Coexisting High-grade Vulvar Intraepithelial Neoplasia (VIN) and Condyloma Acuminatum

ObjectivesSuperficially invasive stage IA squamous vulvar cancer (VSCC) is defined as a single lesion measuring ≤2 cm with a depth of invasion of ≤1.0 mm (FIGO stage IA). This article examines the natural course and prognosis of superficially invasive VSCC.MethodsThis is a retrospective case series of 46 patients (median age 58 years) with superficially invasive stage IA VSCC receiving wide local excision between January 1996 and November 2014 in the University Medical Center Hamburg-Eppendorf.ResultsMedian tumor size was 4 mm. In 39/46 (84.8%) patients peri-tumoral high-grade intraepithelial neoplasia (HSIL) and/or lichen sclerosus (LS) of the vulva were histologically detected: 34 (74.0%) usual type high-grade vulvar intraepithelial neoplasia (uVIN, HSIL), 4 (8.7%) LS with simultaneous VIN (3 uVIN, 1 differentiated VIN (dVIN)), 1 (2.2%) with LS only. 37/46 (80.4%) patients had a R0 resection; in 2 (4.3%) a high-grade VIN was detected in the margin and in 7 (15.2%) the resection status was unknown. The mean follow-up was 58 (range 10–185) months. Four patients (8.7%) suffered from an invasive recurrence after 4, 17, 40, and 54 months, three in the vulva and one in the groin. All local recurrences occurred in women with LS in a combination with high-grade VIN (3 uVIN, 1 dVIN). Two were treated surgically again including inguino-femoral lymphadenectomy (ifLAE) (no regional lymph node metastasis histologically) as invasion depth exceeded 1 mm. The third patient refused treatment. Inguinal recurrence was treated with a bilateral ifLAE, revealing one positive lymph node, followed by adjuvant radiotherapy (groins, pelvis). None of these patients had experienced further recurrences at last follow-up.ConclusionsSuperficially invasive VSCC is characterized by having a very good prognosis. Sole surgical therapy is highly effective. Patients with LS might benefit additionally from intensified surveillance and adequate maintenance therapy in specialized centers.

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Optimizing diagnosis and therapy of high-grade vulvar intraepithelial neoplasia in patients of reproductive age

Problemy reproduktsii ◽

10.17116/repro201723444-49 ◽

2017 ◽

Vol 23 (4) ◽

pp. 44

Author(s):

L. V. Pokul’ ◽

M. R. Orazov ◽

M. G. Lebedeva ◽

T. N. Bebneva ◽

I. L. Penzhoyan

Keyword(s):

Intraepithelial Neoplasia ◽

Reproductive Age ◽

Vulvar Intraepithelial Neoplasia ◽

High Grade ◽

Diagnosis And Therapy

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Good inter-observer agreement for histological diagnosis of high-grade vulvar intraepithelial neoplasia using International Society for the Study of Vulvovaginal Diseases classification system

Evidence-based Oncology ◽

10.1054/ebon.2001.0108 ◽

2001 ◽

Vol 2 (2) ◽

pp. 66-67

Author(s):

John W. Sellors

Keyword(s):

International Society ◽

Classification System ◽

Intraepithelial Neoplasia ◽

Histological Diagnosis ◽

Observer Agreement ◽

Vulvar Intraepithelial Neoplasia ◽

High Grade

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Expression of Human Telomerase Reverse Transcriptase in Vulvar Intraepithelial Neoplasia and Squamous Cell Carcinoma: An Immunohistochemical Study With Survivin and p53

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2011-0440-oa ◽

2012 ◽

Vol 136 (11) ◽

pp. 1359-1365 ◽

Cited By ~ 11

Author(s):

