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Vulvar intraepithelial neoplasia

MedGen UID:
91093
•Concept ID:
C0346210
•
Neoplastic Process
Synonyms: Dysplasia of vulva; Intraepithelial Neoplasia of the Vulva; intraepithelial neoplasia of the vulva; Intraepithelial Neoplasia of Vulva; intraepithelial neoplasia of vulva; Squamous Vulvar Intraepithelial Neoplasia; squamous vulvar intraepithelial neoplasia; VIN; Vulva Intraepithelial Neoplasia; vulva intraepithelial neoplasia; Vulval intraepithelial neoplasia; Vulval Intraepithelial Neoplasia; vulval intraepithelial neoplasia; Vulval intraepithelial neoplasia (VIN); Vulvar Intraepithelial Neoplasia; vulvar intraepithelial neoplasia; Vulvar intraepithelial tumor; vulvar intraepithelial tumor; vulvar intraepithelial tumour
SNOMED CT: Dysplasia of vulva (399382009); Vulval intraepithelial neoplasia (VIN) (399933001); Vulval intraepithelial neoplasia (399933001)
Modes of inheritance:
Not genetically inherited
MedGen UID:
988794
•Concept ID:
CN307044
•
Finding
Source: Orphanet
clinical entity without genetic inheritance.
See: This record
Not genetically inherited (Orphanet)
 
HPO: HP:0032202
Monarch Initiative: MONDO:0005198
Orphanet: ORPHA137583

Definition

Vulvar intraepithelial neoplasia (VIN) is widely accepted as the precursor lesion of vulvar squamous cell carcinoma (VSCC). VSCC arises via either a human papilloma virus (HPV)-associated pathway, or more commonly, via a mechanism independent of HPV, often being linked to chronic inflammatory conditions such as lichen sclerosus (LS). Accordingly, two distinct subtypes of VIN are recognized [from HPO]

Professional guidelines

PubMed

Topical imiquimod as first-line treatment for vulvar intraepithelial neoplasia.
Voss FO, van Beurden M, Jordanova ES
Lancet 2022 May 7;399(10337):1755-1757. Epub 2022 Apr 25 doi: 10.1016/S0140-6736(22)00624-9. PMID: 35483402
Diagnosis and Management of Vulvar Skin Disorders: ACOG Practice Bulletin, Number 224.
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology
Obstet Gynecol 2020 Jul;136(1):e1-e14. doi: 10.1097/AOG.0000000000003944. PMID: 32590724
Vulvar intraepithelial neoplasia: Classification, epidemiology, diagnosis, and management.
Lebreton M, Carton I, Brousse S, Lavoué V, Body G, Levêque J, Nyangoh-Timoh K
J Gynecol Obstet Hum Reprod 2020 Nov;49(9):101801. Epub 2020 May 14 doi: 10.1016/j.jogoh.2020.101801. PMID: 32417455

