Carcinoma in Situ. Diagnosis
Carcinoma in Situ
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Vulvar intraepithelial neoplasia has a peak onset in the fourth decade, preceding the most common age of onset of invasive carcinoma by 10-15 years. The incidence of vulvar carcinoma in situ has markedly increased, whereas the incidence of invasive cell carcinoma has remained stable. A possible explanation of this difference is that sexually active women are not yet old enough to have invasive vulvar carcinoma, and early diagnosis and treatment of in situ carcinoma have blunted any notable increase of vulvar carcinoma. Because in situ and invasive vulvar carcinoma may have different etiologies, the sexually transmitted HPV will more likely be involved with in situ carcinoma, whereas other factors relate to onset of invasive squamous cell carcinoma. A strong association between HPV and vulvar carcinoma has been established.
Diagnosis
Vulvar intraepithelial neoplasia frequently is a multifocal disease; it most commonly affects the central vulva, with the lower half of the vulva most often affected. The mean thickness of the epithelium for all grades of VIN is 0.52 mm. The thickness of the involved epithelium varies with the location of the lesion. Infections caused by HPV are increasingly common and may be responsible for the increased frequency of the diagnosis of VIN. In the most overt form, HPV causes multiple condylomata that in themselves may have a significant degree of atypia and may be associated with intraepithelial neoplasia. Most subtle are the flat condylomata that may occur over the anogenital skin, producing irritative symptoms as well as atypical cytology and histology. Histologic examination of biopsies of specimens from such areas requires an experienced pathologist who is familiar with the subtleties of interpreting the spectra of atypia seen with intra-epithelial neoplasia and HPV infection. The histologic criteria necessary for the diagnosis of carcinoma in situ include virtual full-thickness replacement of the epithelium with atypical or immature squamous cells. Superficial layers of the vulvar epithelium are usually keratinized, unlike the epithelium of the cervix, thus obscuring colposcopic observation of underlying atypical patterns. Erectile dysfunction treatment information.
As many as 40% of patients with carcinoma in situ of the vulva have prior, concurrent, or subsequent neoplasia elsewhere within the anogenital tract. Colposcopic and cytologic review of these areas is necessary. There have been no prospective studies to document risk and progression rates for VIN at any stage. Carcinoma in situ of the vulva remains a disease for which the biologic significance, etiology, and prognosis are yet to be clarified. Viagra professional at canadian health mall.
Cases of carcinoma in situ of the vulva associated with pregnancy have been reported to regress spontaneously during the late puerperium, and the lesions may be managed by close observation to determine the need for treatment. Lesions showing characteristic Bowen cells, as well as those containing perinuclear halos that suggest HPV infection with atypia, but without full-thickness cellular atypia and abnormal mitoses, should be observed with care. They are infrequently associated with invasive carcinoma but may prove to be self-limited with spontaneous regression over a period of up to 6 months.