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Korean Journal of Obstetrics & Gynecology 1998;41(3):897-907.
Published online January 1, 2001.
Primary Invasive Carcinoma of Vagina: Clinicopathologic Characteristics with Human Papillomavirus infection and p53 Status.
N H Park, M H Kim, J W Kim, S Y Ryu, I A Park, Y S Song, S B Kang, H P Lee
Abstract
Primary invasive carcinoma of the vagina is one of the rarest malignant tumors of the female genital tract, so the clinicopathologic characteristics are too difficult to be identified. Association with HPV as an etiologic factor and p53 status were not clearly demonstrated until now. Nineteen patients with primary invasive carcinoma of the vagina were treated at Seoul National University Hospital from 1984 to 1997. We reviewed their clinical records retrospectively and investigated the presence of HPV DNA by PCR and altered expression of p53 by immunohistochemistry[IHC] in paraffin-embedded tissue specimens. The median age of the patients was 56 years[range: 39~77 years]. Five out of 19 patients had a history of previous hysterectomy. The most frequent presenting symptom was a vaginal spotting in 12 patients[63.2%]. Squamous cell carcinoma was the most common histologic type, followed by adenocarcinoma, malignant melanoma and undifferentiated carcinoma in order. Seven were FIGO clinical stage I[37%]; 8, stage II[42%]; 4, stage IV[21%]. Upper one third of vagina was the most commonly involved site[42.1%]. Among 7 surgically treated patients, 3 were managed with adjuvant radiotherapy and one with chemotherapy. Twelve patients were treated primarily with radiotherapy. Among 16 patients followed consistently [median follow-up 37 months], 10 had persistent or recurrent disease, and only six out of 16 followed were disease-free. Out of 12 patients investigated for HPV 16/18 and p53 status, two cases of SCCA were HPV DNA-positive. p53 was detected in 8 tumors. These findings suggest that multicenter cooperative studies are needed to identify the clinopathologic characteristics of this rare malignancy. Oncogenic HPVs may not be a major factor in the development of carcinoma of vagina and the detection of p53 probably is not related to poorer prognosis.
Key Words: Vaginal cancer, Human Papillomavirus, p53


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