Abstract
Vaginal intraepithelial neoplasia (VAIN) is a rare disease associated with human papillomavirus infection. High-grade VAIN is typically treated with either excisional or ablative therapy. However, recurrent VAIN lesions are common and these treatments cause vaginal scarring. Recent studies have indicated that 5% imiquimod is an effective treatment for VAIN. The present report describes a case of a woman diagnosed with recurrent VAIN 3 who was treated with a 5% topical imiquimod cream and achieved a complete response after excision and CO2 laser vaporization. A 53-year-old, gravida 5, para 2 postmenopausal woman who was diagnosed with papillary squamous cell carcinoma by biopsy underwent conization, total abdominal hysterectomy and bilateral salpingo-oophorectomy. A histological examination revealed grade 3 cervical intraepithelial neoplasia with free surgical margins. At 3 years after the hysterectomy, the vaginal smear revealed atypical squamous cells, leading to a pathological diagnosis of VAIN 3. Partial vaginectomy was performed, and VAIN 3 was detected in the lesion with positive margins. At 4 months into follow-up, the vaginal smear revealed a high-grade squamous intraepithelial lesion (HSIL), and subsequent biopsy during colposcopy revealed a pathological diagnosis of VAIN 3. At 3 months after CO2 laser vaporization, the vaginal smear revealed HSIL with suspected recurrence and imiquimod treatment was initiated. One sachet of 5% imiquimod cream (0.25 g) was placed in the entire vagina three times per week for 14 weeks with no apparent complications. At 3 years after the treatment, there has been no recurrence. This case demonstrated that topical imiquimod with careful follow-up is an effective treatment for VAIN and is well-tolerated. Further clinical evidence of the effectiveness and safety of imiquimod in patients diagnosed with VAIN is required.
Highlights
Vaginal intraepithelial neoplasia (VAIN) is a rare disease associated with human papillomavirus (HPV) infection
In the World Health Organization (WHO) 2014 classification, VAIN lesions are graded as vaginal low‐grade and high‐grade squamous intraepithelial lesions (LSIL and HSIL, respectively) with LSIL including VAIN 1 and HSIL including VAIN 2 and VAIN 3
VAIN 1 can be considered a form of productive HPV infection, which can be expectantly managed with a spontaneous regression rate of over 50% [2]
Summary
Vaginal intraepithelial neoplasia (VAIN) is a rare disease associated with human papillomavirus (HPV) infection. We here report a case of a woman who was diagnosed with recurrent VAIN 3 and treated with 5% topical imiquimod cream after surgical treatment and achieved a complete response. SASAGASAKO et al: VAIN SUCCESSFULLY TREATED WITH IMIQUIMOD squamous cell carcinoma by biopsy (Fig. 1) and underwent conization, resulting in a pathological diagnosis of grade 3 cervical intraepithelial neoplasia (CIN). Eight months after the hysterectomy, a vaginal smear revealed atypical squamous cells, cannot exclude HSIL (ASC‐H). Vaginal biopsy was performed 1 month later on the lesion at the 8‐o'clock position during colposcopy, resulting in a pathological diagnosis of VAIN 3 (Fig. 3). At 53 days and 74 days after the treat‐ ment, the vaginal smear revealed ASC‐H and was negative for intraepithelial lesion or malignancy (NILM). As of 3 years after the treatment, there has been no recurrence
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