Diagnosis Of Vulvar Intraepithelial Neoplasia Research Articles

Vulval premalignant lesions: a review article.

Vulvar intraepithelial neoplasia (VIN) is a noninvasive squamous lesion that is a precursor of vulvar squamous cell cancer. Currently, no screening tests are available for detecting VIN, and a biopsy is performed to confirm the clinical diagnosis. Despite sharing many risk factors with cervical intraepithelial neoplasia, the diagnosis of VIN is poses challenges, contributing to its increasing prevalence. This study aimed to analyze the underlying risk factors that contribute to the development of VIN, identify specific populations at risk, and define appropriate treatment approaches. Differentiated VIN (dVIN) and usual VIN (uVIN) are the classifications of VIN. While dVIN is associated with other vulvar inflammatory disorders, such as lichen sclerosis, the more prevalent uVIN is associated with an underlying human papillomavirus infection. Patients with differentiated VIN have an increased risk of developing invasive malignancies. Few effective surveillance or management techniques exist for vulvar intraepithelial neoplasia, a preinvasive neoplasm of the vulva. For suspicious lesions, a thorough examination and focused biopsy are necessary. Depending on the specific needs of each patient, a combination of surgical and medical approaches can be used.

The results analysis of cytological examination of vulvar intraepithelial neoplasia compared to histology report

Timely diagnosis and effective treatment of precancerous diseases of the female genital organs prevent the development of oncogynecological diseases. Vulvar intraepithelial neoplasia is a precancerous disease characterized by lesions of the stratified squamous epithelium with impaired maturation and normal keratinization of cells, but without inclusion of the basement membrane in the pathological process. The main methods of diagnosis of vulvar intraepithelial neoplasia are vulvoscopy, cytological and histological examination.
 The aim of this study was to assess the clinical significance and effectiveness of different sampling methods for cytological examination in comparison with histological report.
 Materials and methods. The study involved 235 women aged 35-79 years, with a mean age of 57±11,3 years with complaints of pain, burning, discomfort and itching in the vulva. All patients underwent a simple vulvoscopy, where atrophy of the mucosa, partial or complete loss of the clitoris and / or labia minora, fissures, ecchymoses (haemorrhages), eroded surfaces, exophytic growths from 1 to 5 cm were detected. Material sampling was performed by various cytological methods.
 Results. According to the results of the study, no significant differences between the methods of cytological sampling were observed. The cytological report was compared to the result of histological examination of biopsies. According to the results of cytological examination, squamous cell carcinoma of the vulva was detected in 12 patients, atrophy was identified in 5 women and squamous epithelial scales cytologically detected in the remaining 218 women.
 Conclusions. The sensitivity and specificity of cytological examination methods were high in the presence of eroded surfaces and exophytic lesions. It was found that cytological research methods were not informative enough to detect vulvar cancer, which is in the stratum of hyperkeratosis, and was diagnosed in 5.1 % of patients. Therefore, for the reliability of the results and confirmation of the diagnosis it is necessary to conduct histological examination, with the help of which 14.9 % of patients were diagnosed with squamous cell carcinoma

Presence of human papilloma virus in Caucasian women living in the central Europe diagnosed with vulvar intraepithelial neoplasia.

The role of human papilloma virus (HPV) in the development of cancerous states of female reproductive tract has been widely debated. However, the information about presence of HPV in the Caucasian women living in the central Europe diagnosed with vulvar intraepithelial neoplasia (VIN) is missing. So far, no recommendation was made to complete HPV detection in time of vulvar biopsy or after the results of positive VIN are obtained. We aimed to assess the presence of HPV in women with vulvar intraepithelial neoplasia diagnosed at the Department of Gynecology, Obstetrics and Oncological Gynecology in Bytom, Poland. The retrospective examination of 120 consecutive vulvar biopsies obtained from women with persistent vulvar itching was done. Only patients with diagnosis of VIN were included in the further analysis. HPV DNA was detected using HPV Linear Array Genotyping Test including 14 HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68). Out of 120 vulvar samples retrieved, 18 women were positive for VIN, including15 usual VIN (uVIN) and three differentiated type (dVIN ). 10 samples were eligible for DNA detection. HPV DNA was found in two women with uVIN (HPV 16 and 51). It is advisable to recommend HPV genotyping in women with VIN, regardless of their age and histologic type. The incidence of HPV infection in Caucasian women from the central Europe with VIN should be further studied.

