[Pathological and clinical observations on precancerous lesions of the vulva]

The vulvar epithelial lesions which have been subjected to histological examinations in Nagasaki University Hospital (1965-1985) and its 5 affiliated hospitals (1975-1985) included 133 cases in vulvar dystrophies, 72 in other benign lesions, 18 in squamous cell carcinoma in situ, 10 in vulvar Paget's disease, and 59 in invasive carcinoma. These lesions were studied pathologically and endocrinologically, and the pathogenesis of vulvar carcinoma and whose clinical problems were discussed. Serum hormone level in lichen sclerosus In a lichen sclerosus group, serum testosterone level was higher, as compared to that of a coetaneous group in the control, and androstenedione remained normal whereas 5 alpha-dihydrotestosterone (DHT) was decreased significantly. This led us to apply a 2% testosterone propionate ointment to the local skin, and which resulted in an apparent increase in DHT; the greater the increase multiple, the more the significance in clinical efficacy; suggesting that application of testosterone ointment may lead to the activation of 5 alpha-reductase and subsequently to an increase in DHT by which clinical symptoms also were alleviated. Papillomavirus antigen A test was carried out, for each lesion to search human papillomavirus (HPV) antigen, using avidin-bioton peroxidase complex (ABC) method with monoclonal antibody against papillomavirus. The results obtained revealed that antigens were negative on all in the case with lichen sclerosus and in a hyperplastic dystrophy case not associated with atypia, but cases judged as being positive included 9 of 14 with atypia and 5 of 6 with carcinoma in situ.(ABSTRACT TRUNCATED AT 250 WORDS)