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High Grade Vulvar Squamous Intraepithelial Lesion

MedGen UID:
141672
•Concept ID:
C0495107
•
Neoplastic Process
Synonyms: Grade 2 VIN; Grade 2 Vulvar Intraepithelial Neoplasia; Grade 3 VIN; Grade II VIN; Grade II Vulvar Intraepithelial Neoplasia; Intraepithelial Neoplasia of the Vulva Grade 2; Intraepithelial Neoplasia of Vulva Grade 2; Moderate dysplasia of vulva; VIN - Vulval intraepithelial neoplasia grade 2; VIN 2 of Usual Type; VIN 3 of Usual Type; VIN Grade 2; VIN, Usual Type; Vulva Intraepithelial Neoplasia Grade 2; Vulva Intraepithelial Neoplasia Grade 3; Vulval intraepithelial neoplasia grade 2; Vulvar High Grade Squamous Intraepithelial Lesion; Vulvar High-Grade Squamous Intraepithelial Lesion; Vulvar HSIL; Vulvar Intraepithelial Neoplasia 2 of Usual Type; Vulvar Intraepithelial Neoplasia 3 of Usual Type; Vulvar Intraepithelial Neoplasia Grade 2; Vulvar Intraepithelial Neoplasia Grade 3; Vulvar Intraepithelial Neoplasia, Usual Type
SNOMED CT: Vulval intraepithelial neoplasia grade 2 (276874005); Moderate dysplasia of vulva (276874005); VIN - Vulval intraepithelial neoplasia grade 2 (276874005)

Definition

An intraepithelial lesion of the vulvar squamous epithelium associated with HPV infection. It is characterized by loss of maturation, nuclear hyperchromasia, high nuclear:cytoplasmic ratios, cytological and architectural atypia, and mitoses. Two morphological patterns have been described: basaloid (undifferentiated) and warty (condylomatous, bowenoid). It carries a significant but relatively low risk of progression to squamous cell carcinoma if untreated. (WHO 2020) [from NCI]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVHigh Grade Vulvar Squamous Intraepithelial Lesion

Professional guidelines

PubMed

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
Committee Opinion No.675: Management of Vulvar Intraepithelial Neoplasia.
Obstet Gynecol 2016 Oct;128(4):e178-e182. doi: 10.1097/AOG.0000000000001713. PMID: 27661656
Committee Opinion No. 675 Summary: Management of Vulvar Intraepithelial Neoplasia.
Obstet Gynecol 2016 Oct;128(4):937-938. doi: 10.1097/AOG.0000000000001704. PMID: 27661648

Recent clinical studies

Etiology

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia.
Kesic V, Carcopino X, Preti M, Vieira-Baptista P, Bevilacqua F, Bornstein J, Chargari C, Cruickshank M, Erzeneoglu E, Gallio N, Gultekin M, Heller D, Joura E, Kyrgiou M, Madić T, Planchamp F, Regauer S, Reich O, Esat Temiz B, Woelber L, Zodzika J, Stockdale C
Int J Gynecol Cancer 2023 Apr 3;33(4):446-461. doi: 10.1136/ijgc-2022-004213. PMID: 36958755Free PMC Article
Cervical Colposcopy: Indications and Risk Assessment.
Burness JV, Schroeder JM, Warren JB
Am Fam Physician 2020 Jul 1;102(1):39-48. PMID: 32603071
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

Cervical Colposcopy: Indications and Risk Assessment.
Burness JV, Schroeder JM, Warren JB
Am Fam Physician 2020 Jul 1;102(1):39-48. PMID: 32603071
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 Neoplasms, Benign and Malignant.
Allbritton JI
Obstet Gynecol Clin North Am 2017 Sep;44(3):339-352. doi: 10.1016/j.ogc.2017.04.002. PMID: 28778635
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

