Vulvar intraepithelial neoplasia Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2018;40(1):26-31
A vulvar squamous intraepithelial lesion is deemed to be a preceding lesion to vulvar cancer, especially in women aged under 40 years, holders of an acquired or idiopathic immunosuppression. Several treatments have been used to treat these lesions. One of the aesthetically acceptable therapeutic methods is the CO2 laser vaporization.
In a transversal study, 46 records of immunosuppressed women bearing a vulvar low grade and/or high grade squamous intraepithelial lesion were selected out of the retrospective analysis, computing age, date of record, date of vulvar lesion treatment with CO2 laser, the time elapsed between the first and the last visit (in months), the number of visits, the presence or absence of condylomatous lesions in other female lower genital tract sites and whether or not recurrences and persistence of intraepithelial lesions have been noticed during the follow-up.
Patients bearing vulvar high-grade squamous intraepithelial lesion and immunosuppressed (serumpositive forhumanimmunodeficiency virus [HIV] or with solid organs transplantation) have shown a higher level of persistence of lesions and a higher chance of having other areas of the female lower genital tract involved.
While the CO2 laser vaporization is the most conservative method for the treatment of vulvar high-grade intraepithelial lesions, it is far frombeing the ideal method, dueto the intrinsic infection features considered. The possibility of persistence, recurrences and spontaneous limited regression indicates that a closer surveillance in the long-term treated cases should be considered, in special for immunosuppressed patients.
Summary
Rev Bras Ginecol Obstet. 2018;40(1):26-31
A vulvar squamous intraepithelial lesion is deemed to be a preceding lesion to vulvar cancer, especially in women aged under 40 years, holders of an acquired or idiopathic immunosuppression. Several treatments have been used to treat these lesions. One of the aesthetically acceptable therapeutic methods is the CO2 laser vaporization.
In a transversal study, 46 records of immunosuppressed women bearing a vulvar low grade and/or high grade squamous intraepithelial lesion were selected out of the retrospective analysis, computing age, date of record, date of vulvar lesion treatment with CO2 laser, the time elapsed between the first and the last visit (in months), the number of visits, the presence or absence of condylomatous lesions in other female lower genital tract sites and whether or not recurrences and persistence of intraepithelial lesions have been noticed during the follow-up.
Patients bearing vulvar high-grade squamous intraepithelial lesion and immunosuppressed (serumpositive forhumanimmunodeficiency virus [HIV] or with solid organs transplantation) have shown a higher level of persistence of lesions and a higher chance of having other areas of the female lower genital tract involved.
While the CO2 laser vaporization is the most conservative method for the treatment of vulvar high-grade intraepithelial lesions, it is far frombeing the ideal method, dueto the intrinsic infection features considered. The possibility of persistence, recurrences and spontaneous limited regression indicates that a closer surveillance in the long-term treated cases should be considered, in special for immunosuppressed patients.
Summary
Rev Bras Ginecol Obstet. 1998;20(7):371-376
DOI 10.1590/S0100-72031998000700001
The purpose of the present study was to evaluate some epidemiological, clinical and pathological characteristics of the different grades of vulvar intraepithelial neoplasia (VIN), and its relation with the presence of human papillomavirus (HPV). The charts of 46 women with VIN, examined from 1986 through 1997, were reviewed. For statistical analysis the chi² with yates correction when appropriate, and Fisher's exact tests were used. Regarding the grade of VIN, six women presented VIN 1, six others had VIN 2 and the remaining 34 presented VIN 3. All women presented similar characteristics such as age, menstrual status and age at first sexual intercourse. Women with more than one lifetime sexual partner had a tendency to show more VIN 3 (p = 0.090). Cigarette smoking was significantly associated with the severity of the vulvar lesion (p = 0.031). HPV was significantly more frequent in women younger than 35 years of age (p = 0.005) and in women with multiple lesions (p = 0.089). Although the number of lesions were not related to the severity of VIN (p = 0.703), lesions with extensions greater than 2 cm were significantly associated with VIN 3 (p = 0.009). The treatment of choice for VIN 3 was surgery, including local resection and simple vulvectomy. Eight women relapsed, and only one had VIN 2. We concluded that among women with VIN, cigarette smoking and more than one lifetime sexual partner were associated with high-grade lesions. HPV was more frequent among patients younger than 35 years of age presenting multiple lesions. Women with VIN 3 presented lesions bigger than 2 cm and a high relapse rate, despite the type of treatment applied.
