Yang Fan, Li HongYi, Qi Xiaorong, Bian Ce
Department of Obstetrics & Gynaecology, West China Second Hospital.
Key Laboratory of Obstetric & Gynaecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2019 Sep;98(39):e17043. doi: 10.1097/MD.0000000000017043.
Post-hysterectomy collision tumors of the vulva has rarely been reported. Though long-term HPV infection may induce vulva tumor, but the relationship between HPV infection and collision vulva tumor is not clear. And there are no clear rules of the post-hysterectomy cancer surveillance for human papilloma virus (HPV) long-term infections. So here we first report a case of post-hysterectomy rare collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland and hope to bring new direction to our future research.
A 48-year-old woman with long-term HPV infection, 3 years after hysterectomy, gravida 3, para 2, was admitted to our hospital with complaints of a 4-month history of an itching vulva ulceration. An anabrosis was located on the surface of the solid mass of the bartholin gland at the posterior part of the right labium and the right inguinal lymph nodes were palpable. Result of the incisional biopsy of the ulcer area at local hospital was atypical squamous cells couldn't exclude high-grade squamous intraepithelial lesion (ASC-H). Subsequently more authoritative pathological consultation results suggested squamous cell carcinoma of the vulva.
Post-hysterectomy collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland.
The extensive excision of the vulva, bilateral inguinal lymph nodes dissection, and local skin flap transposition surgeon was done to this patient. The final certificate diagnosis was: vulvar tumor T1bM0N0 composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland; HPV infection; post hysterectomy, and bilateral salpingectomy.
The patient recovered well after surgery, and consequently received 6 courses of TC (paclitaxel + carboplatin) chemotherapy, and 9 months and 13 days followed up. So far patient recorded as complete response (CR).
Collision vulva tumor occurred post-hysterectomy is extremely rare. It is most likely related to long-term HPV infection, which suggests us should to modify the manner of the post-hysterectomy cancer surveillance for HPV long-term infections. For patients with high-risk HPV infection, even if the cytology results are negative, we may should perform colposcopy and vulva biopsy more positively to prevent the disease from progressing into cancer. And the pathogenesis of relationship between HPV infection and collision vulva tumor is still need further investigation.
子宫切除术后外阴碰撞瘤鲜有报道。虽然长期HPV感染可能诱发外阴肿瘤，但HPV感染与外阴碰撞瘤之间的关系尚不清楚。而且对于人乳头瘤病毒（HPV）长期感染的子宫切除术后癌症监测尚无明确规则。因此，我们首次报道一例子宫切除术后罕见的伴有长期HPV感染的外阴碰撞瘤，该肿瘤由大阴唇鳞状细胞癌和巴氏腺腺鳞癌组成，希望能为我们未来的研究带来新方向。
一名48岁长期HPV感染女性，子宫切除术后3年，孕3产2，因外阴瘙痒溃疡4个月病史入院。右侧大阴唇后部巴氏腺实性肿块表面有糜烂，右侧腹股沟淋巴结可触及。当地医院溃疡部位切口活检结果为非典型鳞状细胞，不能排除高级别鳞状上皮内病变（ASC-H）。随后更权威的病理会诊结果提示为外阴鳞状细胞癌。
子宫切除术后伴有长期HPV感染的外阴碰撞瘤，由大阴唇鳞状细胞癌和巴氏腺腺鳞癌组成。
对该患者进行了外阴广泛切除、双侧腹股沟淋巴结清扫及局部皮瓣转移手术。最终确诊为：由大阴唇鳞状细胞癌和巴氏腺腺鳞癌组成的外阴肿瘤T1bM0N0；HPV感染；子宫切除术后，双侧输卵管切除术。
患者术后恢复良好，随后接受了6个疗程的TC（紫杉醇+卡铂）化疗，随访9个月零13天。目前患者记录为完全缓解（CR）。
子宫切除术后发生的外阴碰撞瘤极为罕见。极有可能与长期HPV感染有关，这提示我们应改变子宫切除术后对HPV长期感染的癌症监测方式。对于高危HPV感染患者，即使细胞学结果为阴性，我们可能也应更积极地进行阴道镜检查和外阴活检，以防止疾病进展为癌症。而且HPV感染与外阴碰撞瘤之间关系的发病机制仍需进一步研究。
