RESUMEN
ANTECEDENTES Memorando N°000179-2023-EF-NEUMO/INEN emitido por la jefa del departamento de Patología del Instituto Nacional de Enfermedades Neoplásicas (INEN) al jefe de la Unidad Funcional de Tecnologías Sanitarias (UFETS), donde se solicita la evaluación del "ESCÁNER DIGITAL Y USO DE INTELIGENCIA ARTIFICIAL EN CITOLOGÍA CERVICOVAGINAL", con la finalidad de valorar su empleo en el INEN. La citología cérvico-vaginal digital implica sustituir el microscopio convencional por una serie de tecnologías como: un sistema de visualización (monitor con resolución adecuada), un escáner (sirve para digitalizar las imágenes), un sistema de almacenamiento (para gestionar la información guardada) y un software (algoritmo de inteligencia artificial). Este procedimiento digital toma 3 minutos para su procesamiento. Estos dispositivos se encargarán de separar las láminas con muestra positivas de las negativas, las primeras pasarán por citopatología y las segundas pasarán por un control de calidad. TECNOLOGÍA: El cáncer de cuello uterino ocupa el cuarto lugar de mortalidad en mujeres a nivel mundial y el segundo, en el Perú. Para el año 2020 se reportaron 4,270 nuevos casos, correspondientes al 11.5% total de casos diagnosticados de cáncer.1 La citología cervical se utiliza desde hace décadas como método de detección del cáncer de cuello uterino. Se realiza mediante la observación microscópica de la morfología de las células cervicales por parte de los citopatólogos2 . El proceso para realizar esta citología convencional consiste, primero, en tomar muestras cérvico-vaginales, conservarlas, embalar, transportar y remitirlas; asimismo realizar la coloración mediante la técnica de Papanicolaou para posteriormente, realizar el diagnóstico. Esta técnica se complementa con el sistema Bethesda, el cual es útil para que el personal médico y técnico pueda interpretar e informar los resultados de citología cervical3 . Esta técnica manual de lectura de citología convencional, análisis microscópico y validación de resultados realizados por un citopatólogo, toma un tiempo aproximado de 20 minutos según lo indicado por el área solicitante. Estudios recientes demuestran que la sensibilidad para la detección de lesiones cervicales varía del 44-86%, mientras la especificidad se sitúa alrededor del 98%. En el presente documento se analizará este nuevo sistema de citología asistido por Inteligencia artificial y los costos para implementarlo, además el impacto económico que tendrá con respecto al procedimiento manual existente (lectura de citología convencional y análisis microscópico). METODOLOGÍA: Para encontrar la mayor cantidad de evidencia científica disponible sobre el tema de la solicitud se siguió el siguiente procedimiento: Primero, se formuló la estrategia TICO siguiendo los lineamientos de "Adopting Hospital based Health Technology Assessment". Segundo, se realizó una búsqueda sistemática de la información tanto en Medline (A través de Pubmed), a fin de identificar artículos relevantes para el análisis. Tercero, se realizó un análisis de los abstracts de la evidencia recolectada y se decidió que estudios serían integrados para establecer el análisis de evidencia que finalmente sería descrito en los siguientes apartados. ANÁLISIS DE ESCENARIOS: Se calculó para el presente análisis, el costo medio por el nuevo dispositivo y su comparador, además se añadió el costo incremental que es la diferencia entre los costes medios de cada uno y la ratio de costos que es el cociente entre el coste medio de la tecnología nueva y la actual. En este apartado, realizaremos un análisis costo-beneficio a partir de la comparación de los costos totales por año de cada escenario y que nos servirá para determinar el impacto económico; es decir, nos indicará si habría un ahorro o gasto por la adquisición y uso de la nueva tecnología. CONCLUSIONES: El cáncer de cuello uterino es una de las neoplasias más frecuentes en nuestro país, por lo cual un sistema de tamizaje es importante para la detección temprana de esta neoplasia. El escáner digital asistido por inteligencia artificial es una intervención utilizada en los últimos años para el tamizaje del cáncer de cérvix. Se realizó una búsqueda sistemática en MEDLINE con el fin de evaluar la intervención descrita con la Lectura manual a través de un anatomopatólogo. Un estudio prospectivo reportó que el sistema de citología asistido por IA puede excluir la mayor parte de la citología normal, y mejorar la sensibilidad con una especificidad clínicamente equivalente para la detección de lesiones tipo NIC2 o de mayor grado, en comparación con la lectura de citología manual (Nivel de evidencia alta según GRADE). Mientras que un estudio retrospectivo determinó que la lectura asistida