Pathology - Vulval and Vaginal Flashcards
Vulval intraepithelial neoplasia (2 types)
VIN
paget’s disease
VIN age groups and respective disease course
bimodal
- young women - often multifocal, recurrent or persistent causing treatment problems
- older women - greater risk of progression to invasive squamous carcinoma
VIN behaviour vs CIN
variable
less predictable than CIN
3 grades like CIN
Is VIN HPV related ?
Often, but not always
especially usual type, in younger women
What is VIN often synchronous with?
CIN and VaIN
What is usual type VIN
Younger,
HPV related,
higher risk of developing another HPV-related malignancy of anogenital tract
What is differentiate type of VIN
older, chronic dermatological conditions, greater invasive potential, shorter time between diagnosis and SCC than usual –type Vin, not HPV related
Clinical presentation of VIN (symptoms and signs)
pruritis, but some asympotomatic
Exam: white, grey, red, raised lesions
Diagnosis of VIN
visual inspection and biopsy
Management of VIN (4)
Biopsy to first confirm lesion does not contain invasive cancer
laser therapy
wide local excision +/- imiquimod
long term f/u due to close association with HPV
Management of Partial thickness VIN
most spontaneously regress, no active treatment required
What are the risk factors for high rate of recurrence in VIN?
smoking
larger lesion size
positive margin
Who gets Vulvar Invasive Squamous Carcinoma?
elderly women
How does VISC present?
ulcer or exophytic mass
Risk factors for vulvar cancer
VIN - premalignant
Lichen sclerosis - 4%
Pagets disease of vulva
con also arise from normal epithelium
