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01.01.2009 | Leitthema

Diagnostik und Therapie der Lymphknoten bei Tumoren von Vagina und Vulva

verfasst von: Prof. Dr. H-G. Schnürch, M. Hampl

Erschienen in: Die Onkologie | Ausgabe 1/2009

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Zusammenfassung

Der Lymphabfluss aus der Vulva und dem distalen Drittel der Vagina verläuft über die Leistenlymphknoten (Leisten-LK), der aus den proximalen zwei Vaginaldritteln nach pelvin. Die Indikation zur Behandlung der Leisten-LK muss wegen hoher Komplikationsraten streng indiziert werden. Ab einer Infiltrationstiefe von 1 mm ist eine relevante Metastasierung zu erwarten. Bei Indikationsstellung zur LNE (Lymphonodektomie) sollte grundsätzlich eine inguinofemorale LNE durchgeführt werden. Bei lateral gelegenen T1-Tumoren der Vulva und freien ipsilateralen LK kann auf die kontralaterale LNE verzichtet werden. Bei fortgeschrittenem Befall der Leiste ist eine Behandlung der pelvinen LK durch Operation oder Bestrahlung indiziert. Bei sehr großen LK-Metastasen ist eine kombinierte Behandlung durch operatives Debulking und anschließende Radiochemotherapie zu diskutieren. Eine obligate postoperative Bestrahlung ist bei erhöhtem Rezidivrisiko indiziert. Dabei ist der Radiochemotherapie eine höhere Erfolgsrate zuzuordnen.
Literatur
1.
Zurück zum Zitat Abang Mohammed DK, Uberoi R, de BLA, Monaghan JM (2000) Inguinal node status by ultrasound in vulva cancer. Gynecol Oncol 77:93–96CrossRef Abang Mohammed DK, Uberoi R, de BLA, Monaghan JM (2000) Inguinal node status by ultrasound in vulva cancer. Gynecol Oncol 77:93–96CrossRef
2.
Zurück zum Zitat Benedet JL, Turko M, Fairey RN, Boyes DA (1979) Squamous cell carcinoma of the vulva: results of treatment 1938–1976. Am J Obstet Gynecol 134:201–206PubMed Benedet JL, Turko M, Fairey RN, Boyes DA (1979) Squamous cell carcinoma of the vulva: results of treatment 1938–1976. Am J Obstet Gynecol 134:201–206PubMed
3.
Zurück zum Zitat Benedet JL, Miller DM, Ehlen TG (1997) Basal cell carcinoma of the vulva: clinical features and treatment results in 28 patients. Obstet Gynecol 90:765–768PubMedCrossRef Benedet JL, Miller DM, Ehlen TG (1997) Basal cell carcinoma of the vulva: clinical features and treatment results in 28 patients. Obstet Gynecol 90:765–768PubMedCrossRef
4.
Zurück zum Zitat Bipat S, Fransen GA, Spijkerboer AM et al (2006) Is there a role for magnetic resonance imaging in the evaluation of inguinal lymph node metastases in patients with vulva carcinoma? Gynecol Oncol 103:1001–1006PubMedCrossRef Bipat S, Fransen GA, Spijkerboer AM et al (2006) Is there a role for magnetic resonance imaging in the evaluation of inguinal lymph node metastases in patients with vulva carcinoma? Gynecol Oncol 103:1001–1006PubMedCrossRef
5.
Zurück zum Zitat Burke TW, Levenback C, Coleman RL et al (1995) Surgical therapy of T1 and T2 vulvar carcinoma; further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol 57:215–220PubMedCrossRef Burke TW, Levenback C, Coleman RL et al (1995) Surgical therapy of T1 and T2 vulvar carcinoma; further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol 57:215–220PubMedCrossRef
6.
Zurück zum Zitat Buscema J, Stern JL, Woodruff JD (1981) Early invasive carcinoma of the vulva. Am J Obstet Gynecol 140:563–569PubMed Buscema J, Stern JL, Woodruff JD (1981) Early invasive carcinoma of the vulva. Am J Obstet Gynecol 140:563–569PubMed
7.