por IA tuvo una sensibilidad equivalente y especificidad mayor que los citólogos expertos; y mayor sensibilidad y especificidad que los médicos citológicos. En mujeres con PVH positivo, la lectura asistida por IA mejoró la especificidad para NIC1 o menos, sin reducir la sensibilidad en comparación con la lectura manual (Nivel de evidencia baja según el sistema GRADE). El costo total anual para realizar una lectura y análisis de resultados con el procedimiento nuevo (uso de escáner e IA) es un estimado de S/ 553,234.88. El costo total anual para realizar una lectura y análisis de resultados con el procedimiento actual (análisis microscópico y lectura de citología convencional) sería S/ 203,418.26. El impacto económico por la diferencia de costos entre el nuevo procedimiento que incorpora la nueva tecnología y el actual procedimiento manual se calculó en S/ 349,816.62 aproximadamente, por lo cual se requeriría de un análisis de impacto presupuestal.
Asunto(s)
Humanos , Femenino , Vagina/citología , Neoplasias Vaginales/prevención & control , Inteligencia Artificial , Neoplasias del Cuello Uterino/prevención & control , Cuello del Útero/citología , Equipos y Suministros , Evaluación en Salud/economía , Análisis Costo-Beneficio/economíaRESUMEN
The present document includes consensus-based recommendations from the Brachytherapy Group (GEB) of the Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM) for interstitial high-dose-rate (HDR) brachytherapy (BT) for gynaecologic malignancies. A nine-item survey-which included questions on experience with interstitial BT; indications and technique; applicator type; magnetic resonance imaging (MRI)-based planning; dose; fractionation schedule; and treatment planning-was sent to all radiation oncology departments (n = 174) in Spain in 2021. Responses were received from 36 centres (50% of all centres [n = 72] with a BT unit). The consensus-based recommendations presented here are based on a review of the available literature, professional experience among the group of experts, and in-person discussions held during the annual meeting of these two societies. We describe the results of the survey and the following: indications; contraindications; patient selection; description of applicators; role of imaging in planning; contouring; dose prescription; dosimetric reconstruction; optimisation; and dose indications for cancers of the cervix, vagina, and vulva. The various clinical scenarios in which interstitial BT is used in the treatment of gynaecological tumours are described in detail, including cervix intracavitary/interstitial hybrid HDR-BT; cervix perineal templates/freehand implants; primary vaginal malignancies/vaginal recurrences; and vulvar interstitial implants.
Asunto(s)
Braquiterapia , Neoplasias de los Genitales Femeninos , Oncología por Radiación , Neoplasias del Cuello Uterino , Neoplasias Vaginales , Femenino , Humanos , Neoplasias de los Genitales Femeninos/radioterapia , Braquiterapia/métodos , Dosificación Radioterapéutica , Física , Planificación de la Radioterapia Asistida por Computador/métodosRESUMEN
Freehand needles can be used with multichannel vaginal cylinders (MCVC) to cover vaginal cancer >7 mm thick or with supra-vaginal extension. We report our institutional outcomes using this novel hybrid technique. Patients with vaginal malignancies treated with HDR BT using MCVC plus freehand needles from 2014-2021 at our institution were identified. Clinical characteristics, details of brachytherapy, initial response, and overall local control (LC) outcomes were recorded. LC was analyzed via Kaplan-Meier method. 34 patients were identified with median follow-up 1.9 years. 19 patients had primary endometrial cancer with vaginal recurrence/disease, and remaining had primary vaginal cancer or other primaries. 7 patients had recurrence after previous RT course. 25 patients received EBRT with median dose 45 Gy in 25 fractions, and rest received BT alone. Median HR-CTV D90 for patients treated with EBRT plus BT was 77.4 Gy. 30 patients had complete local response to BT on initial examination and/or follow-up imaging. 1 and 2-year LC rates in patients without prior RT treated with EBRT + BT were 94.1% and 94.1%, respectively. 1 and 2-year LC rates for those without prior RT were 88.1% and 76.4%, respectively. 1 and 2-year LC rates for those with prior RT were 68.6% and 34.3%, respectively. 1 patient had vaginal laceration requiring surgical repair, and 1 patient developed small bowel obstruction 1 month after BT, with no additional acute grade 3+ toxicities identified. Our approach with MCVC plus freehand needles with MRI-based planning was feasible and safe, with excellent initial local response and low rate of serious toxicities.
