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How Can We Treat Vulvar Carcinoma in Pregnancy? A Systematic Review of the Literature.

ABSTRACT: According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17-41 years). The tumor size range was 0.3-15 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before-and-after delivery (11/37, 30%). We found that 21/37 (57%) cases were stage I, 2 II (5%), 11 III (30%), and 3 IVB (8%). HPV-related features (condylomas/warts; HPV infection; high-grade squamous intraepithelial lesion) were reported in 11/37 (30%) cases. We also found that 9/37 (24%) patients had inflammatory conditions (lichen sclerosus/planus, psoriasis, chronic dermatitis). The time-to-recurrence/progression (12/37, 32%) ranged from 0 to 36 (mean 9) months. Eight women died of disease (22%) 2.5-48 months after diagnosis, 2 (5%) were alive with disease, and 23 (62%) were disease-free at the end of follow-up. Pregnant patients must be followed-up. Even if they are small, newly arising vulvar lesions should be biopsied, especially in women with risk factors (HPV, dermatosis, etc.). The treatment of VSCCs diagnosed in late third trimester might be delayed until postpartum. Elective cesarean section may prevent vulvar wound dehiscence. In the few reported cases, pregnancy/fetal outcomes seemed to not be affected by invasive treatments during pregnancy. However, clinicians must be careful; larger cohorts should define the best treatment. Definite guidelines are lacking, so a multidisciplinary approach and discussion with patients are mandatory.

SUBMITTER: Palicelli A

PROVIDER: S-EPMC7921964 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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How Can We Treat Vulvar Carcinoma in Pregnancy? A Systematic Review of the Literature.

Palicelli Andrea A Giaccherini Lucia L Zanelli Magda M Bonasoni Maria Paola MP Gelli Maria Carolina MC Bisagni Alessandra A Zanetti Eleonora E De Marco Loredana L Torricelli Federica F Manzotti Gloria G Gugnoni Mila M D'Ippolito Giovanni G Falbo Angela Immacolata AI Sileo Filomena Giulia FG Aguzzoli Lorenzo L Mastrofilippo Valentina V Bonacini Martina M De Giorgi Federica F Ricci Stefano S Bernardelli Giuditta G Ardighieri Laura L Zizzo Maurizio M De Leo Antonio A Santandrea Giacomo G de Biase Dario D Ragazzi Moira M Dalla Dea Giulia G Veggiani Claudia C Carpenito Laura L Sanguedolce Francesca F Asaturova Aleksandra A Boldorini Renzo R Disanto Maria Giulia MG Goia Margherita M Wong Richard Wing-Cheuk RW Singh Naveena N Mandato Vincenzo Dario VD

Cancers 20210217 4

According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17-41 years). The tumor size range was 0.3-15 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before-and-after delivery (11/37, 30%). We found that 21/37 (57%) cases were stage I, 2 II (5%), 11 III (30%), and 3 IVB (8%). HPV-related features (condylomas/warts; HPV infection; high-grade squamous intraepithelial l ...[more]

PMID: 33671249

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Project description:IntroductionHepatocellular carcinoma (HCC) is the most frequent primary malignant liver tumor and typically develops in the context of chronic liver disease, such as liver cirrhosis or chronic hepatitis B virus infection. Ultrasound evaluation, CT scan, and MRI are used to detect HCC. α-fetoprotein (AFP) is a common marker used to detect HCC in the non-pregnant population, which notoriously increases in pregnant women in relation to gestational age. Treatment is driven by the extent of the disease and the severity of underlying liver disease. Pregnancy may represent an obstacle to diagnosis and appropriate treatment of HCC. The aim of this descriptive systematic review was to describe the clinical features and maternal and neonatal outcomes of HCC in pregnancy.Material and methodsWe performed a systematic review of the literature about HCC diagnosed in pregnancy and the postpartum period, with signs or symptoms arising in pregnancy. We included case reports and case series describing the clinical features of women diagnosed with HCC, fibrolamellar variant of HCC, and mixed HCC and cholangiocarcinoma during pregnancy or the postpartum period (with onset of symptoms during pregnancy), from inception to March 2023. The study protocol was registered with the PROSPERO database (Registration number: ID CRD42021275584).ResultsWe identified 180 records. The articles included in this systematic review were 47 case reports and 5 case series, for a total of 63 pregnancies. The two most frequent predisposing conditions were hepatitis B virus infection (30/63; 47%) and liver cirrhosis (14/63; 22%). Ultrasound evaluation was the most used technique to detect HCC. AFP was higher than normal in 28/46 patients tested (61%). Surgical treatment was the most used therapy, both during pregnancy and after delivery. Twenty-six patients (26/63; 42%) died within 6 months of diagnosis. Survival >24 months was 9% (4/46) in symptomatic and 29% (5/17) in asymptomatic women. No patient with cirrhotic liver survived more than 12 months. Thirty-eight newborns were alive at 28 days of age (38/63; 61%).ConclusionsHepatocellular carcinoma in pregnancy is associated with a high risk of maternal and neonatal mortality. Diagnosis in asymptomatic high-risk women or following abnormal maternal serum AFP screening is associated with better maternal outcomes.

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How Can We Treat Vulvar Carcinoma in Pregnancy? A Systematic Review of the Literature.

Publications

How Can We Treat Vulvar Carcinoma in Pregnancy? A Systematic Review of the Literature.

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