Difference between revisions of "Classic vulvar intraepithelial neoplasia"

From Libre Pathology
Jump to navigation Jump to search
(redirect w/ cat.)
 
(split out)
Line 1: Line 1:
#redirect [[Vulva#Classic_vulvar_intraepithelial_neoplasia]]
'''Classic vulvar intraepithelial neoplasia''', abbreviated '''classic VIN''', is a pre-neoplastic lesion of the [[vulva]] strongly associated with the [[human papilloma virus]].  It is also known as '''usual vulvar intraepithelial neoplasia''', abbreviated '''uVIN'''.<ref name=pmid24399036>{{Cite journal  | last1 = Reyes | first1 = MC. | last2 = Cooper | first2 = K. | title = An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis. | journal = J Clin Pathol | volume =  | issue =  | pages =  | month = Jan | year = 2014 | doi = 10.1136/jclinpath-2013-202117 | PMID = 24399036 }}</ref>


It should '''not''' be confused with ''[[differentiated vulvar intraepithelial neoplasia]]''.
==General==
Epidemiology:
*Classic VIN, like CIN, is associated with [[HPV]] and seen in younger women.
*May be multifocal, i.e. associated with cervical ([[CIN]]) or vaginal ([[VAIN]]) lesions;<ref>{{Cite journal  | last1 = Pai | first1 = K. | last2 = Pai | first2 = S. | last3 = Gupta | first3 = A. | last4 = Rao | first4 = P. | last5 = Renjhen | first5 = P. | title = Synchronous vulvar intraepithelial neoplasia (VIN) of warty type and cervical intraepithelial neoplasia (CIN): case report. | journal = Indian J Pathol Microbiol | volume = 49 | issue = 4 | pages = 585-7 | month = Oct | year = 2006 | doi =  | PMID = 17183865 }}</ref> multifocality has a strongly association with immunosuppression.<ref name=pmid16713062>{{Cite journal  | last1 = Ait Menguellet | first1 = S. | last2 = Collinet | first2 = P. | last3 = Houfflin Debarge | first3 = V. | last4 = Nayama | first4 = M. | last5 = Vinatier | first5 = D. | last6 = Leroy | first6 = JL. | title = Management of multicentric lesions of the lower genital tract. | journal = Eur J Obstet Gynecol Reprod Biol | volume = 132 | issue = 1 | pages = 116-20 | month = May | year = 2007 | doi = 10.1016/j.ejogrb.2006.04.011 | PMID = 16713062 }}</ref>
Classic VIN is graded like cervical pre-cancerous lesions:
*VIN I.
**DDx: [[condyloma acuminatum]].<ref name=pmid15870532>{{Cite journal  | last1 = Rufforny | first1 = I. | last2 = Wilkinson | first2 = EJ. | last3 = Liu | first3 = C. | last4 = Zhu | first4 = H. | last5 = Buteral | first5 = M. | last6 = Massoll | first6 = NA. | title = Human papillomavirus infection and p16(INK4a) protein expression in vulvar intraepithelial neoplasia and invasive squamous cell carcinoma. | journal = J Low Genit Tract Dis | volume = 9 | issue = 2 | pages = 108-13 | month = Apr | year = 2005 | doi =  | PMID = 15870532 }}</ref>
**Uncommon.
*VIN II.
**Not common.
*VIN III.
**Commonly seen.
==Microscopic==
Features:
*Increased [[NC ratio]].
*Multinucleation.
*Lack of maturation to surface (not very useful -- unlike in the cervix).<ref>LAE. February 2009.</ref>
**May have "vertical streaming" - the long axis of the cells are perpendicular to the free surface & basement membrane.
*Apical mitoses.
DDx:
*[[Condyloma acuminatum]].
*[[Vulvar squamous cell carcinoma]].
*[[Extramammary Paget disease]].
*[[Dermatomycosis]] (fungal infection) - esp. [[candidiasis]].
===Images===
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150314/figure/F3/ VIN I - koilocytes (nih.gov)].<ref name=pmid21702970/>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150314/figure/F4/ VIN I (nih.gov)].<ref name=pmid21702970>{{Cite journal  | last1 = Kotsopoulos | first1 = IC. | last2 = Tampakoudis | first2 = GP. | last3 = Evaggelinos | first3 = DG. | last4 = Nikolaidou | first4 = AI. | last5 = Fytili | first5 = PA. | last6 = Kartsiounis | first6 = VC. | last7 = Gerasimidou | first7 = DK. | title = Implication of human papillomavirus-66 in vulvar carcinoma: a case report. | journal = J Med Case Rep | volume = 5 | issue =  | pages = 232 | month =  | year = 2011 | doi = 10.1186/1752-1947-5-232 | PMID = 21702970 | PMC = 3150314 }}</ref>
*[http://www.flickr.com/photos/euthman/2658773592/ VIN III (flickr.com)].
*[http://commons.wikimedia.org/wiki/File:Vulvar_intraepithelial_neoplasia3_2.jpg VIN III (WC)].
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/female/warty_VIN.html VIN (brown.edu)].
==IHC==
*Classic VIN: p16 +ve, p53 -ve.
*Differentiated VIN: p16 -ve, p53 +ve.<ref name=pmid20062014>{{Cite journal  | last1 = Pinto | first1 = AP. | last2 = Miron | first2 = A. | last3 = Yassin | first3 = Y. | last4 = Monte | first4 = N. | last5 = Woo | first5 = TY. | last6 = Mehra | first6 = KK. | last7 = Medeiros | first7 = F. | last8 = Crum | first8 = CP. | title = Differentiated vulvar intraepithelial neoplasia contains Tp53 mutations and is genetically linked to vulvar squamous cell carcinoma. | journal = Mod Pathol | volume = 23 | issue = 3 | pages = 404-12 | month = Mar | year = 2010 | doi = 10.1038/modpathol.2009.179 | PMID = 20062014 }}</ref>
Note:
*p16 can be thought of as a poor man's HPV test.
===Sign out===
====VIN I====
<pre>
VULVA, BIOPSY:
- CLASSIC VULVAR INTRAEPITHELIAL NEOPLASIA (VIN) I (MILD DYSPLASIA).
- NEGATIVE FOR INVASIVE MALIGNANCY.
</pre>
====VIN III====
<pre>
VULVA, EXCISION:
- CLASSIC VULVAR INTRAEPITHELIAL NEOPLASIA (VIN) III (SEVERE DYSPLASIA)
  WITH FOCAL ULCERATION.
- MARGIN FOCALLY POSITIVE FOR VIN III.
- NEGATIVE FOR INVASIVE MALIGNANCY.
</pre>
==See also==
*[[Vulva]].
==References==
{{Reflist|2}}
[[Category:Vulva]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 01:52, 25 February 2014

