RESUMO
AIM: Lipschütz ulcers (LU) were first described as rare vulvar ulcerations that affect adolescents without previous history of sexual contact. However, more LU patients have been identified in acute genital ulcers (AGU) services in Europe. PURPOSE: To review cases of AGU and analyze the occurrence of LU in the Ob/Gyn Emergency Department of a Brazilian private hospital, using the currently used diagnostic criteria. METHODS: All female patients who sought our service with AGU complaints from January 2009 to July 2015 were selected and had their medical records reviewed, considering the clinical data and some diagnostic criteria, that included: < 20 years old, first AGU episode, sudden onset, absence of sexual contact 3 months before onset and the absence of immunodeficiency. RESULTS: 273 patients eligible for analysis were identified according to the criteria and 12 (4.39%) of them were identified with the possible diagnosis of LU. By applying less restrictive criteria that allowed the inclusion of patients of any age and sexual status, 98 were identified (35.89%). CONCLUSIONS: Despite being described as a rare pathology, ours and previous results indicate a considerable number of AGU cases, suggesting that LU should be better known and considered for differential diagnosis.
Assuntos
Úlcera/diagnóstico , Doenças da Vulva/diagnóstico , Adolescente , Adulto , Idoso , Brasil , Criança , Bases de Dados Genéticas , Diagnóstico Diferencial , Europa (Continente) , Feminino , Herpes Genital/complicações , Herpes Genital/diagnóstico , Humanos , Pessoa de Meia-Idade , Úlcera/patologia , Úlcera/virologia , Doenças da Vulva/patologia , Doenças da Vulva/virologia , Adulto JovemRESUMO
OBJECTIVE: We sought to determine the prevalence of human papillomavirus (HPV) subtypes in vulvar seborrheic keratoses (SK) by polymerase chain reaction (PCR) in women with a theoretically low risk of recent HPV transmission. We also attempted to identify which histopathologic features best correlated with HPV and specific subtypes. METHODS: Twenty-eight cases of vulvar SK in women older than 50 years old were retrospectively pulled from our files from a 7-year period. Cases were histologically examined for the presence of 7 features: parakeratosis, horn cysts, pigmentation, "clonal" cells, papillomatosis, "whorls," and reticulation of rete. For controls, PCR was performed on all cases for HPV detection and typing. Ten cutaneous SK and 7 vulvar condyloma acuminata were also evaluated for HPV by PCR. RESULTS: Twenty-one vulvar SK had sufficient genetic material for HPV PCR analysis. Only 3 (14.29%) were positive for HPV, 2 were type 6, and 1 was an unknown type. All cutaneous SK were negative and all condyloma acuminatum were positive for HPV. There was no histologic feature that separated HPV-positive from HPV-negative vulvar SK, although there was a tendency for parakeratosis to be associated with HPV positivity. CONCLUSIONS: The rate of HPV positivity in vulvar SK in women older than 50 years is much lower than expected and not statistically significantly associated with specific histologic features. One explanation may be that vulvar SK have diminishing levels of HPV genetic material in the relatively older ages of the patients in our study. Alternatively, vulvar SK may have no relationship to HPV, and strict histologic criteria may separate vulvar SK from condyloma acuminatum. In this instance, the few cases of HPV-positive vulvar SK may reflect incidental persistence of HPV in vulvar epidermis. Furthermore, these possibilities may vary among different populations, for example, based on patient age.
