Mauro Francesco Pio Maiorano

Radiation necrosis mimicking tumor recurrence after chemoradiation for vaginal squamous cell carcinoma

Radiation necrosis is a rare but serious complication of pelvic chemoradiotherapy that may closely mimic tumor recurrence on both imaging and clinical examination. We describe the case of a 43-year-old woman with FIGO stage II vaginal squamous cell carcinoma and synchronous CIN3 who developed profuse vaginal discharge and necrotic cervical lesions five months after completing chemoradiation and brachytherapy. MRI revealed a necrotic cervical mass with suspicious features, while biopsies initially yielded inconclusive results. A multidisciplinary approach was adopted: the patient received empirical antibiotics, underwent necrotic tissue debridement, and repeat biopsies. Final histology showed no viable malignancy, confirming radiation necrosis. The patient was managed conservatively with symptomatic improvement. This case highlights the diagnostic challenge of distinguishing necrosis from recurrence, where early imaging, cytology, and even initial biopsies may be misleading. Thorough evaluation and repeated sampling are essential to avoid overtreatment. We provide a literature-informed comparison of distinguishing features to guide clinical decision-making.

Vulvar Paget’s disease: prognostic factors and survival outcomes from a retrospective cohort analysis

Vulvar Paget's disease (VPD) is a rare intra-epithelial neoplasm with a high recurrence rate and uncertain prognostic factors. This retrospective study aimed to evaluate disease-free survival (DFS) and overall survival (OS) in 27 patients diagnosed with VPD, assessing the impact of surgical type, disease extent, resection margins, lymphadenectomy, wound dehiscence and age. Kaplan-Meier analysis and Cox proportional hazards regression were used to determine survival outcomes and prognostic factors. The results revealed that surgical type had a significant influence on OS, with patients undergoing simple excision/vulvectomy achieving better survival outcomes than those who underwent radical vulvectomy (p = 0.036). Age was also identified as a significant predictor of OS, with increasing age associated with reduced risk of mortality (p = 0.017). However, no significant associations were found between DFS and any of the clinical factors examined, except for borderline significance for wound dehiscence (p = 0.061). The literature review confirmed the high recurrence rate and heterogeneity in outcomes. These findings reinforce the need for individualized treatment, as radical surgery did not confer a survival advantage. Given the emerging role of molecular biomarkers such as HER2 and PD-L1 in VPD, future studies should explore targeted therapies to optimize treatment strategies. Larger, multi-centric studies with extended follow-up are needed to refine prognostic factors and improve patient outcomes.