Recovery therapy after photodynamic therapy of background and precancerous diseases of the vulva

A comprehensive approach that includes the treatment of background and precancerous diseases of the vulva by photodynamic therapy and plasma therapy as rehabilitation therapy was developed. The method’s effectiveness was evaluated. The study is also aimed at evaluating the effectiveness of plasma therapy after treatment of background and precancerous diseases of the vulva by photodynamic therapy. The work is based on the study results of 60 patients aged 32 to 70 years old, mean age was (53.3+3.6) years, with a morphologically verified diagnosis of vulvar intraepithelial neoplasia, mixed vulvar dystrophy (Lichen sclerosus et atrophicus, squamous cell hyperplasia), which were divided into two groups. Patients of both groups underwent photodynamic therapy using an intravenous photosensitizer «Fotolon®» (RUE «Belmedpreparaty», Republic of Belarus), which is a complex of chlorine ебс trisodium salt with low molecular weight polyvinylpyrrolidone. The session of photodynamic therapy was performed 3^1 hours after the end of the FS infusion using a universal laser coagulator «Likar-Hirurg (Surgeon)» («Photonica Plus», Ukraine, A-660 nm). Plasma therapy was performed for patients of group 2 after photodynamic therapy. It has been established that the use of photodynamic therapy and plasma therapy increases the effect of treatment of background and precancerous diseases of the vulva, accelerates the period of damaged tissues regeneration and rehabilitation of patients twice and prolongs the recurrence-free period of the disease. Keywords: photodynamic therapy, plasma therapy, precancerous diseases of the vulva.

Papillomavirus genotyping on formaldehyde fixed paraffin-embedded tissues in vulvar intraepithelial neoplasia.

Few studies have described the epidemiology of human papillomavirus (HPV) in vulvar intraepithelial neoplasia (VIN). The aim of this study was to genotype HPV on formalin fixed paraffin-embedded tissues in VIN lesions. A 5-year retrospective study was conducted by including all patients attending the teaching hospital of Nice with a diagnosis of VIN between 1st January 2010 and 31st December 2014. For all patients, HPV genotyping was performed with the PapilloCheck® microarray kit, routinely used on cervical cytology samples, and optimized for formaldehyde fixed paraffin-embedded tissues in VIN. Forty patients were included in the study: 39 patients had usual VIN and one presented with differentiated VIN. Among the 39 patients with usual VIN, the prevalence of HPV was 90% (35/39). Thirty-two patients had high grade VIN (82%) and seven low grade VIN (18%). In high grade VIN, the most represented HPV types were: HPV 16 (21/32 66%), HPV 56 (3/32 9%) and HPV 33 (2/32 6%). In low grade VIN, the most represented HPV types were: HPV 16 (4/7 57%) and HPV 6 (3/7 43%). Interestingly, 5/39 (13%) of patients diagnosed with usual VIN also had co-existing lichen sclerosus. We have optimized a HPV genotyping technique, routinely used on cervical cytology samples, and on paraffin fixed embedded tissue showing VIN. Moreover, we have identified five patients with lichen sclerosus co-existing with usual VIN. This association has rarely been reported and proves that these two entities can coexist.

HPV status and favourable outcome in vulvar squamous cancer.

