Patients with usual vulvar intraepithelial neoplasia-related vulvar cancer have an increased risk of cervical abnormalities

Abstract

BACKGROUND: Vulvar squamous cell carcinoma (SCC) originates the following two pathways, related to differentiated (d) vulvar intraepithelial neoplasia (VIN) or to human papillomavirus (HPV)-related usual (u) VIN. Multicentric HPV infections (cervix, vagina and vulva) are common. We hypothesise that patients with a uVIN-related vulvar SCC more often have cervical high-grade squamous intraepithelial lesions (HSILs) compared with women with dVIN-related vulvar SCC. METHODS: All vulvar SCCs (201) were classified to be dVIN-(n ¼ 164) or uVIN related (n ¼ 37). Data with regard to the smear history and cervical histology were retrieved from PALGA, the nationwide Netherlands database of histo-and cytopathology. For HSIL cervical smears of which histology was taken, HPV DNA analysis on both the vulvar and cervical specimens was performed. RESULTS: At least one smear was available in 145 (72%) of the 201 patients. Patients with a uVIN-related vulvar SCC more often had an HSIL compared with patients with a dVIN-related SCC (35 vs 2%, Po0.001). A total of 10 of the 13 HSILs were histologically assessed and identical HPV types were found in the vulva and cervix. CONCLUSION: These data emphasise the necessity to differentiate between dVIN-and uVIN-related vulvar tumours and to examine the entire lower female ano-genital tract once an uVIN-related lesion is found.

Vulvar intraepithelial neoplasia

“…A decreased immune response to HPV infection is associated with multifocality (more than one lesion on the vulva) and multicentricity (involvement of vagina, cervix, and/or anus as well as the vulva) [30,31,32]. Usually, the same type of HPV is involved in all the lesions [31].…”

“…Usually, the same type of HPV is involved in all the lesions [31]. Younger patients have a higher risk of multifocal lesions (59% in women aged 20e34 and 10% in patients >50 years of age) [33], but older patients have more often intraepithelial lesions at uncommon sites (vagina, anus, and periurethral region) [34].…”

“…Cervical cytology or HPV DNA screening with reflex cytology should be repeated annually because of the high risk of multicentric intraepithelial neoplasia in uVIN patients [31]. The duration and frequency of follow-up may potentially impact progression rates, symptomatology, and quality of life (QOL).…”

High-resolution genomic profiling of human papillomavirus-associated vulval neoplasia

“…The incidence of HPV-positive VIN and VSCC is steadily increasing worldwide (Joura et al, 2000). An association has been reported (Hording et al, 1996;de Bie et al, 2009) between the development of classic VIN/VSCC and cervical intraepithelial neoplasia (CIN)/cervical SCC (CxSCC) but little is known of whether, in addition to their positive HPV status and regional proximity, these lesions share genetic similarities.…”

A multicenter study of the clinical characteristics of usual‐type vulvar intraepithelial neoplasia in China

“…The records of patients who received surgical treatment with a postoperative histologic diagnosis of uVIN were kept. An early invasive SCC arising in a uVIN lesion was an exclusion International Journal of Gynecology and Obstetrics 117 (2012) [18][19][20][21][22] criterion, however. The other exclusion criterion was patient referral to 1 of the 3 academic hospitals after initial management elsewhere because of the vagueness of the primary presentation reports.…”