2 research outputs found
Molecular and immunological mechanisms of epithelial disorders of the vulva
The vulva is the outer part of the female genital tract, bordered by the symphisis
pubis, the labiocrural folds and the anus. It consists of the following structures: the
mons pubis, the labia majora and minora, the clitoris, the vestibule of the vagina and
the urethral orifice (Figure 1). Embryologically all three germ layers are present at
the vulva; the cloacal endoderm, the urogenital ectoderm and the paramesonephric
mesoderma.
Different epithelia, from keratinized squamous epithelium on the labia majora and
minora to squamous mucosa in the vestibule, cover the vulva. Dysplastic changes in
the epithelium of the vulva are known as Vulvar Intraepithelial Neoplasia (VIN). In the
past, various definitions have been used to describe these dysplastic vulvar lesions:
morbus Bowen, Queyrat’s erythroplasia, carcinoma simplex, bowenoid papulosis,
early vulvar cancer, vulvar atypia, hyperplastic dystrophy, carcinoma in situ and
dysplasia (graded into mild dysplasia (VIN1), moderate dysplasia (VIN2) and severe
dysplasia (VIN3)). To simplify this complexity of terms and to enhance diagnostic
reproducibility, the International Society for the Study of Vulvovaginal Diseases
(ISSVD) defined a new terminology in 2004.7 We nowadays classify two types of VIN:
1. Usual type VIN (uVIN), which is caused by a persistent Human Papilloma Virus
(HPV) infection.
2. Differentiated type VIN (dVIN), which is not associated with HPV, but with chronic
inflammatory and/or autoimmune processes, such as lichen sclerosus and lichen
planus, involving vulvar mucosa and skin.
Spontaneous regression of VIN lesions has been described, but malignant
transformation into vulvar cancer has also been reported. Vulvar cancer is the
fourth most common gynecological type of cancer.11 Worldwide the incidence rate is
1 to 2 per 100.000 women, and around 27.000 women are diagnosed each year.12 In
the Netherlands about 200 new cases are identified each year
No evidence of vertical transmission of SARS-CoV-2 after induction of labour in an immune-suppressed SARS-CoV-2-positive patient
We present a case of a 38+1 weeks pregnant patient
(G1P0) with a proven COVID-19 infection, who was
planned for induction of labour because of pre-existent
hypertension, systemic lupus erythematosus, respiratory
problem of coughing and mild dyspnoea without fever
during the COVID-19 pandemic in March 2020. To
estimate the risk of vertical transmission of Severe Acute
Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2)
during labour and delivery, we collected oropharyngeal,
vaginal, urinary, placental and neonatal PCRs for SARSCoV-2 during the period of admission. All PCRs, except
for the oropharyngeal, were negative and vertical
transmission was not observed. Labour and delivery
were uncomplicated and the patient and neonate were
discharged the next day. We give a short overview of the
known literature about SARS-CoV-2-related infection
during pregnancy, delivery and outcome of the neonate