Revised FIGO staging for carcinoma of the vulva

Hacker, Neville F.

doi:10.1016/j.ijgo.2009.02.011

Cited by 113 publications

(75 citation statements)

References 15 publications

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“…1,9 All ISCCs were keratinizing. Applying the recent International Federation of Gynecology and Obstetrics (FIGO) staging, most cases of ISCC were staged as FIGO I (n 5 31; IA, n 5 2; IB, n 5 29) and 1 as FIGO IIIb.…”

Section: Materials and Methods Tissue Specimensmentioning

confidence: 99%

Expression of Human Telomerase Reverse Transcriptase in Vulvar Intraepithelial Neoplasia and Squamous Cell Carcinoma: An Immunohistochemical Study With Survivin and p53

Wellenhofer¹,

Brustmann²

2012

Archives of Pathology &Amp; Laboratory Medicine

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N Context.-Human telomerase reverse transcriptase (hTERT), an enzyme that enables cells to overcome replicative senescence and to divide indefinitely, is overexpressed in many cancers and their precursor lesions.Objective.-To test whether hTERT expression is related to neoplastic progression and resistance to apoptosis in vulvar epithelia.Design.-Immunoexpression of hTERT was evaluated in 101 formalin-fixed, paraffin-embedded archival vulvar epithelia consisting of normal squamous vulvar epithelia (n = 25), lichen sclerosus (n = 10), high-grade classic vulvar intraepithelial neoplasia (n = 16), differentiated vulvar intraepithelial neoplasia (n = 18), and vulvar invasive keratinizing squamous cell carcinoma (n = 32) and related to survivin and p53 expression. Immunostaining for all factors was scored for moderate and strong intensities with regard to quantity to determine upregulation and overexpression (score 0, 0% immunoreactive cells; score 1+, ,5% immunoreactive cells; score 2+, 5% to 50% immunoreactive cells; score 3+, .50% immunoreactive cells). Score 3+ was considered as overexpression.Results.-Nuclear hTERT immunoexpression was closely related to survivin reactivity, increased from normal vulvar squamous epithelia to lichen sclerosus and to high-grade classic vulvar intraepithelial neoplasia, differentiated vulvar intraepithelial neoplasia, and invasive keratinizing squamous cell carcinoma (P , .001), and followed the morphologic distribution of atypical squamous epithelial cells. Overexpression of hTERT was comparable to that seen for p53 in invasive keratinizing squamous cell carcinoma (P = .62); significant differences were calculated for differentiated vulvar intraepithelial neoplasia (P = .003) and highgrade classic vulvar intraepithelial neoplasia (P = .001).Conclusion.-Human telomerase reverse transcriptase is upregulated in vulvar intraepithelial neoplasia and invasive keratinizing squamous cell carcinoma compared with nonneoplastic squamous epithelia of the vulva as an apparently early and preinvasive event in the neoplastic transformation, with development of cellular longevity and resistance to apoptosis by survivin activation as associated features, independent of the etiology of vulvar intraepithelial neoplasia.(Arch Pathol Lab Med. 2012;136:1359-1365; doi: 10.5858/arpa.2011-0440-OA) I nvasive squamous cell carcinoma (ISCC) is the most common type of all invasive vulvar cancers. Vulvar intraepithelial neoplasias (VINs) are precancerous changes, defined as proliferative intraepithelial squamous lesions that display abnormal growth, exhibiting lack of cellular maturation and crowding of cells. According to the grade of dysplasia, they are designated as VIN grade 1, 2, or 3. The vast majority of VIN lesions are considered grade 2 or 3, with a distinction between these 2 grades being highly subjective. Basaloid and warty (condylomatous) or classic subtypes of VIN are associated with relatively younger women, and evidence of human papillomavirus (HPV) nucleic acids. A third, ''differentiated'' su...