Asunto(s)
Braquiterapia , Neoplasias Vaginales , Femenino , Humanos , Neoplasias Vaginales/diagnóstico por imagen , Neoplasias Vaginales/radioterapia , Braquiterapia/métodos , Dosificación Radioterapéutica , Agujas , Imagen por Resonancia MagnéticaRESUMEN
Vaginal cancer often poses a challenge for clinical and radiological diagnosis, and its risk factors, progression, and treatment are still poorly established. Although vaginal malignancies are rare, even globally, their rates have increased due to the increased access to healthcare and the evolution of screening measures and diagnostic methods. Because the vaginal cavity is a virtual space, it can harbor lesions that often go unnoticed and, not infrequently, diagnosed belatedly. MRI and, more recently, PET/CT are part of the imaging armamentarium that have already been incorporated into the clinical staging and management of gynecological tumors, allowing excellent morphological characterization of the lesion, its topography and relationship with adjacent structures for the investigation of disease dissemination, overcoming limitations of clinical methods, such as speculum examination, usually restricted to observation only of the superficial characteristics of these lesions. Some vaginal neoplasms have characteristic MRI patterns, which, combined with expert knowledge of anatomy, allow identification of local macroscopic details (such as the mucosal, submucosal, and muscle layers). Furthermore, the application of PET/CT, already well established for identifying systemic disease, has a large impact on patient prognosis. The objective of this work is to review the epidemiological aspects of primary vaginal cancers and the imaging patterns of their main histological subtypes based on MRI and PET/CT, with a brief discussion of the local anatomy, oncological staging, and treatment.
Asunto(s)
Neoplasias Vaginales , Femenino , Fluorodesoxiglucosa F18 , Humanos , Imagen por Resonancia Magnética/métodos , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tomografía de Emisión de Positrones/métodos , Pronóstico , Neoplasias Vaginales/diagnóstico por imagenRESUMEN
PURPOSE: To explore the underlying risk factors and to prevent misdiagnosis of cervical intraepithelial neoplasia (CIN) coexisted with vaginal intraepithelial neoplasia (VaIN). METHODS: Clinical data of patients pathologically diagnosed with CIN were collected from January 2017 to December 2018. A total of 446 cases were analyzed, including 406 cases of single lesions ('CIN single' group) and 40 cases complicated with VAIN ('VAIN concurrent' group). RESULTS: The median age of the VAIN concurrent group was 53 years (46.25-59 years), and the median age of the CIN single group was 44 years (36-50 years). Regarding menopausal status, there were 28 cases (70.0%) in the VAIN concurrent group and 89 cases (21.9%) in the CIN single group (P < 0.005). The median load of high-risk human papillomavirus (Hr-HPV) in the VAIN concurrent and CIN single group was 923.4 relative light units/cutoff (RLU/CO) (145-2172.2 RLU/CO) and 229.155 RLU/CO (18.615-638.1275 RLU/CO), respectively (P = 0.037). The results revealed that the menopausal status was an independent risk factor for VAIN occurrence in CIN patients. The risk of VAIN in menopausal patients was higher than that in non-menopausal CIN patients (OR = 8.311, 95% CI 4.062-17.005). Age and HPV load were also related to the concurrence of VAIN and CIN. CONCLUSION: Examinations regarding vaginal screening are of great importance in the diagnosis of perimenopausal and postmenopausal CIN patients, especially patients with Hr-HPV load. Colposcopy and tissue biopsy should also be performed, when necessary, to avoid misdiagnosis and the appearance of vaginal lesions.
