Vulvar intraepithelial neoplasia
Encyclopedia
The term Vulvar intraepithelial neoplasia (VIN) refers to particular changes that can occur in the skin that covers the vulva
. VIN is not cancer
, and in some women it disappears without treatment. If the changes become more severe, there is a chance that cancer might develop after many years, and so it is referred to as a precancerous condition.
of the vulva
that shows dysplasia
with varying degrees of atypia
. The epithelial basement membrane
is intact and the lesion is thus not invasive but has invasive potential.
The terminology of VIN evolved over several decades. In 1989 the Committee on Terminology, International Society for the Study of Vulvar Disease (ISSVD) replaced older terminology such as vulvar dystrophy
, Bowen's disease
, and Kraurosis vulvae by a new classification system for Epithelial Vulvar Disease:
The patient may have no symptoms, or local symptomatology including itching, burning, and pain.
The diagnosis is always based on a careful inspection and a targeted biopsy
.
before their initial sexual contact has been shown to reduce incidence of VIN.
. Laser therapy has also been useful for VIN.
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
. VIN is not cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
, and in some women it disappears without treatment. If the changes become more severe, there is a chance that cancer might develop after many years, and so it is referred to as a precancerous condition.
ISSVD Classification
Medically speaking, the term denotes a squamous intraepithelial lesionLesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
of the vulva
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
that shows dysplasia
Dysplasia
Dysplasia , is a term used in pathology to refer to an abnormality of development. This generally consists of an expansion of immature cells, with a corresponding decrease in the number and location of mature cells. Dysplasia is often indicative of an early neoplastic process...
with varying degrees of atypia
Atypia
Atypia is a clinical term for abnormality in a cell. The term is medical jargon for an atypical cell. Atypia: Etymology: Gk, a + typos, without type; a condition of being irregular or nonstandard....
. The epithelial basement membrane
Basement membrane
The basement membrane is a thin sheet of fibers that underlies the epithelium, which lines the cavities and surfaces of organs including skin, or the endothelium, which lines the interior surface of blood vessels.- Composition :...
is intact and the lesion is thus not invasive but has invasive potential.
The terminology of VIN evolved over several decades. In 1989 the Committee on Terminology, International Society for the Study of Vulvar Disease (ISSVD) replaced older terminology such as vulvar dystrophy
Dystrophy
Dystrophy is any condition of abnormal development, often denoting the degeneration of muscles.-Types:* Muscular dystrophy* Duchenne muscular dystrophy* Becker's muscular dystrophy* Reflex neurovascular dystrophy* Retinal dystrophy* Conal dystrophy...
, Bowen's disease
Bowen's disease
Bowen's disease is a neoplastic skin disease, it can be considered as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Mark Bowen...
, and Kraurosis vulvae by a new classification system for Epithelial Vulvar Disease:
- Nonneoplastic epithelial disorders of vulva and mucosa:
- Lichen sclerosusLichen sclerosusLichen sclerosus is an uncommon disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital skin....
- Squamous hyperplasia
- Other dermatoses
- Lichen sclerosus
- Mixed neoplastic and nonneoplastic disorders
- Intraepithelial neoplasia
- Squamous vulvar intraepithelial neoplasia (VIN)
- VIN I, mildest form
- VIN II, intermediate
- VIN III, most severe form including carcinoma in situCarcinoma in situCarcinoma in situ is an early form of cancer that is defined by the absence of invasion of tumor cells into the surrounding tissue, usually before penetration through the basement membrane. In other words, the neoplastic cells proliferate in their normal habitat, hence the name "in situ"...
of the vulva
- Non-squamous intraepithelial neoplasia
- Extramammary Paget's diseaseExtramammary Paget's diseaseExtramammary Paget’s disease , also Extramammary Paget disease, is a rare, slow-growing, usually non-invasive intraepithelial adenocarcinoma outside of the mammary gland and includes Paget's disease of the vulva and the extremely rare Paget's disease of the penis...
- Tumors of melanocyteMelanocyte-External links: - "Eye: fovea, RPE" - "Integument: pigmented skin"...
s, non invasive
- Extramammary Paget's disease
- Squamous vulvar intraepithelial neoplasia (VIN)
- Invasive disease (vulvar carcinoma)
Diagnosis
The diagnosis is always based on a careful inspection and a targeted biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
.
Prevention
Vaccinating girls with HPV vaccineHPV vaccine
The human papilloma virus vaccine prevents infection with certain species of human papillomavirus associated with the development of cervical cancer, genital warts, and some less common cancers...
before their initial sexual contact has been shown to reduce incidence of VIN.
Treatment
The treatment of VIN is local to wide excision, in case of very extensive involvement or recurrency even a simple vulvectomyVulvectomy
Vulvectomy refers to a gynecological procedure in which the vulva is partly or completely removed. Usually performed as a last resort in certain cases of cancer, vulvar dysplasia, Human Papilloma Virus or FGM/C...
. Laser therapy has also been useful for VIN.