Treatment of Recurrent Carcinoma in Situ in the Lower Genital Canal

Woodruff, J.D.

doi:10.1097/00003081-196509000-00016

Cited by 23 publications

(9 citation statements)

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“…Although uncommon, dysplastic abnormalities of the vaginal epithelium after hysterectomy demand careful assessment and management. There are three possible explanations for the pathogenesis of the condition (Woodruff 1965): (i) Residual disease indicating inadequate excision of the original lesion. (ii) Multicentre focus of origin.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have produced data which support a multicentric origin of dysplastic disease of the cervix, vagina and vulva (Ferguson & Maclure 1963;Woodruff 1965;Hummer et al 1970;Hammond & Monaghan 1983). Wade-Evans (1976) stated 'a histologically and cytologically normal epithelium at the edge of a demonstrably dysplastic area already carries within it seeds of further malignancy .…”

Section: Discussionmentioning

confidence: 99%

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The management of the patient with abnormal vaginal cytology following hysterectomy

Ireland¹,

Monaghan²

1988

BJOG

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Summary. Thirty‐two patients presenting with abnormal vaginal cytology following hysterectomy were studied. Seven (21·8%) had had hysterectomy for benign conditions whilst 25 (78·1%) had cervical intraepithelial neoplasia (CIN) or invasive cervical carcinoma. Twenty‐five patients had partial or total vaginectomy (15 as the primary procedure), and one required laser treatment following vaginectomy. Of 11 (34·3%) patients treated primarily by laser, five subsequently required vaginectomy because of persistent or recurrent cytological abnormality. All four patients treated with topical 5‐fluorouracil or dinitrochlorobenzene subsequently required surgery. Nine of the 32 patients (28·1%) proved to have invasive carcinoma of the vagina on histological examination of the vaginectomy specimen. At the time of writing all patients in the study are well with no evidence of disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The management of the patient with abnormal vaginal cytology following hysterectomy

Ireland¹,

Monaghan²

1988

BJOG

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“…[3][4][5][6] When a hysterectomy has been performed because of a diagnosis of high-grade cervical intraepithelial neoplasia, up to 7.4% of patients have been reported to develop subsequent vaginal intraepithelial neoplasia (VAIN). 7 Several possible hypotheses have been put forward 8 to explain the pathogenesis of VAIN in this setting: (1) residual disease reflecting incomplete excision of a contiguous, preexisting intraepithelial lesion; (2) multicentric intraepithelial disease; (3) recurrent intraepithelial disease associated with compromised host defenses and occult-persistent human papillomavirus (HPV) infections; and (4) de novo development of intraepithelial lesions following an entirely new HPV infection. Therefore, follow-up of patients who have had hysterectomies for premalignant or malignant diagnoses is often recommended.…”

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confidence: 99%

Correlation of Histopathologic Follow-up Findings With Vaginal Human Papillomavirus and Low-Grade Squamous Intraepithelial Lesion Papanicolaou Test Results