Asunto(s)
Carcinoma in Situ , Infecciones por Papillomavirus , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Neoplasias Vaginales , Adulto , Carcinoma in Situ/epidemiología , Colposcopía , Femenino , Humanos , Persona de Mediana Edad , Infecciones por Papillomavirus/complicaciones , Embarazo , Neoplasias del Cuello Uterino/patología , Neoplasias Vaginales/complicaciones , Displasia del Cuello del Útero/patologíaRESUMEN
BACKGROUND: Leiomyoma of the vulva is rare, accounting for only 0.03% of all gynecological tumors, and it is seldom seen in teenagers. CASE: We describe a case of vulvar leiomyoma in a 14-year-old girl who presented a 10 × 10 cm solid tumor in the right hemivulva without other complaints. SUMMARY AND CONCLUSION: Differential diagnosis includes Bartholin cysts, abscesses, fibromas, and other solid lesions. Although rare, vaginal leiomyoma must be remembered and included as a differential diagnosis for solid lesions in the vagina.
Asunto(s)
Glándulas Vestibulares Mayores , Leiomioma , Neoplasias Vaginales , Neoplasias de la Vulva , Adolescente , Glándulas Vestibulares Mayores/patología , Diagnóstico Diferencial , Femenino , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Neoplasias Vaginales/diagnóstico , Vulva/patología , Neoplasias de la Vulva/diagnóstico , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/cirugíaRESUMEN
Las neoplasias ginecológicas en niñas son raras. Representan menos del 5 % de todos los cánceres en pediatría. No existen estadísticas sobre la incidencia de tumores de vagina en esta etapa de la vida. Se presenta el caso de una niña de 9 meses con sangrado por genitales. La ecografía evidencia una masa sólida en vagina, y la vaginoscopia, un tumor friable. Presenta valores de α-fetoproteína elevados, por lo que se diagnostica tumor de saco vitelino, confirmado por biopsia. Se realiza tratamiento quimioterápico. A menos de 1 año del diagnóstico, se encuentra en remisión completa. Este caso resulta de interés no solo por la rareza, sino también porque el diagnóstico rápido de tumor de saco vitelino permite mejorar los resultados y la sobrevida de las pacientes
Gynecological neoplasms in girls are rare and represent only less than 5 % of all childhood tumors. There are no statistics on the incidence of vaginal tumors at this stage in life. We present a 9-month-old girl evaluated for genital bleeding. Ultrasound reveals a vaginal solid mass and vaginoscopy reports a friable tumor. AFP is elevated. A yolk sac tumor is confirmed by biopsy she receives chemotherapy. Within a year after diagnosis, she remains tumor-free. This is a case of interest, not only because of its rarity, but also because a rapid diagnosis of a yolk sac tumor improves outcomes and patient's survival rates.
Asunto(s)
Humanos , Femenino , Lactante , Neoplasias Vaginales/diagnóstico , Tumor del Seno Endodérmico/diagnóstico , Ultrasonografía , HemorragiaRESUMEN
Gynecological neoplasms in girls are rare and represent only less than 5 % of all childhood tumors. There are no statistics on the incidence of vaginal tumors at this stage in life. We present a 9-month-old girl evaluated for genital bleeding. Ultrasound reveals a vaginal solid mass and vaginoscopy reports a friable tumor. AFP is elevated. A yolk sac tumor is confirmed by biopsy she receives chemotherapy. Within a year after diagnosis, she remains tumor-free. This is a case of interest, not only because of its rarity, but also because a rapid diagnosis of a yolk sac tumor improves outcomes and patient's survival rates.