Alfred Wellenhofer ◽

Hermann Brustmann

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Intraepithelial Neoplasia ◽

Vulvar Intraepithelial Neoplasia ◽

Telomerase Reverse Transcriptase ◽

High Grade ◽

Human Telomerase Reverse Transcriptase ◽

Keratinizing Squamous Cell Carcinoma ◽

Human Telomerase

Context.—Human telomerase reverse transcriptase (hTERT), an enzyme that enables cells to overcome replicative senescence and to divide indefinitely, is overexpressed in many cancers and their precursor lesions. Objective.—To test whether hTERT expression is related to neoplastic progression and resistance to apoptosis in vulvar epithelia. Design.—Immunoexpression of hTERT was evaluated in 101 formalin-fixed, paraffin-embedded archival vulvar epithelia consisting of normal squamous vulvar epithelia (n = 25), lichen sclerosus (n = 10), high-grade classic vulvar intraepithelial neoplasia (n = 16), differentiated vulvar intraepithelial neoplasia (n = 18), and vulvar invasive keratinizing squamous cell carcinoma (n = 32) and related to survivin and p53 expression. Immunostaining for all factors was scored for moderate and strong intensities with regard to quantity to determine upregulation and overexpression (score 0, 0% immunoreactive cells; score 1+, <5% immunoreactive cells; score 2+, 5% to 50% immunoreactive cells; score 3+, >50% immunoreactive cells). Score 3+ was considered as overexpression. Results.—Nuclear hTERT immunoexpression was closely related to survivin reactivity, increased from normal vulvar squamous epithelia to lichen sclerosus and to high-grade classic vulvar intraepithelial neoplasia, differentiated vulvar intraepithelial neoplasia, and invasive keratinizing squamous cell carcinoma (P < .001), and followed the morphologic distribution of atypical squamous epithelial cells. Overexpression of hTERT was comparable to that seen for p53 in invasive keratinizing squamous cell carcinoma (P = .62); significant differences were calculated for differentiated vulvar intraepithelial neoplasia (P = .003) and high-grade classic vulvar intraepithelial neoplasia (P = .001). Conclusion.—Human telomerase reverse transcriptase is upregulated in vulvar intraepithelial neoplasia and invasive keratinizing squamous cell carcinoma compared with nonneoplastic squamous epithelia of the vulva as an apparently early and preinvasive event in the neoplastic transformation, with development of cellular longevity and resistance to apoptosis by survivin activation as associated features, independent of the etiology of vulvar intraepithelial neoplasia.

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Anal Intraepithelial Neoplasia Associated with High-Grade Vulva Injury (Usual-Type Vulvar Intraepithelial Neoplasia): Surgical Treatment with Cutaneous Flap Advancement

Journal of Coloproctology ◽

10.1055/s-0041-1730941 ◽

2021 ◽

Vol 41 (03) ◽

pp. 329-331

Author(s):

José Antonio Cunha-e-Silva ◽

Andrea Povedano ◽

Eduardo Vassalo ◽

Angélica Kneipp ◽

Guilherme Arbex ◽

...

Keyword(s):

Surgical Treatment ◽

Sexually Transmitted Infections ◽

Young Patient ◽

Intraepithelial Neoplasia ◽

Vulvar Intraepithelial Neoplasia ◽

High Grade ◽

Sexually Transmitted ◽

Usual Type ◽

Cutaneous Flap ◽

Intraepithelial Lesions

AbstractThe aim of the present article is to report the case of a young patient with bowenoid papulosis who was a carrier of other sexually-transmitted infections (STIs), such as HIV and high-grade vulva lesion (usual-type vulvar intraepithelial neoplasia, VIN), and to demonstrate the strategy used to manage the case, as well as to discuss important issues regarding the standardization of intraepithelial lesions.8

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Expanding the Morphologic, Immunohistochemical, and HPV Genotypic Features of High-grade Squamous Intraepithelial Lesions of the Vulva With Morphology Mimicking Differentiated Vulvar Intraepithelial Neoplasia and/or Lichen Sclerosus

International Journal of Gynecological Pathology ◽

10.1097/pgp.0000000000000708 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Laurie M. Griesinger ◽

Heather Walline ◽

Grace Y. Wang ◽

Guadalupe Lorenzatti Hiles ◽

Kathryn C. Welch ◽

...

Keyword(s):

Lichen Sclerosus ◽

Intraepithelial Neoplasia ◽

Vulvar Intraepithelial Neoplasia ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Intraepithelial Lesions

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A Clinical and Pathological Overview of Vulvar Condyloma Acuminatum, Intraepithelial Neoplasia, and Squamous Cell Carcinoma

BioMed Research International ◽

10.1155/2014/480573 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 26

Author(s):

Boris Léonard ◽

Frederic Kridelka ◽

Katty Delbecque ◽

Frederic Goffin ◽

Stéphanie Demoulin ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Intraepithelial Neoplasia ◽

Epidemiological Data ◽

Condyloma Acuminatum ◽

Vulvar Intraepithelial Neoplasia ◽

Clinical Implications ◽

Hpv Types ◽

High Risk Hpv

Condyloma acuminatum, intraepithelial neoplasia, and squamous cell carcinoma are three relatively frequent vulvar lesions. Condyloma acuminatum is induced by low risk genotypes of human papillomavirus (HPV). Vulvar intraepithelial neoplasia (VIN) and squamous cell carcinoma have different etiopathogenic pathways and are related or not with high risk HPV types. The goal of this paper is to review the main pathological and clinical features of these lesions. A special attention has been paid also to epidemiological data, pathological classification, and clinical implications of these diseases.

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