It is universally accepted that high-risk human papillomavirus (HR-HPV) is the cause of cervical dysplasia and cancer. More recently, it has been shown that HPV is also a marker of clinical outcome in oropharyngeal cancer. However, contemporary information is lacking on both the prevalence of HPV infection in vulvar cancer (VSCC), its precursor lesion, vulvar intraepithelial neoplasia (VIN) and the influence of HPV-status on the prognosis of this malignancy. We have conducted a detailed population-based study to examine rates of progression of VIN to VSCC, type-specific HPV prevalence in vulvar disease and the influence of HPV status on clinical outcome in VSCC. We observed that the age at which women are diagnosed with VSCC is falling and there is a significant time gap between first diagnosis of VIN and progression to invasive disease. HR-HPV infection was detected in 87% (97/112) cases of VIN and 52% cases (32/62) of VSCC. The presence of HR-HPV in squamous intraepithelial lesion was associated with lower rates of progression to invasive cancer (hazard ratio, 0.22, p = 0.001). In the adjusted analysis, HR-HPV was associated with improved progression-free survival of VSCC compared to those with HPV negative tumours (hazard ratio, 0.32, p = 0.02).

Vulvar intraepithelial neoplasia

Vulvar intraepithelial neoplasia (VIN) is a high-grade intraepithelial squamous lesion and precursor of invasive squamous cell carcinoma (SCC). The 2004 International Society for the Study of Vulvovaginal Disease (ISSVD) classification distinguished two types of VIN: usual type (human papillomavirus (HPV)-related) and differentiated type (not HPV-related). The incidence of usual-type VIN is higher in younger women, while differentiated-type VIN is more common in older patients with chronic dermatologic conditions. Differentiated-type VIN has a greater invasive potential and shorter time between diagnosis and SCC than usual-type VIN. The diagnosis of VIN is carried out by identifying a lesion by visual inspection and confirming by performing a biopsy. Screening tests are not available. Patients with usual-type VIN are at a higher risk of developing another HPV-related malignancy of the anogenital tract; therefore, examination from the cervix to the perianal area is mandatory. The therapeutic approach to VIN balances the invasive potential with the need to be as conservative as possible. Current prophylactic HPV vaccines offer protection against usual-type VIN and related invasive carcinoma.

A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream: clinical implications

The authors report a case of usual-type (basaloid-type) vulvar intraepithelial neoplasia (VIN) 3 that failed to respond to imiquimod cream. A 51-year-old Japanese woman visited her local gynecologist complaining of vulvar itching. Atypical cells were noted in cytology smears, but nine vulvar biopsy specimens showed benign proliferation of epithelial tissue. The patient was placed under careful observation for 8months, when the vulvar smears once again showed atypical cells and biopsy specimens revealed VIN3. The patient was then referred to our hospital where she was given a diagnosis of VIN 3, basaloid type of usual type. The biopsy specimens were positive for p16 and the lesions were confirmed to be human papilloma virus (HPV)-related. We recommended simple vulvectomy but the patient requested conservative treatment with imiquimod cream. With her written informed consent, we prescribed imiquimod cream to be self-administered 3 times a week. Colposcopy and pap smear test were performed every 2weeks. Four weeks after the start of treatment, a fingertip-sized papule was detected at the patient's vaginal introitus. By 6weeks, the lesion had enlarged, and biopsy specimens revealed invasive squamous cell carcinoma. At 7weeks, we performed simple vulvectomy. The surgical specimen showed stage pT1b keratinizing-type squamous cell carcinoma. HPV-16 DNA was detected in the specimen.

Clinicopathologic analysis of 19 cases of usual type vulvar intraepithelial neoplasia

