Incidence Of Vulvar Intraepithelial Neoplasia Research Articles

A Pseudo Papillomatous Vulva: A Diagnostic Challenge

Vulvar malignancies are rarely encountered in dermatology. The vulvar intraepithelial neoplasia (VIN) are the most common ones and the incidence of VIN is increasing in younger women. Early diagnosis and tailoring the management on individual basis may help to reduce the long-term morbidity. We report a case of differentiated VIN of the vulva presenting a pseudo papillomatous aspect mimicking a granulomatous disease.

Vulvar premalignancies – A dermatologist’s perspective

Vulvar malignancies are rarely encountered in dermatology, yet it is imperative to develop a thorough clinical and diagnostic acumen, as early detection and appropriate treatment can improve quality of life or even prevent fatal outcome. The common premalignant vulvar lesions are vulvar intraepithelial neoplasia (VIN), vulvar Paget’s disease, and melanoma in situ. These are notable since they are associated with a high post-treatment recurrence rate. The incidence of VIN is increasing in younger women. Early diagnosis and tailoring the management on individual basis may help to reduce the long-term morbidity. This review describes etiology, clinical features, management, and prognosis of vulvar premalignancies.

The Impact of Focality and Centricity on Vulvar Intraepithelial Neoplasia on Disease Progression in HIV+ Patients: A 10-Year Retrospective Study

Background: The impact of lesion focality and centricity in relation to patient outcome and disease recurrence of vulvar intraepithelial neoplasia (VIN) is an understudied area of research, especially in immunocompromised women. The prevalence and incidence of VIN have increased steadily since the 1980s because of the co-existence of human papillomavirus (HPV) and human immunodeficiency virus (HIV). In this study, we retrospectively examined the records of VIN patients to determine the effect of lesion focality and centricity with respect to the interval to disease recurrence. Materials and Methods: All women diagnosed with VIN and managed between January 2002 and December 2011 were included (n = 90) and followed up until December 2017. Symptoms at the time of presentation, including HIV positivity (n = 75), were collated, including the influences of multifocality and multicentricity on time to disease recurrence. Results: Multicentricity caused a more rapid recurrence of disease than unicentricity (p = 0.006), whereas multifocality increased the risk of recurrence more than unifocality (p < 0.0001). Viral load in the HIV+ patients was not associated with time to disease recurrence, but the reduced number of CD4+ lymphocytes present in HIV+ patients was. Treatment modalities had no effect on disease recurrence. Conclusion: Both focality and centricity have effects on interval to recurrence and final patient outcome, with multifocal disease having a poorer prognosis. Centricity and focality should be recorded at the time of diagnosis and act as a warning for disease recurrence. HIV+ VIN patients with multifocal disease and/or known immunosuppression (low CD4+ lymphocyte counts) should be regarded as “high-risk” patients and treated accordingly.

Traitement des néoplasies vulvaires intra-épithéliales par imiquimod

The incidence of vulvar intra-epithelial neoplasia (VIN) is increasing in the developed countries especially in young women. There is little consensus regarding the optimal management. Surgery used to be the gold standard. Alternatives to surgery are now needed for the treatment of VIN. Many studies investigated the effectiveness of Imiquimod 5% cream in this pathology. We present a literature review of the results published on the subject.

Trends in incidence and survival of Dutch women with vulvar squamous cell carcinoma

AimPrevious studies showed an increase in incidence of vulvar intraepithelial neoplasia (VIN), the premalignant lesion of Vulvar Squamous Cell Carcinoma (VSCC). Furthermore, during the last decades treatment of VSCC became less radical. Considering these changes the aim of this study was to describe trends of incidence and survival of patients with VSCC in the Netherlands. MethodsAll patients with VSCC diagnosed between 1989 and 2010 (n=4614) were selected from the Netherlands Cancer Registry. Trends in age-adjusted incidence rates were evaluated by calculating the estimated annual percentage change (EAPC). Joinpoint regression analysis was used to detect changes in trends. Five-year relative survival rates were calculated for four time periods. ResultsThe incidence of VSCC has increased since 2002 (EAPC 5.0; 95% confidence interval (CI): 2.7–7.7%). In women aged <60years incidence rates increased significantly during the whole study period (EAPC 3.5%; 95% CI: 2.0–4.9), while in women aged ⩾60years only an increase has observed from 2004 onwards (EAPC 5.0; 95% CI: 1.5–8.6). Survival rates did not change over time. ConclusionThe incidence rate of VSCC has increased from 2002 onwards in all women. Over the whole study period the increase was strongest in women aged <60years. The introduction of less radical surgery did not affect survival.

