen , COVID-19/sangre , COVID-19/virología , Prueba de COVID-19/métodos , Resultado Fatal , Femenino , Humanos , Linfopenia , Embarazo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
We present a case of 26-year female who presented with acute urinary retention and vulvar mass. She denies any urinary complaints in the past except for occasional straining for voiding. Imaging revealed a prolapsed ureterocele, it was successfully managed with incision and excising a flap of ureterocele due to the risk of postoperative protrusion of the redundant ureterocele. On follow-up at 6 months she was voiding well without any complaints.
Asunto(s)
Ureterocele/diagnóstico por imagen , Ureterocele/cirugía , Enfermedades de la Vulva/complicaciones , Enfermedades de la Vulva/cirugía , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Prolapso , Colgajos Quirúrgicos , Retención Urinaria/complicaciones , Enfermedades de la Vulva/diagnóstico por imagenRESUMEN
A 6-year old girl was referred because she had a painless enlarged left labium majus. There were no further symptoms. Ultrasound and MRI revealed no hernias, malignancy or cystic abnormalities. We diagnosed CALME, Childhood Asymmetry Labium Majus Enlargement, a non-neoplastic expansion of normal vulvar tissue in response to hormonal changes. Expectant management is preferred.
Asunto(s)
Vulva/patología , Enfermedades de la Vulva/patología , Niño , Femenino , Humanos , Hipertrofia/patología , Imagen por Resonancia Magnética , Ultrasonografía , Vulva/diagnóstico por imagen , Enfermedades de la Vulva/diagnóstico por imagen , Enfermedades de la Vulva/terapia , Espera VigilanteAsunto(s)
Edema/etiología , Hernia/diagnóstico por imagen , Ovario/patología , Enfermedades de la Vulva/patología , Diagnóstico Diferencial , Procedimientos Quirúrgicos Electivos , Femenino , Herniorrafia/métodos , Humanos , Lactante , Resultado del Tratamiento , Ultrasonografía/métodos , Enfermedades de la Vulva/diagnóstico por imagenRESUMEN
BACKGROUND A subcutaneous lipoma is a benign tumor comprised of mature adipocytes. Clinically it presents as a soft, freely moveable, doughy mass that is typically painless and slow growing. Lipomas containing fat necrosis and corresponding palpable nodular elements are rare and suggest an alternative diagnosis. Lipomas in the vulvar region are rare and giant vulvar lipomas with palpable fat necrosis are unreported. CASE REPORT A 25-year-old patient presented with a 4-year history of an enlarging right vulvar mass with multiple small (<1 cm) firm nodules within the tumor. A pelvic MRI (magnetic resonance imaging) did not visualize the nodules but histopathologic examination revealed a benign lipoma containing fat necrosis and discrete areas of calcium deposition. CONCLUSIONS Fat necrosis can occur in vulvar lipomas and present with intratumor nodularity. MRI imaging, clinical findings and histology may be discordant.
Asunto(s)
Necrosis Grasa/diagnóstico por imagen , Necrosis Grasa/cirugía , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Enfermedades de la Vulva/diagnóstico por imagen , Enfermedades de la Vulva/cirugía , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia MagnéticaRESUMEN
A wide range of congenital or acquired conditions, some pretty rare, may affect the vulva and vagina in children. Swelling, visible or palpable masses and abnormal discharges are common symptoms of conditions affecting the vulva and/or the lower genital tract. The majority of these diseases are benign. Ultrasonography is pivotal to elucidate the anatomical origin of these conditions and make the diagnosis. Magnetic resonance imaging can be relevant to improve diagnostic confidence and, if needed, to plan more accurate surgical treatment. The aim of this pictorial essay is to review the related imaging findings to help make radiologists familiar with these conditions.