Recent clinical studies

Etiology

Classification of Vulvar Squamous Cell Carcinoma and Precursor Lesions by p16 and p53 Immunohistochemistry: Considerations, Caveats, and an Algorithmic Approach.
Yang H, Almadani N, Thompson EF, Tessier-Cloutier B, Chen J, Ho J, Senz J, McConechy MK, Chow C, Ta M, Cheng A, Karnezis A, Huvila J, McAlpine JN, Gilks B, Jamieson A, Hoang LN
Mod Pathol 2023 Jun;36(6):100145. Epub 2023 Feb 22 doi: 10.1016/j.modpat.2023.100145. PMID: 36828360
HPV-independent, p53-wild-type vulvar intraepithelial neoplasia: a review of nomenclature and the journey to characterize verruciform and acanthotic precursor lesions of the vulva.
Parra-Herran C, Nucci MR, Singh N, Rakislova N, Howitt BE, Hoang L, Gilks CB, Bosse T, Watkins JC
Mod Pathol 2022 Oct;35(10):1317-1326. Epub 2022 Apr 18 doi: 10.1038/s41379-022-01079-7. PMID: 35437330
Vulvar intraepithelial neoplasia: Classification, epidemiology, diagnosis, and management.
Lebreton M, Carton I, Brousse S, Lavoué V, Body G, Levêque J, Nyangoh-Timoh K
J Gynecol Obstet Hum Reprod 2020 Nov;49(9):101801. Epub 2020 May 14 doi: 10.1016/j.jogoh.2020.101801. PMID: 32417455
Major p53 immunohistochemical patterns in in situ and invasive squamous cell carcinomas of the vulva and correlation with TP53 mutation status.
Tessier-Cloutier B, Kortekaas KE, Thompson E, Pors J, Chen J, Ho J, Prentice LM, McConechy MK, Chow C, Proctor L, McAlpine JN, Huntsman DG, Gilks CB, Bosse T, Hoang LN
Mod Pathol 2020 Aug;33(8):1595-1605. Epub 2020 Mar 20 doi: 10.1038/s41379-020-0524-1. PMID: 32203095
Vulvar intraepithelial neoplasia.
Preti M, Scurry J, Marchitelli CE, Micheletti L
Best Pract Res Clin Obstet Gynaecol 2014 Oct;28(7):1051-62. Epub 2014 Jul 18 doi: 10.1016/j.bpobgyn.2014.07.010. PMID: 25106700

Diagnosis

HPV-independent, p53-wild-type vulvar intraepithelial neoplasia: a review of nomenclature and the journey to characterize verruciform and acanthotic precursor lesions of the vulva.
Parra-Herran C, Nucci MR, Singh N, Rakislova N, Howitt BE, Hoang L, Gilks CB, Bosse T, Watkins JC
Mod Pathol 2022 Oct;35(10):1317-1326. Epub 2022 Apr 18 doi: 10.1038/s41379-022-01079-7. PMID: 35437330
Diagnosis and Management of Vulvar Skin Disorders: ACOG Practice Bulletin, Number 224.
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology
Obstet Gynecol 2020 Jul;136(1):e1-e14. doi: 10.1097/AOG.0000000000003944. PMID: 32590724
Vulvar intraepithelial neoplasia: Classification, epidemiology, diagnosis, and management.
Lebreton M, Carton I, Brousse S, Lavoué V, Body G, Levêque J, Nyangoh-Timoh K
J Gynecol Obstet Hum Reprod 2020 Nov;49(9):101801. Epub 2020 May 14 doi: 10.1016/j.jogoh.2020.101801. PMID: 32417455
Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach.
Woelber L, Prieske K, Mendling W, Schmalfeldt B, Tietz HJ, Jaeger A
Dtsch Arztebl Int 2020 Feb 21;116(8):126-133. doi: 10.3238/arztebl.2020.0126. PMID: 32181734Free PMC Article
Squamous vulvar intraepithelial neoplasia.
Preti M, Van Seters M, Sideri M, Van Beurden M
Clin Obstet Gynecol 2005 Dec;48(4):845-61. doi: 10.1097/01.grf.0000181738.37911.03. PMID: 16286831

