Difference between revisions of "Differentiated vulvar intraepithelial neoplasia"

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#redirect [[Vulva#Differentiated_vulvar_intraepithelial_neoplasia]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Differentiated_vulvar_intraepithelial_neoplasia_-_intermed_mag.jpg
| Width      =
| Caption    = Differentiated vulvar intraepithelial neoplasia. [[H&E stain]].
| Synonyms  = VIN simplex, simplex-type VIN
| Micro      = thickening of the stratum spinosum ([[acanthosis]]), elongation of rete ridges with bridging/anastomoses between rete ridges, nuclear atypia - esp. basal layer, nuclei in stratum corneum (parakeratosis), +/-atypical mitoses
| Subtypes  =
| LMDDx      = [[vulvar squamous cell carcinoma]], [[lichen sclerosus]], [[classic vulvar intraepithelial neoplasia]]
| Stains    =
| IHC        = p53 +ve, p16 -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[vulva]]
| Assdx      = [[lichen sclerosus]], [[vulvar squamous cell carcinoma]]
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Differentiated vulvar intraepithelial neoplasia''', abbreviated '''dVIN''', is a pre-neoplastic pathology of the [[vulva]] typically arising in the context of [[lichen sclerosus]].


It is also known as '''VIN simplex''',<ref name=pmid15910611>{{Cite journal  | last1 = Ruhul Quddus | first1 = M. | last2 = Xu | first2 = C. | last3 = Steinhoff | first3 = MM. | last4 = Zhang | first4 = C. | last5 = Lawrence | first5 = WD. | last6 = Sung | first6 = CJ. | title = Simplex (differentiated) type VIN: absence of p16INK4 supports its weak association with HPV and its probable precursor role in non-HPV related vulvar squamous cancers. | journal = Histopathology | volume = 46 | issue = 6 | pages = 718-20 | month = Jun | year = 2005 | doi = 10.1111/j.1365-2559.2005.02036.x | PMID = 15910611 }}</ref> and '''simplex-type VIN'''.<ref name=pmid24399036/>
==General==
Epidemiology:
*Associated with [[lichen sclerosus]].
*Seen in older women - typically 50s-70s.<ref name=pmid19730361>{{Cite journal  | last1 = Ordi | first1 = J. | last2 = Alejo | first2 = M. | last3 = Fusté | first3 = V. | last4 = Lloveras | first4 = B. | last5 = Del Pino | first5 = M. | last6 = Alonso | first6 = I. | last7 = Torné | first7 = A. | title = HPV-negative vulvar intraepithelial neoplasia (VIN) with basaloid histologic pattern: an unrecognized variant of simplex (differentiated) VIN. | journal = Am J Surg Pathol | volume = 33 | issue = 11 | pages = 1659-65 | month = Nov | year = 2009 | doi = 10.1097/PAS.0b013e3181b40081 | PMID = 19730361 }}</ref>
*More common than ''[[classic VIN]]'' caused by HPV.<ref name=pmid21946295>{{Cite journal  | last1 = Kokka | first1 = F. | last2 = Singh | first2 = N. | last3 = Faruqi | first3 = A. | last4 = Gibbon | first4 = K. | last5 = Rosenthal | first5 = AN. | title = Is differentiated vulval intraepithelial neoplasia the precursor lesion of human papillomavirus-negative vulval squamous cell carcinoma? | journal = Int J Gynecol Cancer | volume = 21 | issue = 7 | pages = 1297-305 | month = Oct | year = 2011 | doi = 10.1097/IGC.0b013e31822dbe26 | PMID = 21946295 }}</ref>
**Differentiated VIN -> keratinizing SCC (~60% of cases).<ref name=pmid24399036/>
**Classic VIN -> warty SCC (~40% of cases).<ref name=pmid24399036>{{Cite journal  | last1 = Reyes | first1 = MC. | last2 = Cooper | first2 = K. | title = An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis. | journal = J Clin Pathol | volume =  | issue =  | pages =  | month = Jan | year = 2014 | doi = 10.1136/jclinpath-2013-202117 | PMID = 24399036 }}</ref>
Note:
*'''Not''' associated with [[HPV]].<ref name=pmid10716158>{{Cite journal  | last1 = Yang | first1 = B. | last2 = Hart | first2 = WR. | title = Vulvar intraepithelial neoplasia of the simplex (differentiated) type: a clinicopathologic study including analysis of HPV and p53 expression. | journal = Am J Surg Pathol | volume = 24 | issue = 3 | pages = 429-41 | month = Mar | year = 2000 | doi =  | PMID = 10716158 }}</ref>
==Microscopic==