Zurück zum Zitat Cohn DE, Dehdashti F, Gibb RK et al (2002) Prospective evaluation of positron emission tomography for the detection of groin node metastases from vulvar cancer. Gynecol Oncol 85:179–184PubMedCrossRef Cohn DE, Dehdashti F, Gibb RK et al (2002) Prospective evaluation of positron emission tomography for the detection of groin node metastases from vulvar cancer. Gynecol Oncol 85:179–184PubMedCrossRef
8.
Zurück zum Zitat Curry SL, Wharton JT, Rutledge F (1980) Positive lymph nodes in vulvar squamous carcinoma. Gynecol Oncol 9:63–67PubMedCrossRef Curry SL, Wharton JT, Rutledge F (1980) Positive lymph nodes in vulvar squamous carcinoma. Gynecol Oncol 9:63–67PubMedCrossRef
9.
Zurück zum Zitat De Hullu JA, Pruim J, Que TH et al (1999) Non-invasive detection of inguinofemoral lymph node metastases in squamous cell cancer of the vulva by L. Int J Gynecol Cancer 9:141–146CrossRef De Hullu JA, Pruim J, Que TH et al (1999) Non-invasive detection of inguinofemoral lymph node metastases in squamous cell cancer of the vulva by L. Int J Gynecol Cancer 9:141–146CrossRef
10.
Zurück zum Zitat Feakins RM, Lowe DR (1997) Basal cell carcinoma of the vulva: a clinicopathologic study of 45 cases. Int J Gynecol Pathol 16:319–324PubMed Feakins RM, Lowe DR (1997) Basal cell carcinoma of the vulva: a clinicopathologic study of 45 cases. Int J Gynecol Pathol 16:319–324PubMed
11.
Zurück zum Zitat Gaarenstroom KN, Kentner GG, Trimbos JB et al (2003) Postoperative complications after vulvectomy and ingfem LNE using separate groin incisions. Int J Gynecol Cancer 13:522–527PubMedCrossRef Gaarenstroom KN, Kentner GG, Trimbos JB et al (2003) Postoperative complications after vulvectomy and ingfem LNE using separate groin incisions. Int J Gynecol Cancer 13:522–527PubMedCrossRef
12.
Zurück zum Zitat Gordonier ME, Malpica A, Burke TW (2003) Groin recurrence in patinetsa with vulvar cancer with negative nodes in superficial lymph node excision. Gynecol Oncol 90:625–628CrossRef Gordonier ME, Malpica A, Burke TW (2003) Groin recurrence in patinetsa with vulvar cancer with negative nodes in superficial lymph node excision. Gynecol Oncol 90:625–628CrossRef
13.
Zurück zum Zitat Hacker NF, Berek JS, Lagasse LD et al (1983) Management of regional lymph nodes and their prognostic influence in vulvar cancer. Obstet Gynecol 61:408–412PubMed Hacker NF, Berek JS, Lagasse LD et al (1983) Management of regional lymph nodes and their prognostic influence in vulvar cancer. Obstet Gynecol 61:408–412PubMed
14.
Zurück zum Zitat Hacker NF, Berek JS, Lagasse LD et al (1984) Individualization of treatment for stage I squamous cell vulvar carcinoma. Obstet Gynecol 63:155–162PubMed Hacker NF, Berek JS, Lagasse LD et al (1984) Individualization of treatment for stage I squamous cell vulvar carcinoma. Obstet Gynecol 63:155–162PubMed
15.
Zurück zum Zitat Hacker NF (2005) Vulvar Cancer. In Berek JS, Hacker NF (eds) Practical gynecologic oncology. Lippincott Williams & Wilkins, Philadelphia, pp 543–583 Hacker NF (2005) Vulvar Cancer. In Berek JS, Hacker NF (eds) Practical gynecologic oncology. Lippincott Williams & Wilkins, Philadelphia, pp 543–583
16.
Zurück zum Zitat Hall TB, Barton DP, Trott PA et al (2003) The role of ultrasound-guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: 5-year experience in 44 patients. Clin Radiol 58:367–371PubMedCrossRef Hall TB, Barton DP, Trott PA et al (2003) The role of ultrasound-guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: 5-year experience in 44 patients. Clin Radiol 58:367–371PubMedCrossRef
17.