Las neoplasias ginecológicas en niñas son raras. Representan menos del 5 % de todos los cánceres en pediatría. No existen estadísticas sobre la incidencia de tumores de vagina en esta etapa de la vida. Se presenta el caso de una niña de 9 meses con sangrado por genitales. La ecografía evidencia una masa sólida en vagina, y la vaginoscopia, un tumor friable. Presenta valores de α-fetoproteína elevados, por lo que se diagnostica tumor de saco vitelino, confirmado por biopsia. Se realiza tratamiento quimioterápico. A menos de 1 año del diagnóstico, se encuentra en remisión completa. Este caso resulta de interés no solo por la rareza, sino también porque el diagnóstico rápido de tumor de saco vitelino permite mejorar los resultados y la sobrevida de las pacientes.
Asunto(s)
Tumor del Seno Endodérmico , Neoplasias Vaginales , Niño , Tumor del Seno Endodérmico/diagnóstico , Femenino , Hemorragia , Humanos , Lactante , Ultrasonografía , Neoplasias Vaginales/diagnósticoRESUMEN
Bilateral diffuse uveal melanocytic proliferation (B-DUMP) is a rare paraneoplastic syndrome typically presenting with bilateral visual loss. B-DUMP is associated with extraocular systemic malignancies with the most common being lung cancer in males and uro-gynaecological cancer in females (mainly ovarian cancer). Cutaneous and/or mucosal involvement in patients with B-DUMP has been reported but it is not well characterised. Herein, we present a female in her 70s with diagnosis of stage IV vaginal clear-cell carcinoma and metastatic melanoma of unknown primary that developed progressive bilateral loss of visual acuity compatible with 'B-DUMP'. Simultaneously, she developed multifocal bilateral bluish-greyish patches on the skin that were shown to have a proliferation of dermal melanocytes. We propose that the clinical and histopathologic cutaneous findings seen in patients with B-DUMP be termed 'diffuse integumentary melanocytic proliferation (DIMP)'.
Asunto(s)
Adenocarcinoma de Células Claras/patología , Síndromes Paraneoplásicos Oculares/patología , Úvea/patología , Neoplasias Vaginales/patología , Adenocarcinoma de Células Claras/complicaciones , Anciano , Femenino , Humanos , Síndromes Paraneoplásicos Oculares/complicaciones , Neoplasias Vaginales/complicacionesRESUMEN
OBJECTIVE: Uterine transposition has emerged as an alternative for fertility preservation in women with pelvic malignancies that require radiotherapy. The goal of this study was to evaluate the short-term outcomes of patients undergoing uterine transposition after trachelectomy for cervical cancer or before chemoradiation for vaginal cancer. METHODS: We retrospectively evaluated patients with early stage cervical cancer after radical trachelectomy or with vaginal cancer with indication for pelvic radiation who had uterine transposition performed as fertility sparing strategy. RESULTS: Four patients with cervical cancer and one patient with vaginal cancer were included. Median age was 32 years (range 28-38). All patients had squamous cell carcinomas. All patients with cervical cancer had radical trachelectomies with sentinel lymph node dissection (SLN). Two of these patients also had pelvic lymphadenectomies. Indications for adjuvant radiotherapy was due to Sedlis criteria in two patients and to lymph node metastasis in the other two patients. The patient with stage IIB vaginal cancer was recommended primary chemoradiation. All patients underwent uterine transposition before radiotherapy. The median uterine transposition surgical time was 90 min (range 80-205) and no early complications (30 days) occurred. Average time from uterine transposition to start of radiotherapy was 16 days (10-28). After radiation, the uterus along with the ovaries and tubes were repositioned and the residual cervix sutured to the vagina. One patient declined uterine reimplantation after radiation and underwent a hysterectomy. After a median follow-up of 25 months (range 1-30), all patients were without evidence of disease. All patients with preserved uterus have normal menses after treatment. One patient has attempted to conceive with IVF techniques without success. CONCLUSIONS: Uterine transposition may be an option in selected patients with cervical and vaginal cancers who want to preserve fertility. However, further studies that address its oncological safety and obstetrical outcomes are encouraged.