Bansal

Austin²,

Zhao³

2011

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Data on high-risk human papillomavirus (hrHPV) DNA test results in vaginal, liquid-based cytology (LBC) specimens and corresponding cytologic and histopathologic correlation data are limited. Objective.—To analyze follow-up correlation data associated with vaginal (after hysterectomy) low-grade squamous intraepithelial lesion (LSIL) LBC and hrHPV test results. Design.—Hospital records were searched for vaginal LSIL LBC and hrHPV results between July 1, 2005, and July 30, 2009. Histopathologic and Papanicolaou test follow-up correlation data were analyzed. Results.—During the study period, 2892 patients with test results from both posthysterectomy vaginal LBC and hrHPV were identified: 148 (5.1%) of the patients had vaginal Papanicolaou test results reported as LSIL, with hrHPV detected in 113 of the 148 patients (76.4%). Of 148 patients, 59 of those with vaginal LSIL including 48 (81.4%) with positive HPV testing and 11 (18.6%) with negative HPV testing results had a follow-up vaginal biopsy. Histopathologic vaginal intraepithelial neoplasia (VAIN) 2/3 was diagnosed in 7 of 59 patients (11.9%) with biopsies. In all 7 patients who were diagnosed with VAIN 2/3, hrHPV was detected in the LBC vial. No VAIN 2/3 diagnoses were documented in the biopsy specimens from the 11 patients with hrHPV− LSIL Papanicolaou test results. Histopathologic VAIN 2/3 was diagnosed from vaginal biopsies in 7 of the 48 patients (14.6%) with vaginal hrHPV+ LSIL test results. Conclusions.—Sensitivity and specificity of hrHPV test results associated with histopathologic follow-up diagnoses of VAIN 2/3 in patients with vaginal LSIL results were 100% and 21.2%, respectively. The positive predictive value of a vaginal hrHPV+ LSIL result for a subsequent histopathologic VAIN 2/3 diagnosis was 14.6%. No cases of VAIN 2/3 were diagnosed in the 11 patients with vaginal hrHPV− LSIL results. Correlations of vaginal cytologic, histopathologic, and human papillomavirus findings were quite similar to correlation findings previously reported in older women with cervical LSIL test results.

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“…VAIN has bccn rcported after hysterectomy for CIN in 0 -9 4 4 % (Gallup & Morley 1975;Woodruff 1965). In Tayside the cervical cytology service has been active since the early 1960s.…”

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confidence: 99%

How Frequently Need Vaginal Smears be Taken After Hysterectomy for Cervical Intraepithelial Neoplasia?

Gemmell

Holmes

Duncan

1990

Obstetrical & Gynecological Survey

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A retrospective longitudinal review identified 341 womcn who had had a hysterectomy in association with CIN 3 , in Taysidc Region, during the ycars 1967-1977; 219 (64%) had completed 10 years of cytology follow-up and of 140 women eligible for 15-year smears 79 (56%) complcted the 15-year follow-up. Eight (4%) of the 219 patients developed abnormal cytology, but in six, smears reverted to normal spontaneously. Two patients had persistently abnormal smears and vaginal intraepithelial ncoplasia (VAIN) was diagnosed. Only one patient completing 15-year follow-up had an abnormal smear and VAIN later diagnosed. No patient over this 15-year period developed invasive vaginal carcinoma. Sixty vaginal carcinomas were identified during the period 1957-1987 from the gynaecology cancer register; only one was associated with a previous diagnosis of CTN 3 at hystcrectomy. With such data we would propose screening 6-monthly during the first postoperative year and then at 2 years. If these smears were normal, the patient could then revert to the normal screening programme. 'l'he aim of a successful cervical cytology scrccning programme is to detect and treat prc-invasive cervical intraepithelial neoplasia (CIN), thereby reducing the incidence and mortality of cervical cancer (Duguid ef al. 1985).While CIN is a frequently cncountered lesion, the histologically identical tutnour in the vagina, vaginal intraepithelial neoplasia (VAIN), is rare. It has bccn generally assumed that the natural history of the two conditions may be similar with regard to the possible devclopment of invasive cancer. For this reason any patient undergoing hystercctomy in association with CIN 3 (carcinoma in sitdsevere dysplasia) has traditionally been carefully lollowed with frequent vault smears. Such intensive follow-up

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Treatment of Recurrent Carcinoma in Situ in the Lower Genital Canal

Cited by 23 publications

References 0 publications

The management of the patient with abnormal vaginal cytology following hysterectomy

The management of the patient with abnormal vaginal cytology following hysterectomy

Correlation of Histopathologic Follow-up Findings With Vaginal Human Papillomavirus and Low-Grade Squamous Intraepithelial Lesion Papanicolaou Test Results

How Frequently Need Vaginal Smears be Taken After Hysterectomy for Cervical Intraepithelial Neoplasia?

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