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Laser CO2 treatment for vulvar lymphedema secondary to gynecological cancer therapy: A report of two cases and review of the literature.

Sopracordevole F, Mancioli F, Canzonieri V, Buttignol M, Giorda G, Ciavattini A - Oncol Lett (2015)

Bottom Line: Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain controversial and are not currently considered to be the standard therapy.Laser CO2 excision and vaporization of the whole skin and mucosal tissue of the vulva was successfully performed to treat the lymphorrhea and improve quality of life.Thus, the present two cases indicated that laser CO2 surgery may present an additional therapy for the treatment of genital lymphedema that is refractory to other treatments.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecological Oncology, Oncological Referral Center, National Cancer Institute, Aviano, Pordenone 33081, Italy.

ABSTRACT

Vulvar lymphedema is an uncommon and disabling side-effect of pelvic lymphadenectomy and pelvic radiotherapeutic treatment for invasive genital cancer. Lymphorrhea, a complication of lymphedema, may be extremely distressing for patients due to the requirement to wear sanitary towels and as the pain and loss of elasticity of the vulvar skin and mucosa can cause discomfort during coitus. Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain controversial and are not currently considered to be the standard therapy. The present study reports two cases of vulvar lymphedema complicated by vulvar lymphorrhea in females who had undergone treatment for cervical and endometrial cancer, respectively; a review of the literature is also included. In the two present cases, vulvar lymphedemas were refractory to standard treatments, including decongestive therapy, manual lymph drainage, elastic bandaging, low-stretch bandaging, exercises and skin care. Laser CO2 excision and vaporization of the whole skin and mucosal tissue of the vulva was successfully performed to treat the lymphorrhea and improve quality of life. Thus, the present two cases indicated that laser CO2 surgery may present an additional therapy for the treatment of genital lymphedema that is refractory to other treatments.

No MeSH data available.


Related in: MedlinePlus

Case two: Marked dilated vessels beneath the epidermis with atrophic changes. Certain vessels contain erythrocytes. Hematoxylin and eosin staining; magnification, ×100.
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f2-ol-09-04-1889: Case two: Marked dilated vessels beneath the epidermis with atrophic changes. Certain vessels contain erythrocytes. Hematoxylin and eosin staining; magnification, ×100.

Mentions: In 2012, the patient was referred to the Department of Gynecological Oncology of Aviano National Cancer Institute due to gradually increasing swelling of the vulva over a period of six months, associated with a genital pain score of 4–5 according to a VAS evaluation (7); the symptoms prohibited regular physical and sexual activity. A gynecological examination revealed multiple, firm, hyperkeratotic glossy papules and swelling of the vulva associated with changes in skin texture and leakage of serous fluid through the skin (lymphorrhea). A vulvar biopsy measuring 1.0×0.8×0.3 cm was used to determine a diagnosis of vulvar lymphedema (Fig. 2). As the standard treatments for lower-limb lymphedema were ineffective in improving the vulvar symptoms, vulvar excisional and vaporization treatments (three sessions) were performed using colposcopy-guided laser CO2 (as described in case one). Due to the patient’s history of erysipelas, a three-day regimen of the antibiotic azithromycin (500 mg/day) was administered. No complications were experienced, and the symptoms of pain and heaviness were relieved following reduction of the edema. During the 24-month follow-up examination, the patient presented with mild vulvar lymphedema without symptoms (VAS score, 0) and without lymphorrhea.


Laser CO2 treatment for vulvar lymphedema secondary to gynecological cancer therapy: A report of two cases and review of the literature.

Sopracordevole F, Mancioli F, Canzonieri V, Buttignol M, Giorda G, Ciavattini A - Oncol Lett (2015)

Case two: Marked dilated vessels beneath the epidermis with atrophic changes. Certain vessels contain erythrocytes. Hematoxylin and eosin staining; magnification, ×100.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356404&req=5

f2-ol-09-04-1889: Case two: Marked dilated vessels beneath the epidermis with atrophic changes. Certain vessels contain erythrocytes. Hematoxylin and eosin staining; magnification, ×100.
Mentions: In 2012, the patient was referred to the Department of Gynecological Oncology of Aviano National Cancer Institute due to gradually increasing swelling of the vulva over a period of six months, associated with a genital pain score of 4–5 according to a VAS evaluation (7); the symptoms prohibited regular physical and sexual activity. A gynecological examination revealed multiple, firm, hyperkeratotic glossy papules and swelling of the vulva associated with changes in skin texture and leakage of serous fluid through the skin (lymphorrhea). A vulvar biopsy measuring 1.0×0.8×0.3 cm was used to determine a diagnosis of vulvar lymphedema (Fig. 2). As the standard treatments for lower-limb lymphedema were ineffective in improving the vulvar symptoms, vulvar excisional and vaporization treatments (three sessions) were performed using colposcopy-guided laser CO2 (as described in case one). Due to the patient’s history of erysipelas, a three-day regimen of the antibiotic azithromycin (500 mg/day) was administered. No complications were experienced, and the symptoms of pain and heaviness were relieved following reduction of the edema. During the 24-month follow-up examination, the patient presented with mild vulvar lymphedema without symptoms (VAS score, 0) and without lymphorrhea.

Bottom Line: Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain controversial and are not currently considered to be the standard therapy.Laser CO2 excision and vaporization of the whole skin and mucosal tissue of the vulva was successfully performed to treat the lymphorrhea and improve quality of life.Thus, the present two cases indicated that laser CO2 surgery may present an additional therapy for the treatment of genital lymphedema that is refractory to other treatments.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecological Oncology, Oncological Referral Center, National Cancer Institute, Aviano, Pordenone 33081, Italy.

ABSTRACT

Vulvar lymphedema is an uncommon and disabling side-effect of pelvic lymphadenectomy and pelvic radiotherapeutic treatment for invasive genital cancer. Lymphorrhea, a complication of lymphedema, may be extremely distressing for patients due to the requirement to wear sanitary towels and as the pain and loss of elasticity of the vulvar skin and mucosa can cause discomfort during coitus. Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain controversial and are not currently considered to be the standard therapy. The present study reports two cases of vulvar lymphedema complicated by vulvar lymphorrhea in females who had undergone treatment for cervical and endometrial cancer, respectively; a review of the literature is also included. In the two present cases, vulvar lymphedemas were refractory to standard treatments, including decongestive therapy, manual lymph drainage, elastic bandaging, low-stretch bandaging, exercises and skin care. Laser CO2 excision and vaporization of the whole skin and mucosal tissue of the vulva was successfully performed to treat the lymphorrhea and improve quality of life. Thus, the present two cases indicated that laser CO2 surgery may present an additional therapy for the treatment of genital lymphedema that is refractory to other treatments.

No MeSH data available.


Related in: MedlinePlus