Summary
Rev Bras Ginecol Obstet. 1998;20(7):371-376
DOI 10.1590/S0100-72031998000700001
The purpose of the present study was to evaluate some epidemiological, clinical and pathological characteristics of the different grades of vulvar intraepithelial neoplasia (VIN), and its relation with the presence of human papillomavirus (HPV). The charts of 46 women with VIN, examined from 1986 through 1997, were reviewed. For statistical analysis the chi² with yates correction when appropriate, and Fisher's exact tests were used. Regarding the grade of VIN, six women presented VIN 1, six others had VIN 2 and the remaining 34 presented VIN 3. All women presented similar characteristics such as age, menstrual status and age at first sexual intercourse. Women with more than one lifetime sexual partner had a tendency to show more VIN 3 (p = 0.090). Cigarette smoking was significantly associated with the severity of the vulvar lesion (p = 0.031). HPV was significantly more frequent in women younger than 35 years of age (p = 0.005) and in women with multiple lesions (p = 0.089). Although the number of lesions were not related to the severity of VIN (p = 0.703), lesions with extensions greater than 2 cm were significantly associated with VIN 3 (p = 0.009). The treatment of choice for VIN 3 was surgery, including local resection and simple vulvectomy. Eight women relapsed, and only one had VIN 2. We concluded that among women with VIN, cigarette smoking and more than one lifetime sexual partner were associated with high-grade lesions. HPV was more frequent among patients younger than 35 years of age presenting multiple lesions. Women with VIN 3 presented lesions bigger than 2 cm and a high relapse rate, despite the type of treatment applied.
Summary
Rev Bras Ginecol Obstet. 2002;24(1):51-57
DOI 10.1590/S0100-72032002000100008
Purpose: to evaluate p53 overexpression value in vulvar intraepithelial neoplasia (VIN) III recurrence/progression. Methods: twenty patients with undifferentiated VIN III were selected and followed up every six months for four years and divided into two groups: fourteen without and six with recurrence/progression lesion. The recurrence/progression cases were distributed as follows: in three patients recurrence occurred only once; in two, twice, and only one progressed to squamous cancer. In both groups the site of vulvar lesion and p53 overexpression and immunostaining pattern were analyzed. A similar study was performed in recurrence/progression cases, besides the analysis of the time interval to occur the arise of recurrence/progression. Results: recurrence was observed in 25% of the cases and, in 5%, progression to carcinoma. The mean time interval for recurrence was 24.5 months. Multifocal location of the initial lesion was the predominant form (50%) in both groups. In the majority of the cases (87.5%) recurrence/progression occurred at the same site of the initial vulvar lesion. p53 overexpression was observed in 50% of the VIN III primary lesions and in 75% of the recurrence/progression cases. Conclusions: p53 overexpression seems to play an important role in VIN III pathogenesis and may predict the clinical course of the lesions. VIN III recurrence/progression has a tendency to occur in the same area of the initial lesion, suggesting the presence of molecular disturbance.
Summary
Rev Bras Ginecol Obstet. 2002;24(1):51-57
DOI 10.1590/S0100-72032002000100008
Purpose: to evaluate p53 overexpression value in vulvar intraepithelial neoplasia (VIN) III recurrence/progression. Methods: twenty patients with undifferentiated VIN III were selected and followed up every six months for four years and divided into two groups: fourteen without and six with recurrence/progression lesion. The recurrence/progression cases were distributed as follows: in three patients recurrence occurred only once; in two, twice, and only one progressed to squamous cancer. In both groups the site of vulvar lesion and p53 overexpression and immunostaining pattern were analyzed. A similar study was performed in recurrence/progression cases, besides the analysis of the time interval to occur the arise of recurrence/progression. Results: recurrence was observed in 25% of the cases and, in 5%, progression to carcinoma. The mean time interval for recurrence was 24.5 months. Multifocal location of the initial lesion was the predominant form (50%) in both groups. In the majority of the cases (87.5%) recurrence/progression occurred at the same site of the initial vulvar lesion. p53 overexpression was observed in 50% of the VIN III primary lesions and in 75% of the recurrence/progression cases. Conclusions: p53 overexpression seems to play an important role in VIN III pathogenesis and may predict the clinical course of the lesions. VIN III recurrence/progression has a tendency to occur in the same area of the initial lesion, suggesting the presence of molecular disturbance.