To reclassify the patients with former diagnosis of vulvar intraepithelial neoplasia (VIN)II, VINII-III, VINIII, Bowen disease and Bowenoid papulosis according to the 2004 modified terminology of International Society for the Study of Vulvar Disease (ISSVD) and evaluate the effects of surgical treatment. According to the 2004 modified terminology of ISSVD, a retrospective review of the histological slides of 19 cases, who diagnosed as VINII, VINII-III, VINIII, Bowen disease and Bowenoid papulosis treated in Peking Union Medical College Hospital from 1999 to 2006, were performed to reclassify by pathologist and the clinicopathologic data were also analyzed. According to the 2004 modified terminology of ISSVD, all 19 cases were reclassified as usual type VIN and were belonged to the subtype of warty type except one, the only Bowen disease patient whose one of focuses belonged to the subtype of basaloid type and the other focus belonged to the subtype of warty type. The primary cure rate of extended local excision was 89% (17/19). There were two cases recurred during follow-up period, and were cured by second surgical treatment and the focuses of recurrence site were still diagnosed as warty type VIN. The patients with former diagnosis of VINII, VINII-III, VINIII, Bowen disease and Bowenoid papulosis are basically reclassified as usual type VIN (warty type) according to the 2004 modified terminology of ISSVD. The results showed that the diagnosis of VIN could be simplified by new terminology. The surgical excision is the good choice and combined cytologic and human papillomavirus (HPV) test during follow up is also important for patients of VIN.

Women's Experiences With Vulvar Intraepithelial Neoplasia

To explore women's experiences with vulvar intraepithelial neoplasia during diagnosis and treatment. Two focus groups, each with 3 participants, were conducted as a pilot study. Participants were asked open-ended questions about their experiences, quality of life, sexual functioning, body image, and well-being. Responses were audio taped, transcribed, and independently analyzed by 2 researchers to identify themes and develop categories of the participants' experiences. Participants were recruited from an urban oncology clinic. The study population consisted of 6 White women ranging in age from 22 to 72 years. Participants with a diagnosis of vulvar intraepithelial neoplasia were recruited using flyers posted in their oncologist's office. An interview guide was used focusing on participants' experiences. Participants described a cyclic journey with vulvar intraepithelial neoplasia related to the recurrent nature of the disease. Two internal influences on the journey were described: spirituality and time in life. Five external influences were discussed: significant others, health care providers, family, friends, and others with vulvar intraepithelial neoplasia. Health care providers cannot alter the recurrent nature of vulvar intraepithelial neoplasia; however, they can better understand a woman's experience and the variables that impact her experience in a negative or positive way.

TRATAMIENTO DE LA NEOPLASIA INTRA EPITELIAL VULVAR MEDIANTE VULVECTOMÍA TEGUMENTARIA

SUMMARY Between 1999 and 2005, 12 patients with the diagnosis of vulvar intraepithelial neoplasia were ingresses. The average age was 50 years (r: 26-74 years). The diagnosis was made by means of biopsy directed by vulvoscopy. In 9 women tegumental vulvectomy were performed according to technique that is described. 54.5% of the patients presented multiples vulvar lesions and 45.5% only one lesion at the examination. In biopsy, 63% of the lesion presented suggestive signs of infection by HPV. 55.5% of the treated patients did not present new lesions and 33% had one or more recurrences, 11% did not attend control, there were no surgical complications or mortality.

Vulvar intraepithelial neoplasia: a synopsis of recent developments.

This review highlights recent advances in our understanding of preneoplastic squamous lesions of the vulva, from a pathologist's perspective. Vulvar intraepithelial neoplasia (VIN) is the preferred nomenclature for these lesions. VIN lesions may or may not be symptomatic and have a variable clinical appearance. Three histological types of VIN are recognized. Although the term bowenoid papulosis was introduced for an entity distinct from VIN, current evidence indicates that cases with this clinical pathological presentation are better classified as VIN. The natural history of VIN is unpredictable, although age is regarded as a risk factor for developing invasive disease. The histopathological differential diagnosis of VIN includes several lesions, among which is a newly described entity-multinucleated atypia of the vulva. VIN1 lesions are diagnosed uncommonly. Whereas the incidence of invasive vulvar carcinoma in North America has not changed, VIN lesions are being increasingly detected. Finally, some histological features of VIN are important to consider with respect to therapy.