Zurück zum Zitat Hawnaur JM, Reynolds K, Wilson G et al (2002) Identification of inguinal lymph node metastases from vulval carcinoma by magnetic resonance imaging: an initial report. Clin Radiol 57:995–1000PubMedCrossRef Hawnaur JM, Reynolds K, Wilson G et al (2002) Identification of inguinal lymph node metastases from vulval carcinoma by magnetic resonance imaging: an initial report. Clin Radiol 57:995–1000PubMedCrossRef
18.
Zurück zum Zitat Hoffmann JS, Kumar NB, Morley GW (1983) Microinvasive squamous carcinoma of the vulva: search for a definition. Obstet Gynecol 61:615–619 Hoffmann JS, Kumar NB, Morley GW (1983) Microinvasive squamous carcinoma of the vulva: search for a definition. Obstet Gynecol 61:615–619
19.
Zurück zum Zitat Hoffman JS, Kumar NB, Morley GW (1985) Prognostic significance of groin lymph node metastases in squamous carcinoma of th vulva. Obstet Gynecol 66:402–406PubMed Hoffman JS, Kumar NB, Morley GW (1985) Prognostic significance of groin lymph node metastases in squamous carcinoma of th vulva. Obstet Gynecol 66:402–406PubMed
20.
Zurück zum Zitat Homesley HD, Bundy BN, Sedlis A et al (1993) Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva (a Gynecologic Oncology Group study). Gynecol Oncol 49:279–283PubMedCrossRef Homesley HD, Bundy BN, Sedlis A et al (1993) Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva (a Gynecologic Oncology Group study). Gynecol Oncol 49:279–283PubMedCrossRef
21.
Zurück zum Zitat Iversen T, Aalders JG, Christensen A, Kolstad P (1980) Squamous cell carcinoma of the vulva: a review of 424 patients, 1956–1974. Gynecol Oncol 9:271–279PubMedCrossRef Iversen T, Aalders JG, Christensen A, Kolstad P (1980) Squamous cell carcinoma of the vulva: a review of 424 patients, 1956–1974. Gynecol Oncol 9:271–279PubMedCrossRef
22.
Zurück zum Zitat Iversen T, Abeler V, Aalders J (1981) Individualized treatment of stage I carcinoma of the vulva. Obstet Gynecol 57:85–89PubMed Iversen T, Abeler V, Aalders J (1981) Individualized treatment of stage I carcinoma of the vulva. Obstet Gynecol 57:85–89PubMed
23.
Zurück zum Zitat Jackson KS, Fankam EF, Das N et al (2006) Unilateral groin and pelvic irradiation for unilaterally nodal –positive women with vulva cancer. Int J Gynecol Cancer 16:283–287PubMedCrossRef Jackson KS, Fankam EF, Das N et al (2006) Unilateral groin and pelvic irradiation for unilaterally nodal –positive women with vulva cancer. Int J Gynecol Cancer 16:283–287PubMedCrossRef
24.
Zurück zum Zitat Klemm P, Marnitz S, Koehler C et al (2005) Clinical implication of laparoscopic pelvic lymphadenectomy in patients with vulvar cancer and positive groin nodes. Gynecol Oncol 99:101–105PubMedCrossRef Klemm P, Marnitz S, Koehler C et al (2005) Clinical implication of laparoscopic pelvic lymphadenectomy in patients with vulvar cancer and positive groin nodes. Gynecol Oncol 99:101–105PubMedCrossRef
25.
Zurück zum Zitat Krishna RP, Sistla SC, Smile R et al (2008) Sonography: an underutilized diagnostic tool in the assessment of metastatic groin nodes. J Clin Ultrasound 36:212–217PubMedCrossRef Krishna RP, Sistla SC, Smile R et al (2008) Sonography: an underutilized diagnostic tool in the assessment of metastatic groin nodes. J Clin Ultrasound 36:212–217PubMedCrossRef
26.
Zurück zum Zitat Land R, Herod J, Moskovic E et al (2006) Routine computerized tomography scanning, groin ultrasound with or without fine needle aspiration cytology in the surgical management of primary squamous cell carcinoma of the vulva. Int J Gynecol Cancer 16:312–317PubMedCrossRef Land R, Herod J, Moskovic E et al (2006) Routine computerized tomography scanning, groin ultrasound with or without fine needle aspiration cytology in the surgical management of primary squamous cell carcinoma of the vulva. Int J Gynecol Cancer 16:312–317PubMedCrossRef
27.