Asunto(s)
Preservación de la Fertilidad/métodos , Neoplasias del Cuello Uterino/radioterapia , Útero/cirugía , Adulto , Carcinoma de Células Escamosas , Femenino , Humanos , Tempo Operativo , Estudios Retrospectivos , Neoplasias del Cuello Uterino/cirugía , Útero/patología , Neoplasias Vaginales/radioterapiaAsunto(s)
Colposcopía/métodos , Preservación de la Fertilidad/métodos , Leiomiosarcoma/cirugía , Neoplasias Vaginales/cirugía , Adulto , Femenino , Humanos , Leiomiosarcoma/diagnóstico por imagen , Leiomiosarcoma/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias Vaginales/diagnóstico por imagen , Neoplasias Vaginales/patologíaRESUMEN
Background: Lipomas are defined as a soft mass of well-differentiated adipose cells among mesenchymal tumors. Considering the localization of lipomas, these masses are commonly seen in subcutaneous tissue. The female reproductive tract is a rare site for development of lipomas and clinical findings appear depending on the size and localization. The connection of the mass with the vagina lumen causes different clinical findings. Intraluminal tumors protrude and arise from the vulva, while extraluminal tumors lead to perineal swelling. This case describes clinical, ultrasonographic, histological examination, and surgical management of extraluminal vaginal lipoma. Case: The present study reports a case of extraluminal vaginal lipoma in a 10-year-old Pitbull crossbred presented with anamnesis of a protruded tissue from the vulvar lips and dysuria following 6-month swelling in the perineum. Clinical examination revealed that the swelling was obvious and localized mostly on the lower left side of the perineum and the vaginal mucosa was protruded from the vulvar lips due to a mass. By vaginal palpation, the mass was not associated with the vaginal mucosa. The mass was located in the perivaginal region and transvaginal ultrasonography revealed a hypoechogenic mass. Based on clinical and ultrasonographic findings, surgery was recommended. The mass was adherent to the serosa of the vagina and it did not enclose the vaginal mucosa. Excision of mass was performed with careful blunt dissection avoiding any urethral disruption and periurethral tissues. After the mass was determined to be extraluminal, there was no need for excision of the vaginal tissue with the mass during operation. Using histopathological examination the mass was identified as a lipoma composed of adipocytes. In addition, ovariohysterectomy was not recommended following the diagnosis of vaginal lipoma. Discussion: Lipomas uncommonly can be localized in...(AU)
Asunto(s)
Animales , Femenino , Perros , Lipoma/diagnóstico por imagen , Lipoma/veterinaria , Neoplasias Vaginales/diagnóstico por imagen , Neoplasias Vaginales/veterinaria , VaginaRESUMEN
Vulvar and vaginal cancers are relatively rare cancers, together responsible for less than 1% of the global cancer incidence among women in 2018. The majority of vaginal cancers and a lesser proportion of vulvar cancers are associated with HPV, with rising incidence rates of vulvar cancer observed in younger women, possibly due to an increased prevalence of high-risk HPV types. This report assesses recent international variations in the incidence rates of vulvar and vaginal cancer derived from high-quality data from population-based cancer registries in 68 countries, and further assesses time trends for selected longer-term series in eight countries (Australia, China, Colombia, India, Norway, Slovakia, the U.S., and the U.K.) over the period 1983 to 2012. We observed a 30-fold variation in the recorded incidence rates of vulvar cancer in contrast with the threefold variation for vaginal cancer. We also observed a rising incidence of vulvar cancer in Australia, Norway and the U.K., and Slovakia, with a more rapid rise in the rates seen in women aged < 60 years at diagnosis. The annual percentage change over the most recent decade varied from 1.7% in Norway to 4.1% in Slovakia. The increases are largely confined to younger women and are likely linked to generational changes in sexual behaviour (earlier age at sexual debut and increasing transmission of HPV among cohorts born 1940 to 1950 and thereafter. Vaginal cancer incidence rates, in contrast, were lower and more stable, despite the higher HPV-attributable fraction relative to vulvar cancer. Irrespective of the trends, an increasing number of women are predicted to be diagnosed worldwide with both cancer types in future decades as population ageing and growth continues. The promise of high-coverage HPV vaccination will likely counter this rising burden, but the impact may take a number of decades.
