Herod J J, Shafi M I, Rollason T P, Jordan J A, Luesley D M
Academic Department of Obstetrics and Gynaecology, City Hospital NHS Trust, Birmingham, UK.
Br J Obstet Gynaecol. 1996 May;103(5):453-6. doi: 10.1111/j.1471-0528.1996.tb09772.x.
To investigate the long-term outcome of patients presenting with vulvar intraepithelial neoplasia (VIN) with superficially invasive carcinoma of the vulva (SICa).
A retrospective study using information obtained from patient case notes.
Twenty-six women found at presentation to have VIN in association with superficially invasive carcinoma were identified during a 15-year period.
Pruritus vulvae was the most frequent presenting symptom in 18 patients (69%). Sixteen women (61.5%) had multiple symptoms. Features noted at vulvar examination were variable and none were pathognomonic of either VIN or of superficial invasion. All patients had VIN 3 in association with a superficially invasive carcinoma. Histological changes associated with human papillomavirus were found in 19 (73%) women. Half had a co-existent or previous abnormality of the lower genital tract. Local excision was the most frequent initial treatment (n = 9 [35%]). Mean follow up time was 65 months (range 12-174). Disease persisted after primary treatment in five women (19%). Both histological recurrence (of either VIN or SICa) or symptomatic recurrence occurred in 10 patients (38%). All patients who experienced recurrence did so within 36 months of treatment. Overall, 12 patients (46%) relapsed (histological or symptomatic recurrence); the mean time was 18 months. Fourteen patients (54%) were managed satisfactorily by their initial treatment. One patient died of recurrent cervical cancer. Three progressed to frankly invasive disease: two (aged 31 and 39 years) with carcinoma of the vulva and one aged 34 years with carcinoma of the perianal margin. All are alive and well after treatment. One patient had recurrence of superficially invasive carcinoma treated by local excision with no further problems. No episode of metastasis via lymphatic or vascular channels has been seen.
Patients with superficially invasive carcinoma of the vulva may be safely treated by local excisional methods without recourse to lymphadenectomy. Relapse after primary treatment is common, and there appears to be a significant risk of progression to frankly invasive carcinoma.
探讨外阴上皮内瘤变（VIN）合并外阴浅表浸润性癌（SICa）患者的长期预后。
一项回顾性研究，利用患者病历中的信息。
在15年期间，共识别出26名初诊时患有VIN合并浅表浸润性癌的女性。
18名患者（69%）最常见的症状是外阴瘙痒。16名女性（61.5%）有多种症状。外阴检查发现的特征各不相同，没有一个是VIN或浅表浸润的特征性表现。所有患者均为VIN 3合并浅表浸润性癌。19名（73%）女性发现与人乳头瘤病毒相关的组织学改变。半数患者同时存在或既往有下生殖道异常。局部切除是最常见的初始治疗方法（n = 9 [35%]）。平均随访时间为65个月（范围12 - 174个月）。5名女性（19%）在初次治疗后疾病持续存在。10名患者（38%）出现组织学复发（VIN或SICa）或症状复发。所有复发患者均在治疗后36个月内复发。总体而言，12名患者（46%）复发（组织学或症状复发）；平均时间为18个月。14名患者（54%）经初始治疗后病情得到满意控制。1名患者死于复发性宫颈癌。3名患者进展为明显的浸润性疾病：2名（年龄分别为31岁和39岁）患有外阴癌，1名34岁患有肛周边缘癌。所有患者治疗后均存活且状况良好。1名患者经局部切除治疗浅表浸润性癌复发后未出现进一步问题。未观察到经淋巴或血管途径转移的情况。
外阴浅表浸润性癌患者可通过局部切除方法安全治疗，无需进行淋巴结清扫。初次治疗后复发很常见，且进展为明显浸润性癌的风险似乎很大。