Assuntos
Ceratose Seborreica/etiologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Doenças da Vulva/etiologia , Idoso , DNA Viral/genética , DNA Viral/isolamento & purificação , Feminino , Genótipo , Histocitoquímica , Humanos , Ceratose Seborreica/patologia , Ceratose Seborreica/virologia , Microscopia , Pessoa de Meia-Idade , Papillomaviridae/classificação , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Doenças da Vulva/patologia , Doenças da Vulva/virologiaRESUMO
The main goal of this study was to investigate, through a biomolecular study, the correlation between papillomatosis of the vulvar vestibule and human papillomavirus (HPV) infection, as well as to establish the necessity of treatment. A total of 44 female adolescents between 12 and 18 years of age were selected through a prospective study with a confirmed diagnosis of papillomatosis of the vulvar vestibule. Vulvar biopsies were obtained for the histological and biomolecular detection of HPV DNA through polymerase chain reaction (PCR). Twenty (45%) adolescents were virgins (group A), the other 24 (55%) were sexually active. The virgin adolescents (group A) and 12 sexually active adolescents (group B) did not show cytological and/or colposcopic alteration, suggesting infection by HPV either on the cervix or vagina. These were compared with 12 other sexually active adolescents who showed cervicovaginal infection caused by HPV (group C). Fisher exact test was applied for statistical analysis of the results, considering alpha equal or less than 0.05. There was no statistically significant difference in relation to HPV DNA through PCR among virgin and sexually active adolescents in group B, however, both differed from those in group C (A + B C: p = 0.048*). The histological study did not reveal evident signs of infection caused by HPV on vestibular papillae, besides perinuclear halos. HPV DNA was detected on vestibular papillae in 27%. Our results confirmed a scarce correlation between vestibular papillae and HPV. Thus, we consider papillomatosis of the vulvar vestibule, in most cases, to be equivalent to physiological papillomatosis and, therefore, should not be treated.
Assuntos
Papillomaviridae/fisiologia , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Doenças da Vulva/patologia , Doenças da Vulva/virologia , Adolescente , Biópsia , Criança , DNA Viral/genética , Feminino , HumanosRESUMO
OBJECTIVE: To evaluate recurrence after excision plus a brief topical application of 99% acetic acid for anovulvar condylomata acuminata. STUDY DESIGN: Thirty women having extensive involvement of the lower genital tract with condylomata acuminata were selected for treatment. In all cases treatment was done on an outpatient basis under local anesthesia. On finalizing the excision, topical 99% acetic acid was briefly applied for (3 seconds) to the surgically treated surface, 0.2 mL for each 10 cm2 of anovulvar surface, with a sterile cotton applicator; immediately afterward, the anovulvar surface was washed with sterile water for 1 minute to neutralize the 99% acetic acid. The primary end point was to measure the rate of local recurrence after therapy. RESULTS: Twenty-six of 30 patients (86.6%) had complete resolution of large genital tract condylomata acuminata with 1-3 local excisions plus brief topical application of 99% acetic acid. Four of 30 patients (13.3%) experienced local recurrence after therapy. CONCLUSION: In this preliminary study, local excision plus a brief topical application of 99% acetic acid with rapid neutralization with sterile water under local anesthesia was well tolerated, without serious local complications and with an acceptable rate of recurrence (13.3%).
Assuntos
Ácido Acético/administração & dosagem , Antivirais/administração & dosagem , Doenças do Ânus/tratamento farmacológico , Condiloma Acuminado/tratamento farmacológico , Doenças da Vulva/tratamento farmacológico , Administração Cutânea , Adolescente , Adulto , Doenças do Ânus/cirurgia , Doenças do Ânus/virologia , Condiloma Acuminado/cirurgia , Feminino , Seguimentos , Humanos , Projetos Piloto , Recidiva , Fatores de Tempo , Resultado do Tratamento , Doenças da Vulva/cirurgia , Doenças da Vulva/virologiaRESUMO
OBJECTIVE: To determine whether human papillomavirus (HPV) plays a role in the genesis of papillomatosis of the vulvar vestibule. METHODS: We conducted a study based on molecular hybridization and histology of biopsy material obtained from the inner surface of the labia minora of 25 women with papillomatosis of the vulvar vestibule who presented no abnormal clinical, cytologic, or colposcopic changes in the cervix or vagina. These women were compared with 24 women with condyloma acuminatum of the vulvar vestibule and with ten women with normal vulvar epithelium and no cervicovaginal changes. All patients included in the study were 35 years or younger, and none was pregnant. RESULTS: Papillomatosis of the vulvar vestibule was rarely found to be HPV positive by molecular hybridization (one of 25, 4%, by dot blot hybridization and one of 15, 6.67%, by polymerase chain reaction [PCR]). This result did not differ significantly from that obtained for the group with normal vulvar epithelium (none of 10 by dot blot and none of six by PCR), but did differ (P = .001) from the result obtained for the group with condyloma acuminatum of the vestibule (12 of 24, 50%, by dot blot and six of six, 100%, by PCR). The biomolecular study of vestibular papillomatosis showed that focal koilocytosis was not correlated with HPV infection. CONCLUSION: Papillomatosis of the vulvar vestibule is not associated with HPV and should be considered a paraphysiologic formation of the vulvar epithelium. The diagnosis of vulvar HPV infection should be avoided in the absence of more explicit clinical-histologic evidence, with no need for biopsies or unnecessary treatments.
