Vulva & female urethra
Squamous tumors and precursors
Differentiated type, vulvar intraepithelial neoplasia (dVIN)

Topic Completed: 1 August 2016

Revised: 5 August 2019

Copyright: 2003-2019,, Inc.

PubMed Search: dVIN

Sarah Strickland, M.D.
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Page views in 2019 to date: 8,814
Cite this page: Strickland S. Differentiated type, vulvar intraepithelial neoplasia. website. Accessed December 6th, 2019.
Essential features
  • Squamous cell carcinoma precursor lesion of the vulva
  • Distinct oncogenic pathway compared to usual type, vulvar intraepithelial neoplasia (uVIN)
  • 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)
  • 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
  • Usually confined to nonhair bearing areas or external sides of atrophic labia minora
  • 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
Prognostic factors
  • Local excision
Clinical images

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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

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dVIN H&E stains

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Atypical keratinocytes

Fig 3: dVIN lesion with
adjacent squamous cell

Positive stains
  • p53: basal layer and suprabasilar extension; may be strong and diffuse (missense mutations) or completely negative (null pattern)
  • Ki67: higher proliferation index in basal layer and thinner suprabasilar layer than normal vulvar epithelium
Negative stains
Molecular / cytogenetics description
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