Therapy

Prevalence of human papillomavirus DNA and p16(INK4a) positivity in vulvar cancer and vulvar intraepithelial neoplasia: a systematic review and meta-analysis.
Li Z, Liu P, Wang Z, Zhang Z, Chen Z, Chu R, Li G, Han Q, Zhao Y, Li L, Miao J, Kong B, Song K
Lancet Oncol 2023 Apr;24(4):403-414. Epub 2023 Mar 15 doi: 10.1016/S1470-2045(23)00066-9. PMID: 36933562
Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial.
Huh WK, Joura EA, Giuliano AR, Iversen OE, de Andrade RP, Ault KA, Bartholomew D, Cestero RM, Fedrizzi EN, Hirschberg AL, Mayrand MH, Ruiz-Sternberg AM, Stapleton JT, Wiley DJ, Ferenczy A, Kurman R, Ronnett BM, Stoler MH, Cuzick J, Garland SM, Kjaer SK, Bautista OM, Haupt R, Moeller E, Ritter M, Roberts CC, Shields C, Luxembourg A
Lancet 2017 Nov 11;390(10108):2143-2159. Epub 2017 Sep 5 doi: 10.1016/S0140-6736(17)31821-4. PMID: 28886907
New approaches to external genital warts and vulvar intraepithelial neoplasia.
Kennedy CM, Boardman LA
Clin Obstet Gynecol 2008 Sep;51(3):518-26. doi: 10.1097/GRF.0b013e31818092a3. PMID: 18677144
Imiquimod.
Garland SM
Curr Opin Infect Dis 2003 Apr;16(2):85-9. doi: 10.1097/00001432-200304000-00004. PMID: 12734440
Vulvar cancer.
Canavan TP, Cohen D
Am Fam Physician 2002 Oct 1;66(7):1269-74. PMID: 12387439

Prognosis

Classification of Vulvar Squamous Cell Carcinoma and Precursor Lesions by p16 and p53 Immunohistochemistry: Considerations, Caveats, and an Algorithmic Approach.
Yang H, Almadani N, Thompson EF, Tessier-Cloutier B, Chen J, Ho J, Senz J, McConechy MK, Chow C, Ta M, Cheng A, Karnezis A, Huvila J, McAlpine JN, Gilks B, Jamieson A, Hoang LN
Mod Pathol 2023 Jun;36(6):100145. Epub 2023 Feb 22 doi: 10.1016/j.modpat.2023.100145. PMID: 36828360
Vulvar intraepithelial neoplasia: Classification, epidemiology, diagnosis, and management.
Lebreton M, Carton I, Brousse S, Lavoué V, Body G, Levêque J, Nyangoh-Timoh K
J Gynecol Obstet Hum Reprod 2020 Nov;49(9):101801. Epub 2020 May 14 doi: 10.1016/j.jogoh.2020.101801. PMID: 32417455
Major p53 immunohistochemical patterns in in situ and invasive squamous cell carcinomas of the vulva and correlation with TP53 mutation status.
Tessier-Cloutier B, Kortekaas KE, Thompson E, Pors J, Chen J, Ho J, Prentice LM, McConechy MK, Chow C, Proctor L, McAlpine JN, Huntsman DG, Gilks CB, Bosse T, Hoang LN
Mod Pathol 2020 Aug;33(8):1595-1605. Epub 2020 Mar 20 doi: 10.1038/s41379-020-0524-1. PMID: 32203095
Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial.
Huh WK, Joura EA, Giuliano AR, Iversen OE, de Andrade RP, Ault KA, Bartholomew D, Cestero RM, Fedrizzi EN, Hirschberg AL, Mayrand MH, Ruiz-Sternberg AM, Stapleton JT, Wiley DJ, Ferenczy A, Kurman R, Ronnett BM, Stoler MH, Cuzick J, Garland SM, Kjaer SK, Bautista OM, Haupt R, Moeller E, Ritter M, Roberts CC, Shields C, Luxembourg A
Lancet 2017 Nov 11;390(10108):2143-2159. Epub 2017 Sep 5 doi: 10.1016/S0140-6736(17)31821-4. PMID: 28886907
Vulvar cancer.
Canavan TP, Cohen D
Am Fam Physician 2002 Oct 1;66(7):1269-74. PMID: 12387439