Classic vulvar intraepithelial neoplasia, abbreviated classic VIN, is a pre-neoplastic lesion of the vulva strongly associated with the human papilloma virus. It is also known as usual vulvar intraepithelial neoplasia, abbreviated uVIN.[1]

It should not be confused with differentiated vulvar intraepithelial neoplasia.

General

Epidemiology:

  • Classic VIN, like CIN, is associated with HPV and seen in younger women.
  • May be multifocal, i.e. associated with cervical (CIN) or vaginal (VAIN) lesions;[2] multifocality has a strongly association with immunosuppression.[3]

Classic VIN is graded like cervical pre-cancerous lesions:

Microscopic

Features:

  • Increased NC ratio.
  • Multinucleation.
  • Lack of maturation to surface (not very useful -- unlike in the cervix).[5]
    • May have "vertical streaming" - the long axis of the cells are perpendicular to the free surface & basement membrane.
  • Apical mitoses.

DDx:

Images

IHC

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

Note:

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

Sign out

VIN I

VULVA, BIOPSY:
- CLASSIC VULVAR INTRAEPITHELIAL NEOPLASIA (VIN) I (MILD DYSPLASIA).
- NEGATIVE FOR INVASIVE MALIGNANCY.

VIN III

VULVA, EXCISION:
- CLASSIC VULVAR INTRAEPITHELIAL NEOPLASIA (VIN) III (SEVERE DYSPLASIA)
  WITH FOCAL ULCERATION.
- MARGIN FOCALLY POSITIVE FOR VIN III.
- NEGATIVE FOR INVASIVE MALIGNANCY.


See also

References

  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.
  2. ↑ Pai, K.; Pai, S.; Gupta, A.; Rao, P.; Renjhen, P. (Oct 2006). "Synchronous vulvar intraepithelial neoplasia (VIN) of warty type and cervical intraepithelial neoplasia (CIN): case report.". Indian J Pathol Microbiol 49 (4): 585-7. PMID 17183865.
  3. ↑ Ait Menguellet, S.; Collinet, P.; Houfflin Debarge, V.; Nayama, M.; Vinatier, D.; Leroy, JL. (May 2007). "Management of multicentric lesions of the lower genital tract.". Eur J Obstet Gynecol Reprod Biol 132 (1): 116-20. doi:10.1016/j.ejogrb.2006.04.011. PMID 16713062.
  4. ↑ Rufforny, I.; Wilkinson, EJ.; Liu, C.; Zhu, H.; Buteral, M.; Massoll, NA. (Apr 2005). "Human papillomavirus infection and p16(INK4a) protein expression in vulvar intraepithelial neoplasia and invasive squamous cell carcinoma.". J Low Genit Tract Dis 9 (2): 108-13. PMID 15870532.
  5. ↑ LAE. February 2009.
  6. ↑ 6.0 6.1 Kotsopoulos, IC.; Tampakoudis, GP.; Evaggelinos, DG.; Nikolaidou, AI.; Fytili, PA.; Kartsiounis, VC.; Gerasimidou, DK. (2011). "Implication of human papillomavirus-66 in vulvar carcinoma: a case report.". J Med Case Rep 5: 232. doi:10.1186/1752-1947-5-232. PMC 3150314. PMID 21702970. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150314/.
  7. ↑ 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.
Retrieved from "https://librepathology.org/w/index.php?title=Classic_vulvar_intraepithelial_neoplasia&oldid=29829"