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Imagen por Resonancia Magnética/métodos , Ultrasonografía/métodos , Enfermedades Vaginales/diagnóstico por imagen , Enfermedades de la Vulva/diagnóstico por imagen , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién NacidoAsunto(s)
Drenaje/efectos adversos , Edema/etiología , Insuficiencia Pancreática Exocrina/cirugía , Trasplante de Órganos/efectos adversos , Insuficiencia Renal/cirugía , Enfermedades de la Vulva/diagnóstico , Edema/diagnóstico por imagen , Edema/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Enfermedades de la Vulva/diagnóstico por imagen , Enfermedades de la Vulva/patologíaAsunto(s)
Hernia Abdominal/cirugía , Perineo/patología , Enfermedades de la Vulva/diagnóstico por imagen , Femenino , Hernia Abdominal/diagnóstico , Humanos , Persona de Mediana Edad , Examen Físico/métodos , Tomografía de Emisión de Positrones/métodos , Mallas Quirúrgicas/efectos adversos , Resultado del Tratamiento , Enfermedades de la Vulva/patologíaAsunto(s)
Divertículo/diagnóstico por imagen , Hernia/diagnóstico por imagen , Trastornos del Suelo Pélvico/diagnóstico por imagen , Diástasis de la Sínfisis Pubiana/diagnóstico por imagen , Vejiga Urinaria/anomalías , Enfermedades de la Vulva/diagnóstico por imagen , Anciano de 80 o más Años , Divertículo/complicaciones , Femenino , Hernia/complicaciones , Herniorrafia , Humanos , Trastornos del Suelo Pélvico/complicaciones , Trastornos del Suelo Pélvico/cirugía , Radiografía , Tomografía Computarizada por Rayos X , Vejiga Urinaria/diagnóstico por imagen , Enfermedades de la Vulva/complicaciones , Enfermedades de la Vulva/cirugíaRESUMEN
Fibroepithelial stromal polyps are mesenchymal lesions occurring typically in reproductive age women with a predilection for the vulvo-vaginal region. Malignancy may mimic this polyp in morphology, rendering further investigations including detailed histopathology mandatory. Histologically its characteristic features are stellate and multinucleate stromal cells identified near the epithelial-stromal interface. This case report discusses incidental finding of largest fibroepithelial polyp presented in a 31-year-old nulliparous woman. She was initially admitted with sepsis and detailed physical examination revealed a right-sided infected pedunculated labial mass measuring 20×21 cm. After initial resuscitation for sepsis, she was further investigated for the mass. Transabdominal ultrasound was essentially normal apart from a small fibroid 3×2 cm in the anterior wall of the uterus. The vulval mass was removed under local and regional anaesthesia and was confirmed to be a giant fibroepithelial stromal polyp on histopathology. The woman recovered well and was followed up until 1 year.
Asunto(s)
Pólipos/diagnóstico por imagen , Sepsis/etiología , Enfermedades de la Vulva/diagnóstico por imagen , Adulto , Femenino , Humanos , Pólipos/patología , Pólipos/cirugía , Resultado del Tratamiento , Ultrasonografía , Enfermedades de la Vulva/patología , Enfermedades de la Vulva/cirugíaRESUMEN
The aim of the study was to verify the efficacy of vulvar Visnadine spray in premenopausal women affected by female sexual arousal disorder (FSAD). Thirty-eight women aged 25-40 years affected by FSAD were enrolled in the randomized crossover study, by two possible sequences: on-demand, washout, daily (A sequence); and daily, washout, on-demand (B sequence). The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess sexual function and sexual distress, respectively. Color Doppler ultrasonography was used to measure clitoral blood flow. The study had two follow-ups at 30 (T1) and 60 days (T2). Thirty-one women completed the study. Mean (SD) sexual activity and vulvar Visnadine spray usage was 1 ± 0.9 weekly during on-demand administration for both the sequences (Vs T0, p = NS). The mean sexual activity during daily usage was 2 ± 0.9 (Vs T0, p < .004) and 2 ± 0.8 (Vs T0, p < .001) for A and B sequences, respectively. FSFI total score, particularly genital arousal, improved more during the daily than during on-demand phases of both sequences (p < .001). Finally, clitoral blood flow improved significantly during daily usage of both the sequences (p < .001). Our study suggests that vulvar Visnadine spray could improve sexual performance of women affected by FSAD, producing changes in subjective and objective sexual aspects.
Asunto(s)
Cromanos/uso terapéutico , Disfunciones Sexuales Fisiológicas/prevención & control , Vagina/efectos de los fármacos , Enfermedades Vaginales/tratamiento farmacológico , Vasodilatadores/uso terapéutico , Vulva/efectos de los fármacos , Enfermedades de la Vulva/tratamiento farmacológico , Administración Cutánea , Administración a través de la Mucosa , Adulto , Aerosoles , Cromanos/administración & dosificación , Clítoris/irrigación sanguínea , Clítoris/efectos de los fármacos , Clítoris/fisiopatología , Clítoris/cirugía , Estudios Cruzados , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Pacientes Desistentes del Tratamiento , Escalas de Valoración Psiquiátrica , Flujo Sanguíneo Regional/efectos de los fármacos , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/psicología , Estrés Psicológico/etiología , Estrés Psicológico/prevención & control , Ultrasonografía Doppler en Color , Vagina/irrigación sanguínea , Vagina/metabolismo , Vagina/fisiopatología , Enfermedades Vaginales/diagnóstico por imagen , Enfermedades Vaginales/fisiopatología , Vasodilatadores/administración & dosificación , Vulva/irrigación sanguínea , Vulva/metabolismo , Vulva/fisiopatología , Enfermedades de la Vulva/diagnóstico por imagen , Enfermedades de la Vulva/fisiopatologíaRESUMEN
Vulval epidermal cysts are rare and infrequently described in literature. They present a difficult diagnostic dilemma and surgical challenges. They most commonly occur as a late complication of female genital mutilation (FGM) and manifest as a primary condition. We present a case of a large vulval epidermal inclusion cyst, lined by vulval squamous epithelium, in a woman with a background of FGM who was referred with suspected vulval cancer. We discuss the clinical presentation, MRI findings, surgical treatment and outcome.