Vulval intraepithelial neoplasia (Complete) Flashcards
What is vulval intraepithelial neoplasia?
Dysplasia of vulval epithelium
What are the main two types of VIN?
Usual type (most common)
* Warty
* Basal
* Mixed
Differentiated type
Usual type VIN is associated with what underlying causes?
HPV (16 & 18)
Smoking
Immunosuppresion
Which HPV serotypes are associated with VIN?
16
18
Usual type VIN are associated with what age ranges?
35-55
What are the main grades of usual type VIN?
VIN I (Low-grade)
VIN II (High-grade)
VIN III (High-grade)
Differentiated type VIN is associated with what underlying cause?
Lichen sclerosus
Differentiated type vulval cancer more commonly occurs in which age groups?
Older women
Which type of VIN is more likely to progress to vulval cancer?
Differentiated VIN (dVIN)
What are the main clinical features of VIN?
Vaginal itching
Vaginal burning
Discomfort or pain during sex
Well-demarcated skin changes:
- Differentiated type: Unifocal, thickened, hyperkeratotic
- Usual type: Multifocal, pigmented, warty or flat
What investigations should be considered in patients with suspected VIN?
Bedside:
Examination of vulva
Invasive:
Punch biopsy: For histological testing
- PCR or in situ hybridisation for high-risk HPV DNA
What histological findings are suggestive of usual type VIN?
Warty or basaloid appearance
What histological findings are suggestive of differentiated type VIN?
Keratinised squamous cells
What is the management of VIN?
Conseravtive:
Follow-up and surveillance for progression or recurrence
Medicine:
Imiquimod: Immune response modifier
5-Fluorouracil: Topical chemotherapeutic agent
Surgical:
Wide local excision
Laser ablation
Partial vulvectomy (extensive disease)
Management dependant on size and type of VIN
What topical options are available for management of VIN?
Imiquimod
5-Fluorouracil
What surgical options are available for VIN?
Wide excision
Laser ablation
Partial vulvectomy (extensive disease)