Features:<ref name=pmid21057461>{{Cite journal  | last1 = van de Nieuwenhof | first1 = HP. | last2 = Bulten | first2 = J. | last3 = Hollema | first3 = H. | last4 = Dommerholt | first4 = RG. | last5 = Massuger | first5 = LF. | last6 = van der Zee | first6 = AG. | last7 = de Hullu | first7 = JA. | last8 = van Kempen | first8 = LC. | title = Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma. | journal = Mod Pathol | volume = 24 | issue = 2 | pages = 297-305 | month = Feb | year = 2011 | doi = 10.1038/modpathol.2010.192 | PMID = 21057461 }}</ref>
*Thickening of the stratum spinosum ([[acanthosis]]).
*Elongation of rete ridges with bridging/anastomoses between rete ridges.
*Nuclear atypia - esp. basal layer.
*Nuclei in stratum corneum (parakeratosis).
*+/-Atypical mitoses.
Notes:
*'''Not''' graded like [[classic VIN]] - considered high-grade by definition.{{fact}}
*Mnemonic ''BAD LAP'': '''b'''asal cell atypia, '''a'''nastomosing rete ridges (bridging), '''d'''VIN, '''l'''ichen sclerosus, '''a'''canthosis, '''p'''arakeratosis.
DDx:
*[[Lichen sclerosus]].
*[[Lichen simplex chronicus]] (squamous hyperplasia).
*[[Vulvar squamous cell carcinoma]].
*[[Classic vulvar intraepithelial neoplasia]].
===Images===
<gallery>
Image:Differentiated_vulvar_intraepithelial_neoplasia_-_low_mag.jpg | Differentiated VIN - low mag. (WC)
Image:Differentiated_vulvar_intraepithelial_neoplasia_-_intermed_mag.jpg | Differentiated VIN - intermed. mag. (WC)
Image: Differentiated vulvar intraepithelial neoplasia - superficial - high mag.jpg | Differentiated VIN - superficial - high mag. (WC)
Image:Differentiated_vulvar_intraepithelial_neoplasia_-_deep_-_high_mag.jpg | Differentiated VIN - deep - high mag. (WC)
</gallery>
www:
*[http://www.nature.com/modpathol/journal/v24/n2/fig_tab/modpathol2010192f3.html#figure-title Differentiated VIN (nature.com)].<ref name=pmid21057461>{{Cite journal  | last1 = van de Nieuwenhof | first1 = HP. | last2 = Bulten | first2 = J. | last3 = Hollema | first3 = H. | last4 = Dommerholt | first4 = RG. | last5 = Massuger | first5 = LF. | last6 = van der Zee | first6 = AG. | last7 = de Hullu | first7 = JA. | last8 = van Kempen | first8 = LC. | title = Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma. | journal = Mod Pathol | volume = 24 | issue = 2 | pages = 297-305 | month = Feb | year = 2011 | doi = 10.1038/modpathol.2010.192 | PMID = 21057461 }}</ref>
*[http://www.nature.com/modpathol/journal/v23/n3/fig_tab/modpathol2009179f1.html Differentiated VIN with bridging rete ridges (nature.com)].<ref name=pmid20062014>{{Cite journal  | last1 = Pinto | first1 = AP. | last2 = Miron | first2 = A. | last3 = Yassin | first3 = Y. | last4 = Monte | first4 = N. | last5 = Woo | first5 = TY. | last6 = Mehra | first6 = KK. | last7 = Medeiros | first7 = F. | last8 = Crum | first8 = CP. | title = Differentiated vulvar intraepithelial neoplasia contains Tp53 mutations and is genetically linked to vulvar squamous cell carcinoma. | journal = Mod Pathol | volume = 23 | issue = 3 | pages = 404-12 | month = Mar | year = 2010 | doi = 10.1038/modpathol.2009.179 | PMID = 20062014 }}</ref>
==IHC==
*Differentiated VIN: p16 -ve, p53 +ve.<ref name=pmid20062014/>
*Classic VIN: p16 +ve, p53 -ve.
Note:
*p16 can be thought of as a poor man's [[HPV]] test.
==Sign out==
<pre>
LABIA MINUS, RIGHT, PUNCH BIOPSY:
- DIFFERENTIATED VULVAR INTRAEPITHELIAL NEOPLASIA.
- LICHEN SCLEROSUS.
</pre>
==See also==
*[[Vulva]].
*[[Classic vulvar intraepithelial neoplasia]].
==References==
{{Reflist|2}}
[[Category:Vulva]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 02:24, 25 February 2014

Differentiated vulvar intraepithelial neoplasia
Diagnosis in short

Differentiated vulvar intraepithelial neoplasia. H&E stain.
Synonyms VIN simplex, simplex-type VIN
LM thickening of the stratum spinosum (acanthosis), elongation of rete ridges with bridging/anastomoses between rete ridges, nuclear atypia - esp. basal layer, nuclei in stratum corneum (parakeratosis), +/-atypical mitoses
LM DDx vulvar squamous cell carcinoma, lichen sclerosus, classic vulvar intraepithelial neoplasia
IHC p53 +ve, p16 -ve
Site vulva
Associated Dx lichen sclerosus, vulvar squamous cell carcinoma
Prevalence uncommon

Differentiated vulvar intraepithelial neoplasia, abbreviated dVIN, is a pre-neoplastic pathology of the vulva typically arising in the context of lichen sclerosus.

