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Table of Contents
Essential features | Terminology | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Prognostic factors | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Molecular / cytogenetics description | Differential diagnosis | Additional referencesCite this page: Differentiated type, vulvar intraepithelial neoplasia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvadifferentiatedVIN.html. Accessed July 16th, 2017.
Essential features
- Squamous cell carcinoma precursor lesion of the vulva
- Distinct oncogenic pathway compared to usual type, vulvar intraepithelial neoplasia (uVIN)
Terminology
- The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD), and the 2014 World Health Organization Classification of Tumors of the Vulva both classify vulvar squamous intraepithelial lesions as:
- Low grade squamous intraepithelial lesion (LSIL) (vulvar LSIL, flat condyloma or HPV effect)
- High grade squamous intraepithelial lesion (HSIL) (vulvar HSIL, VIN usual type)
- Differentiated type VIN (J Low Genit Tract Dis 2016;20:11)
Epidemiology
- 5% of all VIN lesions, much less common than usual type VIN (Crit Rev Oncol Hematol 2008;68:131)
- Post menopausal women (60-80 years)
- Often arises in a background of lichen sclerosus and chronic inflammatory dermatoses
- Risk factors include older age, irritation, inflammation, oxidative and ischemic stress
Sites
- Usually confined to nonhair bearing areas or external sides of atrophic labia minora
Etiology
- NOT related to human papillomavirus (HPV)
- Most cases harbor p53 mutations
Clinical features
- Unifocal / unicentric
- Gray / white discoloration with a roughened surface, white plaques, white elevated nodules, ulcerative red lesion or erythematous red lesion
Diagnosis
- Vulvar biopsy: optimally a punch or small incisional biopsy taken from the edge of the lesion including a small piece of normal tissue (Crit Rev Oncol Hematol. 2008;68:131)
Prognostic factors
- ~33% progress to keratinizing squamous cell carcinoma (Eur J Cancer 2009;45:851)
- Higher risk of malignant progression and over a shortened time frame compared to usual type VIN (Eur J Cancer 2009;45:851)
Treatment
- Local excision
Clinical images
Images hosted on other servers:
dVIN developed on lichen sclerous
Microscopic (histologic) description
- Acanthosis, variable parakeratosis
- Irregular elongation and anastomoses of the rete ridges
- Nuclear atypia confined to basal and parabasal layers
- Nuclear enlargement with coarse chromatin, open vesicular nuclei and prominent nucleoli
- Ample eosinophilic cytoplasm
- Scattered mitoses in basal layer but can extend to upper levels of epithelium
- Prominent intercellular bridges
- Chronic inflammatory infiltrate in underlying or adjacent papillary dermis
- No extension into skin appendages
Microscopic (histologic) images
Images hosted on other servers:
dVIN H&E stains
Atypical keratinocytes
dVIN lesion with adjacent
squamous cell carcinoma
Positive stains
Negative stains
Molecular / cytogenetics description
Differential diagnosis
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