Differentiated vulvar intraepithelial neoplasia

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Differentiated vulvar intraepithelial neoplasia, abbreviated dVIN, is a pre-neoplastic pathology of the vulva typically arising in the context of lichen sclerosus.

Differentiated vulvar intraepithelial neoplasia
Diagnosis in short

Differentiated vulvar intraepithelial neoplasia. H&E stain.
LM thickening of the stratum spinosum (acanthosis), elongation of rete ridges with bridging/anastomoses between rete ridges, nuclear atypia - esp. basal layer, nuclei in stratum corneum (parakeratosis), +/-atypical mitoses
LM DDx vulvar squamous cell carcinoma, lichen sclerosus, classic vulvar intraepithelial neoplasia
IHC p53 +ve, p16 -ve
Site vulva
Associated Dx lichen sclerosus, vulvar squamous cell carcinoma
Prevalence uncommon

It is also known as VIN simplex.[1]

General

Epidemiology:

  • Associated with lichen sclerosus.
  • Seen in older women - typically 50s-70s.[2]
  • More common than classic VIN caused by HPV.[3]
    • Differentiated VIN -> keratinizing SCC (~60% of cases).[4]
    • Classic VIN -> warty SCC (~40% of cases).[4]

Note:

Microscopic

Features:[6]

  • Thickening of the stratum spinosum (acanthosis).
  • Elongation of rete ridges with bridging/anastomoses between rete ridges.
  • Nuclear atypia - esp. basal layer.
  • Nuclei in stratum corneum (parakeratosis).
  • +/-Atypical mitoses.

Notes:

  • Not graded like classic VIN - considered high-grade by definition.[citation needed]
  • Mnemonic BAD LAP: basal cell atypia, anastomosing rete ridges (bridging), dVIN, lichen sclerosus, acanthosis, parakeratosis.

DDx:

Images

  • Differentiated VIN - low mag. (WC)

  • Differentiated VIN - intermed. mag. (WC)

  • Differentiated VIN - superficial - high mag. (WC)

  • Differentiated VIN - deep - high mag. (WC)

www:

IHC

  • Differentiated VIN: p16 -ve, p53 +ve.[7]
  • Classic VIN: p16 +ve, p53 -ve.

Note:

  • p16 can be thought of as a poor man's HPV test.

Sign out

LABIA MINUS, RIGHT, PUNCH BIOPSY:
- DIFFERENTIATED VULVAR INTRAEPITHELIAL NEOPLASIA.
- LICHEN SCLEROSUS.

See also

References

  1. ↑ Ruhul Quddus, M.; Xu, C.; Steinhoff, MM.; Zhang, C.; Lawrence, WD.; Sung, CJ. (Jun 2005). "Simplex (differentiated) type VIN: absence of p16INK4 supports its weak association with HPV and its probable precursor role in non-HPV related vulvar squamous cancers.". Histopathology 46 (6): 718-20. doi:10.1111/j.1365-2559.2005.02036.x. PMID 15910611.
  2. ↑ Ordi, J.; Alejo, M.; Fusté, V.; Lloveras, B.; Del Pino, M.; Alonso, I.; Torné, A. (Nov 2009). "HPV-negative vulvar intraepithelial neoplasia (VIN) with basaloid histologic pattern: an unrecognized variant of simplex (differentiated) VIN.". Am J Surg Pathol 33 (11): 1659-65. doi:10.1097/PAS.0b013e3181b40081. PMID 19730361.
  3. ↑ Kokka, F.; Singh, N.; Faruqi, A.; Gibbon, K.; Rosenthal, AN. (Oct 2011). "Is differentiated vulval intraepithelial neoplasia the precursor lesion of human papillomavirus-negative vulval squamous cell carcinoma?". Int J Gynecol Cancer 21 (7): 1297-305. doi:10.1097/IGC.0b013e31822dbe26. PMID 21946295.
  4. ↑ 4.0 4.1 Reyes, MC.; Cooper, K. (Jan 2014). "An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis.". J Clin Pathol. doi:10.1136/jclinpath-2013-202117. PMID 24399036.
  5. ↑ Yang, B.; Hart, WR. (Mar 2000). "Vulvar intraepithelial neoplasia of the simplex (differentiated) type: a clinicopathologic study including analysis of HPV and p53 expression.". Am J Surg Pathol 24 (3): 429-41. PMID 10716158.
  6. ↑ 6.0 6.1 van de Nieuwenhof, HP.; Bulten, J.; Hollema, H.; Dommerholt, RG.; Massuger, LF.; van der Zee, AG.; de Hullu, JA.; van Kempen, LC. (Feb 2011). "Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma.". Mod Pathol 24 (2): 297-305. doi:10.1038/modpathol.2010.192. PMID 21057461.
  7. ↑ 7.0 7.1 Pinto, AP.; Miron, A.; Yassin, Y.; Monte, N.; Woo, TY.; Mehra, KK.; Medeiros, F.; Crum, CP. (Mar 2010). "Differentiated vulvar intraepithelial neoplasia contains Tp53 mutations and is genetically linked to vulvar squamous cell carcinoma.". Mod Pathol 23 (3): 404-12. doi:10.1038/modpathol.2009.179. PMID 20062014.
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