Assuntos
Papiloma/patologia , Papillomaviridae , Infecções por Papillomavirus/patologia , Infecções Tumorais por Vírus/patologia , Neoplasias Vulvares/patologia , Adulto , Condiloma Acuminado/patologia , Condiloma Acuminado/virologia , DNA Viral/análise , Feminino , Humanos , Hibridização de Ácido Nucleico , Papiloma/virologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Infecções Tumorais por Vírus/virologia , Doenças da Vulva/virologia , Neoplasias Vulvares/virologiaRESUMO
Introduçao: Os autores apresentam um estudo de cinco casos de papilomas e papilomatoses vulvares congênitas em neo e nati-mortos. Material e Métodos: O material utilizado foi proveniente de cinco necrópsias. A avaliaçao histopatológica mostrou aspectos sugestivos de infecçao pelo Pailomavirus humano (HPV). A microscopia eletrônica de três dos casos identificou partículas viróticas nucleares e citoplasmáticas variando de 40 a 60 nm, compatíveis com HPV. Resultados: O estudo imunohistoquímico destas lesoes demonstrou imunopositividade citoplasmática e nuclear. Conclusao: Os autores concluíram que a presença de partículas viróticas somada a imunopositividade em células escamosas, sao evidências do provável envolvimento etiológico do HPV nestas lesoes.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Infecções por Papillomavirus/congênito , Doenças da Vulva/congênito , Papillomaviridae , Infecções por Papillomavirus/patologia , Complicações Infecciosas na Gravidez/virologia , Doenças da Vulva/patologia , Doenças da Vulva/virologia , Infecções Tumorais por Vírus/patologiaRESUMO
The authors present a study of five cases of vulvar congenital papillomas and papillomatoses in stillborns and neonates dead upon birth. The studied material was collected from five necropsies. The histopathological evaluation showed hyperkeratosis, acanthosis, papillomatosis, perinuclear haloes, and nuclear abnormalities. In three of the cases, the electron microscopy identified nuclear and cytoplasmatic viral particles ranging from 40 to 60 nm in size, compatible with HPV. The immunohistochemical study of those lesions showed nuclear and cytoplasmatic positivity. The authors concluded that the presence of viral particles suggestive of HPV added to the immunopositivity indicated the possibility of viral infection.
Assuntos
Papillomaviridae , Infecções por Papillomavirus/congênito , Complicações Infecciosas na Gravidez/virologia , Infecções Tumorais por Vírus/congênito , Doenças da Vulva/congênito , Feminino , Humanos , Recém-Nascido , Infecções por Papillomavirus/patologia , Gravidez , Infecções Tumorais por Vírus/patologia , Doenças da Vulva/patologia , Doenças da Vulva/virologiaRESUMO
Cryostat sections of 20 clinical condylomata of the vulva induced by human papillomavirus and 5 normal control biopsies were examined using immunohistochemistry. The results indicated that in vulvar papillomavirus infection the intraepithelial Langerhans' cells showed abnormal morphology and a significantly lower density than controls. CD1a positive Langerhans' cells were also observed in dermis of condylomata, suggesting an abnormal epithelial traffic of dendritic cells. T lymphocytes with a mean CD4/CD8 ratio of 0.25 and a mean density of 267 +/- 59 cells/mm2 of epithelial section were the main cellular infiltrate in vulvar papillomavirus infection. Most of the T cells were HLA-DR negative. Those condylomata with moderate to severe mononuclear infiltrate showed leucocyte function antigen 1 positive T cells forming small clusters in the lower epithelial half around the ICAM-1 positive keratinocytes. Vulvar warts also showed epithelial areas with overlapped ICAM-1 and HLA-DR expression. Scattered T gamma-delta and B lymphocytes, macrophages and NK cells were observed among the cells of the dermal infiltrate of vulvar condylomata.