Vulvar intraepithelial neoplasia
| Vulvar intraepithelial neoplasia | |
|---|---|
| Classification and external resources | |
 Micrograph of vulvar intraepithelial neoplasia III. H&E stain. |
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| ICD-10 | D07 (ILDS D07.120) |
| ICD-9 | 233.32 |
The term Vulvar intraepithelial neoplasia (VIN) refers to particular changes that can occur in the skin that covers the vulva. VIN is not cancer, and in some women it disappears without treatment. If the changes become more severe, there is a chance that cancer might develop after many years, and so it is referred to as a precancerous condition.[1]
Contents |
[edit] ISSVD Classification
Medically speaking, the term denotes a squamous intraepithelial lesion of the vulva that shows dysplasia with varying degrees of atypia. The epithelial basement membrane is intact and the lesion is thus not invasive but has invasive potential.
The terminology of VIN evolved over several decades. In 1989[2] the Committee on Terminology, International Society for the Study of Vulvar Disease (ISSVD) replaced older terminology such as vulvar dystrophy, Bowen's disease, and Kraurosis vulvae by a new classification system for Epithelial Vulvar Disease:
- Nonneoplastic epithelial disorders of vulva and mucosa:
- Lichen sclerosus
- Squamous hyperplasia
- Other dermatoses
- Mixed neoplastic and nonneoplastic disorders
- Intraepithelial neoplasia
- Squamous vulvar intraepithelial neoplasia (VIN)
- VIN I, mildest form
- VIN II, intermediate
- VIN III, most severe form including carcinoma in situ of the vulva
- Non-squamous intraepithelial neoplasia
- Extramammary Paget's disease
- Tumors of melanocytes, non invasive
- Squamous vulvar intraepithelial neoplasia (VIN)
- Invasive disease (vulvar carcinoma)
The ISSVD further revised this classification in 2004, replacing the three-grade system
with a single-grade system in which only the high-grade disease is classified as VIN. This is subdivided into: 1) usual-type VIN (including warty, basaloid and mixed subtypes)commonly associated with carcinogenic genotypes of HPV and/or HPV persistence factors such as cigarette smoking or immunocompromised states and 2) differentiated VIN, commonly associated with vulvar dermatoses such as lichen sclerosis. Differentiated VIN associated with lichen sclerosis, however, is more likely to be associated with squamous carcinoma than is usual-type VIN.
Flat lesions with basal atypia (formerly VIN I) are considered condylomas and can be
treated as such.
Committee Opinion No.509, American College of Obstetricians and Gynecologists.Obstet
Gynecol 2011; 118:1192-4.
[edit] Causes
Infection with Human Papillomavirus (HPV) is associated with developing VIN.
[edit] Diagnosis
The patient may have no symptoms, or local symptomatology including itching, burning, and pain. The diagnosis is always based on a careful inspection and a targeted biopsy.
[edit] Prevention
Vaccinating girls with HPV vaccine before their initial sexual contact has been shown to reduce incidence of VIN.[3]
[edit] Treatment
The treatment of VIN is local to wide excision, in case of very extensive involvement or recurrency even a simple vulvectomy. Laser therapy has also been useful for VIN.
[edit] Additional images
-
Micrograph of vulvar intraepithelial neoplasia.
.jpg)
[edit] References
- ^ "Vulval intra-epithelial neoplasia (VIN)". Macmillan Cancer Support. http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Vulva/Pre-cancerousconditions/Vin.aspx. Retrieved 2010-06-09.
- ^ Ridley CM, Frankman O, Jones IS, et al. (May 1989). "New nomenclature for vulvar disease: International Society for the Study of Vulvar Disease". Hum. Pathol. 20 (5): 495–6. doi:10.1016/0046-8177(89)90019-1. PMID 2707802.
- ^ "FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers". 2008-09-12. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116945.htm. Retrieved 2010-02-13.
[edit] External links
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