DefinitionThis section has been translated automatically.
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.
ClassificationThis section has been translated automatically.
- 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.:
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Occurrence/EpidemiologyThis section has been translated automatically.
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)
EtiopathogenesisThis section has been translated automatically.
Clinical featuresThis section has been translated automatically.
- 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.
HistologyThis section has been translated automatically.
|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|
- basaloid type
- Condylomatous type (warty type)
- Differentiated type.
DiagnosisThis section has been translated automatically.
- 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!
Complication(s)This section has been translated automatically.
TherapyThis section has been translated automatically.
- Extensive lesions / high grade VIN III: excision with primary closure, possibly split skin grafts.
- Small lesions: cauterization, erbium YAG laser or CO 2 laser ablation, cryosurgery, podophyllotoxin. The less radical the therapy chosen, the higher the risk of recurrence.
- Topical therapy with Imiquimod, where complete eradication of the underlying HPV type was observed.
ProphylaxisThis section has been translated automatically.
LiteratureThis section has been translated automatically.
- Campagne G et al (2003) Successful treatment of a high-grade intraepithelial neoplasia with imiquimod, with vulvar pemphigus as a side effect. Eur J Obstet Gynecol Reprod Biol 109: 224-227
- Fehr MK et al (2002) Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid. Lasers Surg Med 30: 273-279
- Gupta J (1987) Association of human papillomavirus type 16 with neoplastic lesions of the vulva and other genital sites by in situ hybridization. On J catholic 127: 206-209
- Jayne CJ et al (2002) Treatment of vulvar intraepithelial neoplasia 2/3 with imiquimod. J Reprod Med 47: 395-398
- Küppers V (1997) Risk factors for recurrent VIN: role of multifocality and grade of disease. J Reprod Med. 42: 140-147
- Penna C et al (2002) CO2 laser surgery for vulvar intraepithelial neoplasia. Excisional, destructive and combined techniques. J Reprod Med 47: 913-918
- Rodolakis A et al (2003) Vulvar intraepithelial neoplasia (VIN)--diagnostic and therapeutic challenges. Eur J Gynaecol Oncol 24: 317-322
- Saravanamuthu J (2003) The role of angiogenesis in vulvar cancer, vulvar intraepithelial neoplasia, and vulvar lichen sclerosus as determined by microvessel density analysis. Gynecol Oncol 89: 251-258
- Satmary W et al(2018) Vulvar intraepithelial neoplasia: Risk factors for recurrence.
Gynecol Oncol 148:126-131.
- Speck LM (2006) Vaccines for the prevention of human papillomavirus infections. Skin Therapy Lett 11: 1-3
- Travis LB (2002) Successful treatment of vulvar intraepithelial neoplasia with topical imiquimod 5% cream in a lung transplanted patient. Acta Derm Venereol 82: 475-476
- Villa LL et al (2006) High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer 95: 1459-1466
- Wilkinson EJ (1992) Normal histology and nomenclature of the vulva and malignant neoplasms, including VIN. Dermatol Clin 10: 238-244
- Van Seters M et al (2008) Treatment of vulvar intraepithelial neoplasia with topical imiquimod. N Engl J Med 358: 1465-1473
Outgoing links (16)Ain; Bowenoids papulose; Bowen's disease; Co2 laser; Cryosurgery; Electrocoagulation; Erbium yag laser; Erythroplasia queyrat; Hpv vaccine; Mucous membrane melanoma; ... Show all
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