Asunto(s)
Infecciones por Papillomavirus/epidemiología , Neoplasias Vaginales/epidemiología , Neoplasias de la Vulva/epidemiología , Salud de la Mujer/tendencias , Adulto , Factores de Edad , Anciano , Australia/epidemiología , China/epidemiología , Colombia/epidemiología , Femenino , Salud Global/tendencias , Humanos , Incidencia , India/epidemiología , Persona de Mediana Edad , Noruega/epidemiología , Infecciones por Papillomavirus/complicaciones , Sistema de Registros , Eslovaquia/epidemiología , Reino Unido/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. METHODS: Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3 months, 1 year, and 2 years after RT. Imaging studies were assessed for pelvic fractures for up to 5 years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. RESULTS: The median age at diagnosis was 51 years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3 years, respectively. Fractures were associated with baseline osteoporosis (P < .001), higher baseline bone-specific alkaline phosphatase (P < .001), and older age (P = .007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3 months, 1 year, and 2 years, respectively. CONCLUSIONS: A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.
Asunto(s)
Densidad Ósea , Fracturas Óseas/epidemiología , Neoplasias de los Genitales Femeninos/radioterapia , Huesos Pélvicos/lesiones , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia/efectos adversos , Neoplasias Endometriales/radioterapia , Femenino , Humanos , Persona de Mediana Edad , Osteoporosis/complicaciones , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Radioterapia de Intensidad Modulada/efectos adversos , Neoplasias del Cuello Uterino/radioterapia , Neoplasias Vaginales/radioterapia , Adulto JovenRESUMEN
Background: Lipomas are defined as a soft mass of well-differentiated adipose cells among mesenchymal tumors. Considering the localization of lipomas, these masses are commonly seen in subcutaneous tissue. The female reproductive tract is a rare site for development of lipomas and clinical findings appear depending on the size and localization. The connection of the mass with the vagina lumen causes different clinical findings. Intraluminal tumors protrude and arise from the vulva, while extraluminal tumors lead to perineal swelling. This case describes clinical, ultrasonographic, histological examination, and surgical management of extraluminal vaginal lipoma. Case: The present study reports a case of extraluminal vaginal lipoma in a 10-year-old Pitbull crossbred presented with anamnesis of a protruded tissue from the vulvar lips and dysuria following 6-month swelling in the perineum. Clinical examination revealed that the swelling was obvious and localized mostly on the lower left side of the perineum and the vaginal mucosa was protruded from the vulvar lips due to a mass. By vaginal palpation, the mass was not associated with the vaginal mucosa. The mass was located in the perivaginal region and transvaginal ultrasonography revealed a hypoechogenic mass. Based on clinical and ultrasonographic findings, surgery was recommended. The mass was adherent to the serosa of the vagina and it did not enclose the vaginal mucosa. Excision of mass was performed with careful blunt dissection avoiding any urethral disruption and periurethral tissues. After the mass was determined to be extraluminal, there was no need for excision of the vaginal tissue with the mass during operation. Using histopathological examination the mass was identified as a lipoma composed of adipocytes. In addition, ovariohysterectomy was not recommended following the diagnosis of vaginal lipoma. Discussion: Lipomas uncommonly can be localized in...