Vulvar intraepithelial neoplasia: a clinicopathologic study of twenty cases

To investigate the clinical, pathological and immunohistochemical features of vulvar intraepithelial neoplasia (VIN). According to the 2004 modified terminology of International Society for the Study of Vulvovaginal Diseases (ISSVD), the cases were diagnosed as VIN from patients who had performed vulvar biopsy in Beijing Wuzhou Women's Hospital from February 2009 to December 2011, which were reclassified as usual VIN and differentiated VIN. The clinical and pathological studies were conducted respectively. MaxVision immunohistochemical staining was used to detect the expression of Ki-67, p16 and p53 proteins. There were 20 cases of VIN in 237 patients, and the incidence of VIN was 8.4% in all of contemporary vulvar biopsy. In 17 cases of usual VIN, mean age was 29.6 years, the lesion typically presented with atypical cells involving almost all layers of the epithelium, which was equivalent to the high-grade squamous intraepithelial neoplasia of cervix. Immunohistochemistry for Ki-67 and p16 was strongly positive in usual VIN. High risk human papillomavirus (HPV) detection was also positive. The incidence of differentiated VIN was less than usual VIN, and there were only 3 cases in this study. In differentiated VIN, patients aged over 50 years, with mean of 53.7 years, and the lesion most commonly presented with lichen sclerosis background. There were epithelial thickening and extending, and parakeratosis, and atypia was strictly confined to the basal and parabasal layers of the epithelium where the cells enlarged with abundant eosinophilic cytoplasm, presented with prominent nucleoli, increased cellularity and abnormal keratinization. In differentiated VIN, p53 was strongly positive, Ki-67 and p16 immunohistochemical expression was confined to the basal layer only. VIN is a precursor of invasive squamous cell carcinoma of the vulva. The modified terminology of ISSVD classifies VIN as high-grade lesions. Definitive pathological diagnosis of VIN plays an important role in its timely treatment and the prevention of vulvar carcinoma.

Diagnosis and treatment options of vulvar cancer: a review

Vulvar cancer is a rare malignancy in women. However, within the past decade, a distinct increase in the incidence of vulvar intraepithelial neoplasia (VIN) as a precursor lesion, and an increase of vulvar cancer have been reported within Europe and the USA. Surgery is the first choice in treating patients with vulvar cancer, especially in its early stages. In an attempt to decrease the incidence of complications, research was made into modifications of the surgical procedure without compromising the prognosis. The replacement of radical vulvectomy by less wide local excision is one of these modifications. As vulvar cancer is relatively rare, it is possible to give evidence-based treatment recommendations, but usually on a low evidence level. Aim of this paper is to elucidate diagnostics and surgical treatment options in the management of vulvar cancer. We searched major databases (i.e. pubmed) with the following selection criteria: vulvar cancer, en bloc resection, triple incision, and sentinel node biopsy. Today, the operative therapy is much less radical and more emphasized on individualized therapeutic concepts. The tendency is to leave the ultraradical surgical options which suffer from high morbidity towards less radical, minimal invasive techniques. Due to the rarity of the disease further studies will have to be performed by international collaborative groups.

Risikofaktoren der Rezidivhäufigkeit von vulvären intraepithelialen Neoplasien Grad III (VIN III)

The incidence of vulvar intraepithelial neoplasia (VIN) has increased in the last decades. The therapy of VIN is the in toto resection. Still some patients develop VIN recurrence. The aim of this retrospective study is the identification of risk factors for VIN recurrence. 68 Patients with VIN III has been examined in an univariate and multivariate analysis for the following parameters (follow-up: median 27 months): age, HPV, HIV, multicentricity, resection margins (1-4 mm, 5-9 mm, > or = 10 mm). In the univariate analysis positive HPV and HIV status correlated with VIN recurrence. Also resection margins < 5 mm showed a significant correlation with VIN recurrence. Multivariate analysis demonstrated that HPV, HIV and resection margins < 5 mm are independent risk factors. No statistically association was found for age and multicentricity. The aim of VIN therapy must be the total resection with a negative resection margin of > or = 5 mm. HPV- and/or HIV-positive patients have a significantly higher risk for VIN recurrence and need therefore an intensive follow up.

