Raymond H. Kaufman

Gynecologic cancer in children

Abstract Our experience with gynecologic cancer in children has been reviewed. These cases are extremely rare, but when they do occur they can represent difficult management problems. Three representative cases have been presented to call attention to these difficult decisions.

Vulvar dystrophies: An evaluation

Abstract The vulvar biopsy specimens from 128 patients were grouped according to a predetermined classification. When the charts on these 128 patients were reviewed, several facts relative to the vulvar dystrophies were noted. The presence of a vulvar dystrophy, when adequately treated, does not significantly predispose the patient to the developent of vulvar carcinoma. When first seen, the one patient who did develop carcinoma of the vulva had an initial vulvar carcinoma 3 years prior to the diagnosis of a second vulvar carcinoma and associated lichen sclerosus et atrophicus. The symptoms related to the vulvar dystrophies can be adequately controlled with medical treatment. Since the treatment will vary according to the type of dystrophy present, it is important that the diagnosis be accurately made. Vulvectomy is contraindicated as a means of treatment in the vast majority of patients with a vulvar dystrophy.

Human papillomavirus and herpes simplex virus in vulvar squamous cell carcinoma in situ

Human papillomavirus deoxyribonucleic acid were detected in tissue specimens from 38 to 46 patients (83%) with squamous cell carcinoma in situ of the vulva. Herpes simplex virus type 2--related antigen ICSP 34/35 was demonstrated in 23 of the lesions (50%), and antibodies to herpes simplex virus types 1 and 2 were found in 74% and 65% of the serum samples tested, respectively. Both human papillomavirus deoxyribonucleic acid and herpes simplex virus type 2 antigen were detected in 19 cases (41%). Correlation of human papillomavirus type to the ages of the patients revealed that types 16, 18, and 31 are most often seen in older patients, although the frequencies do not differ significantly. No relationship between the presence or absence of herpes simplex virus type 2--related antigen to age of the patient was observed.

A prospective study of herpes simplex virus infection in a defined population in Houston, Texas☆

A seroepidemiologic study was conducted to determine the incidence of antibodies to herpes simplex virus in a population of middle-class Caucasian women. In utero exposure to diethylstilbestrol did not influence the frequency of herpes simplex virus infection. The frequency of infection increased with age and number of sex partners and a 50% increase in incidence of herpes simplex virus type 2 infection was noted during the 4-year period of the study. Subclinical herpes simplex virus type 2 infections apparently occurred in some women without preexisting antibodies to herpes simplex virus type 1.

Human papillomavirus associated with adenocarcinoma and adenosquamous carcinoma of the cervix: analysis by in situ hybridization

The incidence of adenocarcinoma of the cervix appears to be increasing. Recent reports have demonstrated an association between adenocarcinoma of the cervix and human papillomavirus (HPV) by Southern blot hybridizations. In situ deoxyribonucleic acid (DNA) hybridization was performed on paraffin-embedded specimens to localize the source of HPV DNA. In pure adenocarcinoma five of six specimens were positive for HPV DNA. Four specimens contained HPV type 18 and one HPV type 16. Only one of three adenosquamous lesions was positive and it contained both HPV types 16 and 31. These findings suggest an association between HPV and adenocarcinoma of the cervix.

Detection of human papillomavirus DNA before and after development of invasive vulvar cancer

Biopsy and surgical specimens were studied from two patients with squamous cell carcinoma in situ of the vulva and one with verrucous carcinoma of the vulva. All three patients subsequently developed invasive squamous cell carcinoma of the vulva. In two, human papillomaviruses (HPVs) 16 and 18 were found in the lesions before the development of invasive carcinoma. In the specimens with invasive squamous cell carcinoma, HPV16 or 18 or both was found. The third patient had HPV 18 DNA in the specimen demonstrating squamous cell carcinoma in situ; when invasive squamous cell carcinoma was diagnosed 9 years later, HPVs 16 and 18 were found in the latter lesion. These findings lend support to the role of HPVs 16 and 18 in the development of invasive squamous cell carcinoma of the vulva. (Obstet Gynecol 76:540, 1990)