Asunto(s)
Femenino , Animales , Perros , Lipoma/diagnóstico por imagen , Lipoma/veterinaria , Neoplasias Vaginales/diagnóstico por imagen , Neoplasias Vaginales/veterinaria , VaginaRESUMEN
INTRODUCTION: The aim is to assess the outcome of patients treated for vaginal carcinoma with radiation therapy in terms of long-term tolerance and survival. MATERIALS AND METHODS: This single-center retrospective study included patients with squamous cell carcinoma of the vagina treated with pelvic external beam radiation therapy (EBRT) with or without vaginal brachytherapy (VB) between 1990 and 2013. RESULTS: Thirty-seven patients were included with stage I (24%), II (60%), III (8%), or IV (8%) vaginal tumors. Median age was 66 years (range 27-86 years). Median tumor size was 4 cm (range 0.7-12 cm). Seven patients underwent first intention surgery. The 37 patients received pelvic EBRT (45 Gy) with inguinal irradiation in 57% of cases. Fifteen (41%) received concurrent chemotherapy. Low-dose supplemental VB was performed in 31 patients (84%) (median dose: 20 Gy). Median follow-up was 59 months (range 7-322 months). Four patients (11%) had late grade 3-4 complications. Relapse occurred in 11 patients (30%), five of them locally. The 5-year relapse-free and cancer-specific survival rates were 68% and 76%, respectively. Surgery and concurrent chemotherapy did not seem to have an impact on the course of the disease. CONCLUSION: In our experience, pelvic EBRT leads to prolonged survival with acceptable long-term toxicity in patients with squamous cell carcinoma of the vagina.
Asunto(s)
Carcinoma de Células Escamosas/radioterapia , Neoplasias Vaginales/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Braquiterapia/métodos , Braquiterapia/estadística & datos numéricos , Instituciones Oncológicas , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Histerectomía/estadística & datos numéricos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Traumatismos por Radiación/etiología , Dosificación Radioterapéutica , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Carga Tumoral , Neoplasias Vaginales/mortalidad , Neoplasias Vaginales/patologíaRESUMEN
Melanoma is an alteration of melanocytes, cells responsible for skin pigmentation, which allows for unregulated growth, although there is no confirmation about predispositions to this pathology, skin species and white hairs are considered most affected, being especially common in Tordilla colored horses. Although there is a benign form, the case can develop becoming malignant and metastatic in an unpredictable way, and may suffer influence with the advancing age of the horse, with great chances of the tumor becoming aggressive, having high mortality rates, because there is still no effective treatment to combat nodule growth. The aim of the present study was to report a case of melanoma in an equine, female, gray coat, Mangalarga Marchador breed, belonging to Fazenda Escola, Faculty of Nursing Nova Esperança, as well as it possible implications for the reproductive system. In the clinical examination, nodular skin lesions were observed, with firm and painless consistency, located in the regions of the vulva, large lips, oral vestibular of the upper lip and, with the use of vaginoscopy, it was also possible to observe nodules in the vaginal vestibule. Based on these clinical findings, the presumptive diagnosis was melanoma. For a better prognosis, early identification is essential, considering that the later it is done, the greater the possibility of metastasis, reaching subcutaneous regions, cavities and internal organs, compromising physiological functions and being responsible to vaginal obstructions, injuries and decreased fertility, causing great damage to equine reproduction.
Asunto(s)
Femenino , Animales , Neoplasias Vaginales/diagnóstico por imagen , Neoplasias Vaginales/prevención & control , Neoplasias Vaginales/veterinariaRESUMEN
Melanoma is an alteration of melanocytes, cells responsible for skin pigmentation, which allows for unregulated growth, although there is no confirmation about predispositions to this pathology, skin species and white hairs are considered most affected, being especially common in Tordilla colored horses. Although there is a benign form, the case can develop becoming malignant and metastatic in an unpredictable way, and may suffer influence with the advancing age of the horse, with great chances of the tumor becoming aggressive, having high mortality rates, because there is still no effective treatment to combat nodule growth. The aim of the present study was to report a case of melanoma in an equine, female, gray coat, Mangalarga Marchador breed, belonging to Fazenda Escola, Faculty of Nursing Nova Esperança, as well as it possible implications for the reproductive system. In the clinical examination, nodular skin lesions were observed, with firm and painless consistency, located in the regions of the vulva, large lips, oral vestibular of the upper lip and, with the use of vaginoscopy, it was also possible to observe nodules in the vaginal vestibule. Based on these clinical findings, the presumptive diagnosis was melanoma. For a better prognosis, early identification is essential, considering that the later it is done, the greater the possibility of metastasis, reaching subcutaneous regions, cavities and internal organs, compromising physiological functions and being responsible to vaginal obstructions, injuries and decreased fertility, causing great damage to equine reproduction.(AU)