Zurück zum Zitat Leiserowitz GS, Russell AH, Kinney WK et al (1997) Phrophylactic chemoradiation of inguinofemoral lymph nodes in patients with locally extensive vulvar cancer. Gynecol Oncol 66:509–514PubMedCrossRef Leiserowitz GS, Russell AH, Kinney WK et al (1997) Phrophylactic chemoradiation of inguinofemoral lymph nodes in patients with locally extensive vulvar cancer. Gynecol Oncol 66:509–514PubMedCrossRef
28.
Zurück zum Zitat Magrina JF, Webb MJ, Gaffey TA, Symmonds RE (1979) Stage I squamous cell cancer of the vulva. Am J Obstet Gynecol 134:453–457PubMed Magrina JF, Webb MJ, Gaffey TA, Symmonds RE (1979) Stage I squamous cell cancer of the vulva. Am J Obstet Gynecol 134:453–457PubMed
29.
Zurück zum Zitat Moskovic EC, Shepherd JH, Barton DP et al (1999) The role of high resolution ultrasound with guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: a pilot study. Br J Obstet Gynaecol 106:863–867PubMed Moskovic EC, Shepherd JH, Barton DP et al (1999) The role of high resolution ultrasound with guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: a pilot study. Br J Obstet Gynaecol 106:863–867PubMed
30.
Zurück zum Zitat Parker RT, Duncan I, Rampone J, Creasman W (1975) Operative management of early invasive epidermoid carcinoma of the vulva. Am J Obstet Gynecol 123:349–355PubMed Parker RT, Duncan I, Rampone J, Creasman W (1975) Operative management of early invasive epidermoid carcinoma of the vulva. Am J Obstet Gynecol 123:349–355PubMed
31.
Zurück zum Zitat Parthasarathy A, Cheung M K, Osann K et al (2006) The benefit of adjuvant radiation therapy in single-node-positive squamous cellnvulvar carcinoma. Gynecol Oncol 103:1095–1099PubMedCrossRef Parthasarathy A, Cheung M K, Osann K et al (2006) The benefit of adjuvant radiation therapy in single-node-positive squamous cellnvulvar carcinoma. Gynecol Oncol 103:1095–1099PubMedCrossRef
32.
Zurück zum Zitat Piura B, Rabinovich A, Dgani R (1999) Basal cell carcinoma of the vulva. J Surg Oncol 70:172–176PubMedCrossRef Piura B, Rabinovich A, Dgani R (1999) Basal cell carcinoma of the vulva. J Surg Oncol 70:172–176PubMedCrossRef
33.
Zurück zum Zitat Podratz KC, Symmonds RE, Taylor WF (1982) Carcinoma of the vulva: analysis of treatment failures. Am J Obstet Gynecol 143:340–347PubMed Podratz KC, Symmonds RE, Taylor WF (1982) Carcinoma of the vulva: analysis of treatment failures. Am J Obstet Gynecol 143:340–347PubMed
34.
Zurück zum Zitat Podratz KC, Symmonds RE, Taylor WF, Williams TJ (1983) Carcinoma of the vulva: analysis of treatment and survival. Obstet Gynecol 61:63–74PubMed Podratz KC, Symmonds RE, Taylor WF, Williams TJ (1983) Carcinoma of the vulva: analysis of treatment and survival. Obstet Gynecol 61:63–74PubMed
35.
Zurück zum Zitat Ross M, Ehrmann RL (1987) Histologic prognosticators in stage I squamous cell carcinoma of the vulva. Obstet Gynecol 70:774–779PubMed Ross M, Ehrmann RL (1987) Histologic prognosticators in stage I squamous cell carcinoma of the vulva. Obstet Gynecol 70:774–779PubMed
36.
Zurück zum Zitat Ryan M, Stainton C, Slayter EK et al (2003) Aetiology and prevalence of lower limb edema following treatment for gyn cancer. Aust N Z J Obstet Gynecol 43:148–151CrossRef Ryan M, Stainton C, Slayter EK et al (2003) Aetiology and prevalence of lower limb edema following treatment for gyn cancer. Aust N Z J Obstet Gynecol 43:148–151CrossRef
37.
Zurück zum Zitat Schausberger C, Six L, Horvat R, Joura EA (2000) Groin metastasis after extensive microinvasive vulvar cancer. A case report. J Reprod Med 52:78–80 Schausberger C, Six L, Horvat R, Joura EA (2000) Groin metastasis after extensive microinvasive vulvar cancer. A case report. J Reprod Med 52:78–80
38.