Concordance of Gross Surgical and Final Fixed Margins in Vulvar Intraepithelial Neoplasia 3 and Vulvar Cancer

Although vulvar cancer still accounts for approximately 5% of gynecologic malignancies, the incidence of vulvar intraepithelial neoplasia (VIN) has nearly doubled in the past 2 decades. When VIN 3 is severe and not treated, this lesion may progress to frank cancer. Excision is most often preferred to obtain negative surgical margins and to rule out occult invasive cancer—present in up to 20% of patients with biopsy-proved VIN 3. Traditionally, a margin of 2 to 3 cm has been recommended after vulvectomy. This prospective study compared gross surgical margins with final fixed gross margins in 27 women over age 18 who had biopsy-proved VIN 3 or vulvar carcinoma. More than 80% of the women smoked, and nearly 60% had a history of genital dysplasia. Five participants had invasive cancer on preoperative biopsy, whereas 22 had VIN 3. Invasive carcinoma was at stage I in 2 cases, stage II in one, and stage III in 2. Two other cancers were found among women with a preoperative diagnosis of VIN 3, but both were stage IA lesions. After highlighting the vulvar lesion using acetic acid, sutures were placed so as to mark a 1-cm margin for both dysplasia and carcinoma. In the 19 women who could be evaluated, the median fixed margin was 0.85 cm and the mean was 0.83 cm. The difference between the gross and final fixed margins was significant at a level of P = .001. Seven of the 19 women had microscopic VIN 1 and 3 were VIN 3 within the grossly negative 1-cm specimen. In no case, however, did VIN extend beyond the excised 1-cm margin. These findings suggest that when measured in its final fixed state, the gross surgical margin after resection of invasive vulvar cancer or VIN 3 is reduced by approximately 15%. When attempting to gain a negative margin exceeding 8 mm, surgeons may place confidence in a gross surgical margin of 1 cm for VIN 3 and 1 to 2 cm for invasive cancer.

Effect of antiretroviral therapy on the incidence of genital warts and vulvar neoplasia among women with the human immunodeficiency virus

Objective The purpose of this study was to determine the incidence and predictors of genital warts and vulvar intraepithelial neoplasia among women with the human immunodeficiency virus. Study design This was a multicenter prospective cohort study comprised of women without warts or vulvar intraepithelial neoplasia at baseline who underwent CD4 count, human immunodeficiency virus RNA measurement, examination, Papanicolaou test, and biopsy, as indicated, every 6 months. Human papillomavirus DNA typing was examined at baseline. Results The incidence of warts among women who were human immunodeficiency virus seronegative was 1.31 versus 5.01 per 100 person-years among women who were seropositive ( P<.001). Incidence of vulvar intraepithelial neoplasia among women who were seronegative was 1.31 versus 4.67 per 100 person-years among women who were seropositive ( P<.001). In multivariable analysis, warts were associated with highly active antiretroviral therapy (relative hazard, 0.76), CD4 count (relative hazard, 0.91/100 cell/cm 2 increase), acquired immunodeficiency syndrome (relative hazard, 1.25), abnormal Papanicolaou test results (relative hazard, 2.18), high- or medium-risk human papillomavirus types (relative hazard, 1.91), low-risk human papillomavirus types (relative hazard, 1.48), smoking (relative hazard, 1.43), having 1 child (relative hazard, 1.54), and age (relative hazard, 0.74/10 years). Vulvar intraepithelial neoplasia was linked to highly active antiretroviral therapy (relative hazard, 0.65), CD4 count (relative hazard, 0.92), abnormal Papanicolaou test results (relative hazard, 16.03), high- or medium-risk human papillomavirus types (relative hazard, 1.37), and age (relative hazard, 0.85/10 years). Conclusion Warts and vulvar intraepithelial neoplasia are common among women with human immunodeficiency virus. Highly active antiretroviral therapy decreases their incidence.

Vulvar Keratinizing Squamous Cell Carcinoma in a 26-Year-Old Woman

Abstract A 26-year-old Hispanic woman complaining of “itching” and “herpetic lesions” on the vulva for 9 months was seen at a university hospital. On physical examination, multiple vulvar masses were noted. Biopsies taken from these lesions showed invasive keratinizing squamous cell carcinoma. The vulvectomy specimen revealed 4 tumor masses, the largest located on the mons pubis. Although the incidence of vulvar intraepithelial neoplasia has increased in recent years, only very few cases of invasive carcinoma have been reported in young women. The tumors that occur at a younger age characteristically have basaloid or warty histology, in contrast to those occurring in older women, which usually are well-differentiated keratinizing carcinomas. We believe this is an unusual case of vulvar squamous cell carcinoma. In addition to our patient's young age, her tumor had a histologic profile usually found in lesions of an elderly woman. The tumor was negative for human papillomavirus by polymerase chain reaction ...

