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Differentiated vulvar intraepithelial neoplasia (view source)
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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]]. | |||
It is also known as '''VIN simplex'''.<ref name=pmid15910611>{{Cite journal | last1 = Ruhul Quddus | first1 = M. | last2 = Xu | first2 = C. | last3 = Steinhoff | first3 = MM. | last4 = Zhang | first4 = C. | last5 = Lawrence | first5 = WD. | last6 = Sung | first6 = CJ. | title = 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. | journal = Histopathology | volume = 46 | issue = 6 | pages = 718-20 | month = Jun | year = 2005 | doi = 10.1111/j.1365-2559.2005.02036.x | PMID = 15910611 }}</ref> | |||
==General== | |||
Epidemiology: | |||
*Associated with [[lichen sclerosus]]. | |||
*Seen in older women. | |||
Note: | |||
*'''Not''' associated with [[HPV]].<ref name=pmid10716158>{{Cite journal | last1 = Yang | first1 = B. | last2 = Hart | first2 = WR. | title = Vulvar intraepithelial neoplasia of the simplex (differentiated) type: a clinicopathologic study including analysis of HPV and p53 expression. | journal = Am J Surg Pathol | volume = 24 | issue = 3 | pages = 429-41 | month = Mar | year = 2000 | doi = | PMID = 10716158 }}</ref> | |||
==Microscopic== | |||
Features:<ref name=pmid21057461>{{Cite journal | last1 = van de Nieuwenhof | first1 = HP. | last2 = Bulten | first2 = J. | last3 = Hollema | first3 = H. | last4 = Dommerholt | first4 = RG. | last5 = Massuger | first5 = LF. | last6 = van der Zee | first6 = AG. | last7 = de Hullu | first7 = JA. | last8 = van Kempen | first8 = LC. | title = Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma. | journal = Mod Pathol | volume = 24 | issue = 2 | pages = 297-305 | month = Feb | year = 2011 | doi = 10.1038/modpathol.2010.192 | PMID = 21057461 }}</ref> | |||
*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. | |||
*Mnemonic ''BAD LAP'': '''b'''asal cell atypia, '''a'''nastomosing rete ridges (bridging), '''d'''VIN, '''l'''ichen sclerosus, '''a'''canthosis, '''p'''arakeratosis. | |||
DDx: | |||
*[[Lichen sclerosus]]. | |||
*[[Lichen simplex chronicus]] (squamous hyperplasia). | |||
===Images=== | |||
<gallery> | |||
Image:Differentiated_vulvar_intraepithelial_neoplasia_-_low_mag.jpg | Differentiated VIN - low mag. (WC) | |||
Image:Differentiated_vulvar_intraepithelial_neoplasia_-_intermed_mag.jpg | Differentiated VIN - intermed. mag. (WC) | |||
Image:Differentiated_vulvar_intraepithelial_neoplasia_-_deep_-_high_mag.jpg | Differentiated VIN - deep - high mag. (WC) | |||
</gallery> | |||
www: | |||
*[http://www.nature.com/modpathol/journal/v24/n2/fig_tab/modpathol2010192f3.html#figure-title Differentiated VIN (nature.com)].<ref name=pmid21057461>{{Cite journal | last1 = van de Nieuwenhof | first1 = HP. | last2 = Bulten | first2 = J. | last3 = Hollema | first3 = H. | last4 = Dommerholt | first4 = RG. | last5 = Massuger | first5 = LF. | last6 = van der Zee | first6 = AG. | last7 = de Hullu | first7 = JA. | last8 = van Kempen | first8 = LC. | title = Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma. | journal = Mod Pathol | volume = 24 | issue = 2 | pages = 297-305 | month = Feb | year = 2011 | doi = 10.1038/modpathol.2010.192 | PMID = 21057461 }}</ref> | |||
*[http://www.nature.com/modpathol/journal/v23/n3/fig_tab/modpathol2009179f1.html Differentiated VIN with bridging rete ridges (nature.com)].<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> | |||
===IHC=== | |||
*Differentiated VIN: p16 -ve, p53 +ve.<ref name=pmid20062014/> | |||
*Classic VIN: p16 +ve, p53 -ve. | |||
Note: | |||
*p16 can be thought of as a poor man's [[HPV]] test. | |||
==See also== | |||
*[[Vulva]]. | |||
*[[Classic vulvar intraepithelial neoplasia]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Vulva]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||