Zurück zum Zitat Sedlis A, Homesley H, Bundy BN et al (1987) Positive groin lymph nodes in superficial squamous cell vulvar cancer. A gynecologic oncology group study. Am J Obstet Gynecol 156:1159–1164PubMed Sedlis A, Homesley H, Bundy BN et al (1987) Positive groin lymph nodes in superficial squamous cell vulvar cancer. A gynecologic oncology group study. Am J Obstet Gynecol 156:1159–1164PubMed
39.
Zurück zum Zitat Singh K, Orakwue CO, Honest H et al (2006) Accuracy of magnetic resonance imaging of inguinofemoral lymph nodes in vulval cancer. Int J Gynecol Cancer16:1179–1183CrossRef Singh K, Orakwue CO, Honest H et al (2006) Accuracy of magnetic resonance imaging of inguinofemoral lymph nodes in vulval cancer. Int J Gynecol Cancer16:1179–1183CrossRef
40.
Zurück zum Zitat Stehman FB, Bundy BN, Dvoretsky PM, Creasman WT (1992) Early stage 1 carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the gynaecologic oncolgy group. Obstet Gynecol 79:490–497PubMed Stehman FB, Bundy BN, Dvoretsky PM, Creasman WT (1992) Early stage 1 carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the gynaecologic oncolgy group. Obstet Gynecol 79:490–497PubMed
41.
Zurück zum Zitat Struijk APHB, Bouma JJ, Lindert ACM van (1989) Early stage cancer of the vulva: a pilot investigation on cancer of the vulva in gynecologic oncology centers in the Netherlands. Proc Int Gynecol Cancer Soc 2: 303 (abstr) Struijk APHB, Bouma JJ, Lindert ACM van (1989) Early stage cancer of the vulva: a pilot investigation on cancer of the vulva in gynecologic oncology centers in the Netherlands. Proc Int Gynecol Cancer Soc 2: 303 (abstr)
42.
Zurück zum Zitat Velden J Van der, Lindert ACM van, Lammes FB (1995) Extracapsular growth of lymph node metastases in squamous cell cancer of the vulva, the impact on recurrence and survival. Cancer 75:2885–2890PubMedCrossRef Velden J Van der, Lindert ACM van, Lammes FB (1995) Extracapsular growth of lymph node metastases in squamous cell cancer of the vulva, the impact on recurrence and survival. Cancer 75:2885–2890PubMedCrossRef
43.
Zurück zum Zitat Velden J Van der (2000) Surgery in the primary management of vulvar cancer. In Luesley DM (ed) Cancer and precancer of the vulva. Arnold, London, pp 106–119 Velden J Van der (2000) Surgery in the primary management of vulvar cancer. In Luesley DM (ed) Cancer and precancer of the vulva. Arnold, London, pp 106–119
44.
Zurück zum Zitat Velden J Van der, Ansink A (2005) Primary groin irradiation vs primary groin surgery for early vulvar cancer (Review). The Cochrane Library Issue 2 Velden J Van der, Ansink A (2005) Primary groin irradiation vs primary groin surgery for early vulvar cancer (Review). The Cochrane Library Issue 2
45.
Zurück zum Zitat Wharton JT, Gallagher S, Rutledge FN (1974) Microinvasive carcinoma of the vulva. Am J Obstet Gynecol 118:159–162PubMed Wharton JT, Gallagher S, Rutledge FN (1974) Microinvasive carcinoma of the vulva. Am J Obstet Gynecol 118:159–162PubMed
46.
Zurück zum Zitat Wilkinson EJ, Rico MJ, Pierson KK 57 (1982) Microinvasive carcinoma of the vulva. Int J Gynecol Pathol 1:29–39PubMedCrossRef Wilkinson EJ, Rico MJ, Pierson KK 57 (1982) Microinvasive carcinoma of the vulva. Int J Gynecol Pathol 1:29–39PubMedCrossRef
Metadaten
Titel
Diagnostik und Therapie der Lymphknoten bei Tumoren von Vagina und Vulva
verfasst von
Prof. Dr. H-G. Schnürch
M. Hampl
Publikationsdatum
01.01.2009
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 1/2009
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-008-1539-2

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