Clinical prediction guides

High-grade vulvar intraepithelial neoplasia: comprehensive characterization and long-term vulvar carcinoma risk.
Thuijs NB, van Beurden M, Duin S, Heideman DAM, Berkhof J, Steenbergen RDM, Bleeker MCG
Histopathology 2024 Jan;84(2):301-314. Epub 2023 Sep 19 doi: 10.1111/his.15050. PMID: 37726173
Recent advances in treating female genital human papillomavirus related neoplasms with topical imiquimod.
Borella F, Gallio N, Mangherini L, Cassoni P, Bertero L, Benedetto C, Preti M
J Med Virol 2023 Nov;95(11):e29238. doi: 10.1002/jmv.29238. PMID: 38009696
Topical imiquimod versus surgery for vulvar intraepithelial neoplasia: a multicentre, randomised, phase 3, non-inferiority trial.
Trutnovsky G, Reich O, Joura EA, Holter M, Ciresa-König A, Widschwendter A, Schauer C, Bogner G, Jan Z, Boandl A, Kalteis MS, Regauer S, Tamussino K
Lancet 2022 May 7;399(10337):1790-1798. Epub 2022 Apr 25 doi: 10.1016/S0140-6736(22)00469-X. PMID: 35483400
Erosive Vulvar Lichen Planus and Risk of Vulvar Neoplasia.
Lyra J, Melo C, Figueiredo R, Polonia-Valente R, Falcão V, Beires J, Vieira-Baptista P
J Low Genit Tract Dis 2021 Jan 1;25(1):71-75. doi: 10.1097/LGT.0000000000000581. PMID: 33214502
Major p53 immunohistochemical patterns in in situ and invasive squamous cell carcinomas of the vulva and correlation with TP53 mutation status.
Tessier-Cloutier B, Kortekaas KE, Thompson E, Pors J, Chen J, Ho J, Prentice LM, McConechy MK, Chow C, Proctor L, McAlpine JN, Huntsman DG, Gilks CB, Bosse T, Hoang LN
Mod Pathol 2020 Aug;33(8):1595-1605. Epub 2020 Mar 20 doi: 10.1038/s41379-020-0524-1. PMID: 32203095

Recent systematic reviews

Prevalence of human papillomavirus DNA and p16(INK4a) positivity in vulvar cancer and vulvar intraepithelial neoplasia: a systematic review and meta-analysis.
Li Z, Liu P, Wang Z, Zhang Z, Chen Z, Chu R, Li G, Han Q, Zhao Y, Li L, Miao J, Kong B, Song K
Lancet Oncol 2023 Apr;24(4):403-414. Epub 2023 Mar 15 doi: 10.1016/S1470-2045(23)00066-9. PMID: 36933562
A systematic review of laser therapy for vulvar skin conditions.
Kim K, Desai M, Elsensohn A, Kraus CN
J Am Acad Dermatol 2023 May;88(5):1200-1201. Epub 2023 Jan 11 doi: 10.1016/j.jaad.2023.01.003. PMID: 36639033
A Systematic Review of Risk Factors for Development, Recurrence, and Progression of Vulvar Intraepithelial Neoplasia.
Jamieson A, Tse SS, Brar H, Sadownik LA, Proctor L
J Low Genit Tract Dis 2022 Apr 1;26(2):140-146. doi: 10.1097/LGT.0000000000000662. PMID: 35249976
Precursor lesions of vulvar squamous cell carcinoma - histology and biomarkers: A systematic review.
Dasgupta S, Ewing-Graham PC, Swagemakers SMA, van der Spek PJ, van Doorn HC, Noordhoek Hegt V, Koljenović S, van Kemenade FJ
Crit Rev Oncol Hematol 2020 Mar;147:102866. Epub 2020 Jan 15 doi: 10.1016/j.critrevonc.2020.102866. PMID: 32058913
Prevalence and type distribution of human papillomavirus in squamous cell carcinoma and intraepithelial neoplasia of the vulva.
Faber MT, Sand FL, Albieri V, Norrild B, Kjaer SK, Verdoodt F
Int J Cancer 2017 Sep 15;141(6):1161-1169. Epub 2017 Jun 21 doi: 10.1002/ijc.30821. PMID: 28577297

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