It is also known as VIN simplex,[1] and simplex-type VIN.[2]

General

Epidemiology:

  • Associated with lichen sclerosus.
  • Seen in older women - typically 50s-70s.[3]
  • More common than classic VIN caused by HPV.[4]
    • Differentiated VIN -> keratinizing SCC (~60% of cases).[2]
    • Classic VIN -> warty SCC (~40% of cases).[2]

Note:

Microscopic

Features:[6]

  • Thickening of the stratum spinosum (acanthosis).
  • Elongation of rete ridges with bridging/anastomoses between rete ridges.
  • Nuclear atypia - esp. basal layer.
  • Nuclei in stratum corneum (parakeratosis).
  • +/-Atypical mitoses.

Notes:

  • Not graded like classic VIN - considered high-grade by definition.[citation needed]
  • Mnemonic BAD LAP: basal cell atypia, anastomosing rete ridges (bridging), dVIN, lichen sclerosus, acanthosis, parakeratosis.

DDx:

Images

  • Differentiated VIN - low mag. (WC)

  • Differentiated VIN - intermed. mag. (WC)

  • Differentiated VIN - superficial - high mag. (WC)

  • Differentiated VIN - deep - high mag. (WC)

www:

IHC

  • Differentiated VIN: p16 -ve, p53 +ve.[7]
  • Classic VIN: p16 +ve, p53 -ve.

Note:

  • p16 can be thought of as a poor man's HPV test.

Sign out

LABIA MINUS, RIGHT, PUNCH BIOPSY:
- DIFFERENTIATED VULVAR INTRAEPITHELIAL NEOPLASIA.
- LICHEN SCLEROSUS.

See also

References

  1. ↑ Ruhul Quddus, M.; Xu, C.; Steinhoff, MM.; Zhang, C.; Lawrence, WD.; Sung, CJ. (Jun 2005). "Simplex (differentiated) type VIN: absence of p16INK4 supports its weak association with HPV and its probable precursor role in non-HPV related vulvar squamous cancers.". Histopathology 46 (6): 718-20. doi:10.1111/j.1365-2559.2005.02036.x. PMID 15910611.
  2. ↑ 2.0 2.1 2.2 Reyes, MC.; Cooper, K. (Jan 2014). "An update on vulvar intraepithelial neoplasia: terminology and a practical approach to diagnosis.". J Clin Pathol. doi:10.1136/jclinpath-2013-202117. PMID 24399036.
  3. ↑ Ordi, J.; Alejo, M.; Fusté, V.; Lloveras, B.; Del Pino, M.; Alonso, I.; Torné, A. (Nov 2009). "HPV-negative vulvar intraepithelial neoplasia (VIN) with basaloid histologic pattern: an unrecognized variant of simplex (differentiated) VIN.". Am J Surg Pathol 33 (11): 1659-65. doi:10.1097/PAS.0b013e3181b40081. PMID 19730361.
  4. ↑ Kokka, F.; Singh, N.; Faruqi, A.; Gibbon, K.; Rosenthal, AN. (Oct 2011). "Is differentiated vulval intraepithelial neoplasia the precursor lesion of human papillomavirus-negative vulval squamous cell carcinoma?". Int J Gynecol Cancer 21 (7): 1297-305. doi:10.1097/IGC.0b013e31822dbe26. PMID 21946295.
  5. ↑ Yang, B.; Hart, WR. (Mar 2000). "Vulvar intraepithelial neoplasia of the simplex (differentiated) type: a clinicopathologic study including analysis of HPV and p53 expression.". Am J Surg Pathol 24 (3): 429-41. PMID 10716158.
  6. ↑ 6.0 6.1 van de Nieuwenhof, HP.; Bulten, J.; Hollema, H.; Dommerholt, RG.; Massuger, LF.; van der Zee, AG.; de Hullu, JA.; van Kempen, LC. (Feb 2011). "Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma.". Mod Pathol 24 (2): 297-305. doi:10.1038/modpathol.2010.192. PMID 21057461.
  7. ↑ 7.0 7.1 Pinto, AP.; Miron, A.; Yassin, Y.; Monte, N.; Woo, TY.; Mehra, KK.; Medeiros, F.; Crum, CP. (Mar 2010). "Differentiated vulvar intraepithelial neoplasia contains Tp53 mutations and is genetically linked to vulvar squamous cell carcinoma.". Mod Pathol 23 (3): 404-12. doi:10.1038/modpathol.2009.179. PMID 20062014.
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