Vulvar Intraepithelial Neoplasia; Long-Term Follow-Up of Treated and Untreated Women

OBJECTIVE To investigate the long term outcome of patients with vulvar intraepithelial neoplasia. DESIGN A retrospective study using information obtained from patient casenotes. SAMPLE One hundred and thirty-three women with a primary diagnosis of vulvar intraepithelial neoplasia (VIN), identified during a 15-year period. RESULTS The diagnosis of vulvar intraepithelial neoplasia increased throughout the study period. Human papilloma virus changes were noted in 104 patients (78%); these women were significantly younger than those without (P < or = 0.001). Nineteen (14%) were managed by observation or medical treatment and the remainder by surgical methods. Histological or symptomatic recurrence after surgical treatment occurred in 55 (48%). When disease recurred, it usually did so within four years of treatment. Recurrence was more common following laser vapourisation than after local excision (75% vs 40%; P < or = 0.01). Progression to invasive disease occurred in nine patients (7%), none of whom were in the group being observed. Four deaths occurred in this group, three from gynaecological malignancies of the lower genital tract. CONCLUSION Patients with vulvar intraepithelial neoplasia require long term follow up, and the risk of invasion may be higher than previously thought. Surgical treatment when required should be by excisional rather than ablative methods in most instances. In selected cases it is also possible to safely manage patients by more conservative methods.

Vulvar intraepithelial neoplasia: long term follow up of treated and untreated women.

To investigate the long term outcome of patients with vulvar intraepithelial neoplasia. A retrospective study using information obtained from patient casenotes. One hundred and thirty-three women with a primary diagnosis of vulvar intraepithelial neoplasia (VIN), identified during a 15-year period. The diagnosis of vulvar intraepithelial neoplasia increased throughout the study period. Human papilloma virus changes were noted in 104 patients (78%); these women were significantly younger than those without (P < or = 0.001). Nineteen (14%) were managed by observation or medical treatment and the remainder by surgical methods. Histological or symptomatic recurrence after surgical treatment occurred in 55 (48%). When disease recurred, it usually did so within four years of treatment. Recurrence was more common following laser vapourisation than after local excision (75% vs 40%; P < or = 0.01). Progression to invasive disease occurred in nine patients (7%), none of whom were in the group being observed. Four deaths occurred in this group, three from gynaecological malignancies of the lower genital tract. Patients with vulvar intraepithelial neoplasia require long term follow up, and the risk of invasion may be higher than previously thought. Surgical treatment when required should be by excisional rather than ablative methods in most instances. In selected cases it is also possible to safely manage patients by more conservative methods.

Unrecognized invasive carcinoma in vulvar intraepithelial neoplasia (VIN)

Sixty-nine patients having had pretreatment biopsy diagnosis of vulvar intraepithelial neoplasia were treated with surgical excision of all visible lesions. Complete surgical specimens were submitted for pathological study in an attempt to identify occult invasive vulvar carcinoma. Unsuspected invasion was noted in 13 patients (18.8%). Superficial invasion (<1 mm) was seen in 8 patients, 4 had > 1 mm of invasion, and one verrucous carcinoma was identified. Patients of advancing age with disease that had a raised and irregular surface pattern were more likely to have lesions with occult invasion. Treatment that utilizes ablative techniques cannot be recommended based on the use of preoperative representative biopsies.

Carbon Dioxide Laser Therapy for Vulvar Intraepithelial Neoplasia

Carbon dioxide (CO2) laser therapy for vulvar intraepithelial neoplasia (VIN) is a very accurate method of treatment, giving excellent cosmetic results. Forty-three women diagnosed as suffering from VIN were treated by means of the CO2 laser. In 19 of 26 premenopausal patients, VIN was associated with histologic evidence of human papillomavirus (HPV) infection (73.1%). In only 2 of 17 postmenopausal women, such evidence was found (11.8%)—a statistically significant difference. Five women experienced recurrence of the disease. Four were premenopausal, and all had association with HPV infection. In one postmenopausal patient, no signs of HPV were found. We conclude that the association of HPV with the diagnosis of VIN has a deleterious effect on treatment results.