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Section: Materials and Methods Tissue Specimensmentioning

confidence: 99%

Expression of Human Telomerase Reverse Transcriptase in Vulvar Intraepithelial Neoplasia and Squamous Cell Carcinoma: An Immunohistochemical Study With Survivin and p53

Wellenhofer¹,

Brustmann²

2012

Archives of Pathology &Amp; Laboratory Medicine

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“…Moreover, the number and morphology (size and extracapsular spread) of positive lymph nodes have been taken into account because they have been shown to be important prognostic factors, whereas the bilaterality of positive nodes have been discounted due to controversy from previous studies. 6 After the establishment of the 1988 FIGO criteria for carcinoma of the corpus uteri, uterine sarcomas including leiomyosarcoma, endometrial stromal sarcoma (ESS), adenosarcoma and carcinosarcoma, were classified according to the FIGO criteria for carcinoma of the corpus uteri because of their relative rarity. However, this old classification is no longer sufficient because more information on uterine sarcomas has become available and this justified the independent staging.…”

mentioning

confidence: 99%

International Federation of Gynecology and Obstetrics (FIGO) staging system revised: what should be considered critically for gynecologic cancer?

Kim

Song

2009

J Gynecol Oncol

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The International Federation of Gynecology and Obstetrics (FIGO), the first organization to develop a staging system of gynecologic cancer, became the official patron of the Annual Report for the development and changes of gynecologic cancer classification and staging since 1958.1 Thereafter, FIGO staging system has been structured to represent major prognostic factors in predicting patients' outcomes and lending order to the complex dynamic behavior of gynecologic cancers. The purpose of the FIGO staging system is to offer a classification of the extent of gynecologic cancer in order to provide a method of conveying one's clinical experience to others for the comparison of treatment methods without ambiguity. To achieve this objective, FIGO staging systems have been updated several times according to the latest available data over the past decades, thus implying that the FIGO staging system is responsive and adaptive to scientific development. Recently, the revised FIGO staging system for carcinoma of the vulva, cervix, endometrium, and uterine sarcomas was approved by the members of FIGO Executive Board in early September 2008. 2,3 Thus, we must become accustomed to the new staging system, and apply it in future clinical settings from now on. For revising the FIGO staging system for carcinoma of the cervix, the 2 major issues, surgical staging and lymph node involvement, have been considered because clinical staging is less accurate than surgical staging, despite significant advances in imaging techniques. Also, lymph node involvement is known to be a poor prognostic factor regardless of the disease extent. The FIGO Committee on Gynecologic Oncology decided that clinical staging should be continued, while lymph nodal assessment during staging is not necessary because surgical staging cannot be employed worldwide, especially in low-resource countries. Thus, the above two changes have been approved in the new staging system as follows. First, the subdivision of the tumor size (with a 4 cm cut-off in maximum diameter) has been applied for previous stage IIA, while the subdivision regarding the tumor size, and uni-or bilateral parametrial invasion has not been considered in previous stages IIB-IIIB, because of few available data and identity of treatment. Second, the previous stage 0 has been deleted from the new clinical staging system because it is a pre-invasive lesion. 4 In the revised FIGO staging system for carcinoma of the endometrium, there are 4 major changes, which are as follows. First, the previous stages IA and IB have been combined as stage IA because there was no significant difference in a 5-year survival among previous stage IA G1, IB G1, IA G2 and IB G2, as stated in volumes 23 to 26 of the FIGO annual report. Moreover, stage IB is now equal to or greater than the outer one-half of the myometrium. Second, stage II no longer has a subset A and B, and involvement of the endocervical gland of the cervix is now considered stage I. Third, pelvic and paraaortic lymph node involvement in previous stage ...

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“…Even large tumours have an excellent prognosis if the lymph node status is negative. 2 In the previous staging, this led to the prognosis of patients with Stage I and Stage II disease being similar. In this sense, the staging system had to be improved in order to have a more accurate prediction of outcome.…”

Section: Discussionmentioning

confidence: 97%