Vin N90.0-N90.2

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Intraepithelial neoplasia of the vulva; leukoplakia of the vulva; Vulval intraepithelial neoplasia; vulvar intraepithelial neoplasia; vulvar leukoplakia

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Vulval Intraepithelial Neoplasias (VIN) are incipient precursor lesions for squamous cell carcinomas of the vulva. S.a. spinocellular carcinoma, vulvar carcinoma. It is the most common prein vasi ve disease of the vulva and is defined by cellular atypia of the squamous epithelium with disturbance of the tissue structure.

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  • Classification according to histological criteria (ISSVD). A distinction is made:
    • Squamous type (vulvar intraepithelial neoplasia)
    • Non-squamous guy.
  • The squamous type (VIN) is divided into 3 grades of severity:
    • VIN I: Mild intraepithelial neoplasia
    • VIN II: Moderate intraepithelial neoplasia
    • VIN III: Severe intraepithelial neoplasia:
      • differentiated (2-10% of cases), no association with HPV infection
      • undifferentiated (90% of cases), evidence of high-risk HV!
  • The non-squamous type includes pathogenetically different clinical pictures, e.g.:

In this classification, terms such as M. Bowen, erythroplasia queyrat and bowenoid papulose are no longer used, they are classified as stage VIN III. S.a. AIN (anal intraepithelial neoplasia).

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Etiologically, two groups of patients can be distinguished:

  • Predominantly older patients > 60 years, in whom a differentiated type VIN III or a vulvar carcinoma develops.
  • Pat. < 50 years with undifferentiated type VIN III (basaloid or condylomatous type) or vulvar carcinoma . Frequent detection of HPV-DNA (HPV-16)! After therapy 35% recurrence rate (Satmary W et al. 2018)

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Common association with HPV disease. The incidence of HPV DNA increases as the severity of VIN increases. Depending on the method used, HPV can be detected in 50-90% of cases. The most common type of HPV DNA is type 16.

Clinical features
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  • Initially, patients complain of no or unspecific symptoms such as itching, pain and soreness. This often leads to self-treatment and protraction of the disease.
  • Leukoplakia: Very variable and dependent on the stage of VIN, with sharply defined, flat or bumpy leukoplakia;
  • In addition, reddish-brownish or deep red, occasionally also brown-black, moderately indurated plaques with or without scaling, sharply separated from the normal skin or mucous membrane.
  • Erosions: Often flat erosions or macerations are found.
  • Erythroplasia: Rarely is the pure erythematous type (older nomenclature: Erythroplasia Queyrat) with a weeping, velvety surface. This non-cornifying variant of VIN III usually develops on the non-cornifying squamous epithelium of the introitus vaginae and on the inner sides of the small labia.
  • Indurated ulcerations may be an indication of infiltrating growth.
  • A particular diagnostic and therapeutic problem are the multifocal lesions occurring at the vulva. They are more prone to recurrence than the unifocal variants.

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Loss of normal skin stratification. Frequently nuclear polymorphisms, hyperchromatinization and koilocytosis. Barely inflammatory infiltrates. The basement membrane is intact.Table 1: Stages of VIN
Stadium Dysplasia/Grading Histological description
VIN I Mild dysplasia small cellular atypias, often koilocytes with enlarged irregular nuclei and halo; restricted to lower epithelial third
VIN II Moderate dysplasia Replacement of the lower and middle vulvar epithelium by narrow basaloid cells with increased nuclear plasma ratio.
VIN III Severe dysplasia/carcinoma in situ Replacement of > 75% of the vulvar epithelium by narrow basaloid cells with increased nuclear plasma ratio
VIN III is further divided according to histological criteria:
  • basaloid type
  • Condylomatous type (warty type)
  • Differentiated type.

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  • Clinic, Biopsy
  • HPV detection from biopsy
  • Papanicolaou smears: The material obtained by Papanicolaou smears or the grading based on it correlates relatively poorly with histologically confirmed lesions.

Notice! Suspect areas must be biopsied!

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Recurrence tendency (especially with VIN III and multifocal occurrence), transition to invasive vulvar carcinoma.

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HPV vaccination is recommended. The vaccines Cervarix and Gardasil are approved for this purpose. S.a.u. HPV vaccine.

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Last updated on: 29.10.2020