Therapy

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia.
Kesic V, Carcopino X, Preti M, Vieira-Baptista P, Bevilacqua F, Bornstein J, Chargari C, Cruickshank M, Erzeneoglu E, Gallio N, Gultekin M, Heller D, Joura E, Kyrgiou M, Madić T, Planchamp F, Regauer S, Reich O, Esat Temiz B, Woelber L, Zodzika J, Stockdale C
Int J Gynecol Cancer 2023 Apr 3;33(4):446-461. doi: 10.1136/ijgc-2022-004213. PMID: 36958755Free PMC Article
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) Consensus Statements on Pre-invasive Vulvar Lesions.
Preti M, Joura E, Vieira-Baptista P, Van Beurden M, Bevilacqua F, Bleeker MCG, Bornstein J, Carcopino X, Chargari C, Cruickshank ME, Erzeneoglu BE, Gallio N, Heller D, Kesic V, Reich O, Stockdale CK, Temiz BE, Woelber L, Planchamp F, Zodzika J, Querleu D, Gultekin M
J Low Genit Tract Dis 2022 Jul 1;26(3):229-244. Epub 2022 Jun 21 doi: 10.1097/LGT.0000000000000683. PMID: 35763611Free PMC Article
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
Human papillomavirus in the HIV-infected host: epidemiology and pathogenesis in the antiretroviral era.
Brickman C, Palefsky JM
Curr HIV/AIDS Rep 2015 Mar;12(1):6-15. doi: 10.1007/s11904-014-0254-4. PMID: 25644977
Human papillomavirus vaccines and anal carcinoma.
Franceschi S, De Vuyst H
Curr Opin HIV AIDS 2009 Jan;4(1):57-63. doi: 10.1097/COH.0b013e32831b9c81. PMID: 19339940

Prognosis

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
Vulval squamous cell carcinoma and its precursors.
Singh N, Gilks CB
Histopathology 2020 Jan;76(1):128-138. doi: 10.1111/his.13989. PMID: 31846523
Human Papillomavirus-Independent Squamous Lesions of the Vulva.
Watkins JC
Surg Pathol Clin 2019 Jun;12(2):249-261. Epub 2019 Apr 5 doi: 10.1016/j.path.2019.01.001. PMID: 31097103
Clinical and molecular classification of vulvar squamous pre-cancers.
Cohen PA, Anderson L, Eva L, Scurry J
Int J Gynecol Cancer 2019 May;29(4):821-828. Epub 2019 Feb 7 doi: 10.1136/ijgc-2018-000135. PMID: 30737358

Clinical prediction guides

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
Molecular events in the pathogenesis of vulvar squamous cell carcinoma.
Xing D, Fadare O
Semin Diagn Pathol 2021 Jan;38(1):50-61. Epub 2020 Sep 25 doi: 10.1053/j.semdp.2020.09.010. PMID: 33032902Free PMC Article
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
High-grade squamous intraepithelial lesion arising adjacent to vulvar lymphangioma circumscriptum: a tertiary institutional experience.
Bae GE, Yoon G, Song YJ, Kim HS
Oncotarget 2016 Jul 26;7(30):48120-48129. doi: 10.18632/oncotarget.10158. PMID: 27329721Free PMC Article
Immunohistochemistry and in situ hybridization for the diagnosis and classification of squamous lesions of the anogenital region.
Pirog EC
Semin Diagn Pathol 2015 Sep;32(5):409-18. Epub 2015 Feb 7 doi: 10.1053/j.semdp.2015.02.015. PMID: 25862555

Recent systematic reviews

Risk of Development of Vulvar Cancer in Women With Lichen Sclerosus or Lichen Planus: A Systematic Review.
Vieira-Baptista P, Pérez-López FR, López-Baena MT, Stockdale CK, Preti M, Bornstein J
J Low Genit Tract Dis 2022 Jul 1;26(3):250-257. Epub 2022 Mar 11 doi: 10.1097/LGT.0000000000000673. PMID: 35285455
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
Medical and surgical interventions for the treatment of usual-type vulval intraepithelial neoplasia.
Lawrie TA, Nordin A, Chakrabarti M, Bryant A, Kaushik S, Pepas L
Cochrane Database Syst Rev 2016 Jan 5;2016(1):CD011837. doi: 10.1002/14651858.CD011837.pub2. PMID: 26728940Free PMC Article
Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: a systematic review.
Stier EA, Sebring MC, Mendez AE, Ba FS, Trimble DD, Chiao EY
Am J Obstet Gynecol 2015 Sep;213(3):278-309. Epub 2015 Mar 19 doi: 10.1016/j.ajog.2015.03.034. PMID: 25797230Free PMC Article
Chromosomal gains and losses in human papillomavirus-associated neoplasia of the lower genital tract - a systematic review and meta-analysis.
Thomas LK, Bermejo JL, Vinokurova S, Jensen K, Bierkens M, Steenbergen R, Bergmann M, von Knebel Doeberitz M, Reuschenbach M
Eur J Cancer 2014 Jan;50(1):85-98. Epub 2013 Sep 17 doi: 10.1016/j.ejca.2013.08.022. PMID: 24054023

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