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'''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]] | ||