title: Grade 3 vulvar and anal intraepithelial neoplasia in a HIV seropositive child--therapeutic result: case report.
abstract: A case report of a HIV seropositive 8-year-old child with vulvar and anal border neoplasia, both grade 3, and the adopted therapeutic management are presented. The mother reported the history of a progressively growing verrucous lesion in the vulva since the age of three and a half years. On physical examination a pigmented and elevated lesion was observed in the whole vulvar region extending to the anal region and intergluteal sulcus. After biopsies and anatomic pathological examination, antiretroviral therapy, adequate for age, and topical application of podophyllotoxin associated with Thuya officinalis extract was started. Three months afterwards vaporization and CO2 laser excision were performed in five sequential sessions, thereafter associated with topical imiquimod application. After the first two sessions of laser therapy early relapses occurred. After four weeks of imiquimod use, already a significant improvement of the lesions was observed, making the following laser therapy sessions easier. We conclude that antiretroviral therapy associated with podophyllotoxin and Thuya was not effective regarding regression of the lesions. Laser therapy alone led to early relapses. The local use of imiquimod associated with laser was effective in decreasing and controling the lesions.
authors.affiliation: Sector of Pathology of the Inferior Genital Tract, Department of Gynecology, UNIFESP, Department of Gynecology, Hospital AC Camargo, São Paulo, Brazil.
authors.forename: N M Speck
authors.initials: NM
authors.lastname: de Góis
authors.forename: R R L
authors.initials: RR
authors.lastname: Costa
authors.forename: F
authors.initials: F
authors.lastname: Kesselring
authors.forename: V G
authors.initials: VG
authors.lastname: de Freitas
authors.forename: J C L
authors.initials: JC
authors.lastname: Ribalta
authors.forename: M P
authors.initials: MP
authors.lastname: Kobata
authors.forename: N S
authors.initials: NS
authors.lastname: Taha
mesh_terms: D000287:Administration, Topical; D000634:Aminoquinolines / Q000008:administration & dosage; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000473:pathology / Q000628:therapy*; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D006679:HIV Seropositivity; D006801:Humans; D000077271:Imiquimod; D016867:Immunocompromised Host; D028022:Low-Level Light Therapy / Q000379:methods; D030361:Papillomavirus Infections / Q000473:pathology / Q000628:therapy; D018570:Risk Assessment; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000634:Aminoquinolines; D019380:Anti-HIV Agents; D000077271:Imiquimod