Trends in Vulvar Neoplasia:

The reported incidence of vulvar intraepithelial neoplasia (VIN) has been increasing in many countries. This study compared the numbers of cases of VIN and squamous cell cancer of the vulva seen in Austria during two 4-year periods spaced 10 years apart. The authors reviewed the records of all patients treated for high-grade VIN and invasive squamous cell carcinoma of the vulva from 1985 through 1988 and from 1995 through 1998. During the first 4-year period, 29 patients were diagnosed with VIN 2 or 3. Twelve of these women (41.3%) were less than 50 years old. From 1995 to 1998, 99 cases of VIN 2 or 3 were treated; 59 of the patients (59.6%) were less than 50 years old. Invasive squamous cell cancer of the vulva was diagnosed in 126 patients (7 These findings indicate a 307% increase in the overall incidence of high-grade VIN and a 394% increase among younger women. Although there were fewer cases of squamous cell cancer of the vulva seen in the latter period, in women under 50 years of age the diagnosis of invasive disease increased by 157%. Younger women made up only 5% of the patients with squamous cell carcinoma of the vulva seen during 1985–1988, but they made up 16% of the patients during 1995-1998 (P

Intraepithelial and Invasive Squamous Cell Neoplasia of the Vulva: Trends in Incidence, Recurrence, and Survival Rate in Norway

Objective: To characterize time trends in incidence of intraepithelial and invasive vulvar neoplasia, transition of intraepithelial vulvar neoplasia to invasive cancer, and survival rate based on a total population. Methods: The Cancer Registry of Norway was used to identify all Norwegian inhabitants diagnosed during 1956–1990 with squamous cell carcinoma of the vulva, and all those with intraepithelial vulvar neoplasia diagnosed during 1973–92. Results: The incidence rate of intraepithelial neoplasia increased three-fold from 1973–77 to 1988–92, and 3.4% changed into invasive disease. Multivariate analyses identified age as a significant variable. The age-adjusted incidence rate for squamous cell carcinoma was constant for the whole period. The ratio between recurrence and the total number of invasive cancer varied from 21% to 31%. The 5-year survival rates have not changed significantly over the period. Age was revealed as a strong prognostic factor, showing an excess death rate by increasing age. Conclusion: The incidence of vulvar intraepithelial neoplasia has increased substantially over the last 40 years, but that of invasive vulvar cancer has not changed appreciably.

Trends in Squamous Cell Carcinoma of the Vulva: The Influence of Vulvar Intraepithelial Neoplasia

Objective: To determine trends in the clinicopathology of vulvar squamous cell carcinoma over the past 2 decades, with particular reference to the possible effects of the increasing incidence of vulvar intraepithelial neoplasia (VIN) during this time.Methods: Two cohorts of 56 and 57 women with squamous cell carcinoma of the vulva and separated by at least 2 decades were reviewed retrospectively. Pathologic specimens were analyzed concurrently.Results: In the 1965–1974 cohort, only one of 56 patients was younger than 50 years of age at the time of presentation, whereas in the 1990–1994 cohort, 12 of 57 (21%) were younger than 50 years of age (P = .001). Ten of 13 women younger than 50 years of age, compared with 13 of 100 of women 50 years of age or older, had warty or basaloid VIN associated with their invasive carcinoma (P < .001). Cigarette smoking and multiple lower genital tract neoplasia were both significantly more common in women younger than 50 years of age (P < .001).Conclusion: Over the past 2 decades, a subset of women younger than 50 years of age with squamous cell carcinoma of the vulva has emerged. Most of these carcinomas appear to arise in a field of warty or basaloid VIN. This suggests that the increasing incidence of VIN seen in young women during the past 2 decades is being reflected now in VIN-associated squamous cell carcinoma of the vulva in younger women.

The pathology of vulvar neoplasia

Current literature on the pathology of vulvar disease continues to focus on vulvar intraepithelial neoplasia, the role of human papillomavirus in vulvar neoplasia, and Paget's disease of the vulva. Of particular concern is an increasing incidence of vulvar intraepithelial neoplasia noted over the past several decades, specifically among younger women. Human papillomavirus has emerged as a major factor in this trend. Furthermore, a more aggressive course may ensue in these young women, requiring diligent follow-up.