Vaginal intraepithelial neoplasia

from Wikipedia, the free encyclopedia
Classification according to ICD-10
N89.0 Low grade vaginal dysplasia (VAIN I)
N89.1 Moderate vaginal dysplasia (VAIN II)
N89.2 Severe vaginal dysplasia, not elsewhere classified
N89.3 Vaginal dysplasia, unspecified
D07.2 Carcinoma in situ: vagina, including VAIN III
ICD-10 online (WHO version 2019)

The vaginal intraepithelial neoplasia (VAIN) is a form of lesion of the vagina -Schleimhaut. More precisely, it is a neoplasm of atypical squamous epithelium in the vaginal mucosa without invasive growth. It is similar to the intraepithelial neoplasia of the vulva and the cervix (see Vulvar Intraepithelial Neoplasia and Cervical Intraepithelial Neoplasia), but with 2-3 cases per 1 million women it is much rarer. The median age of those affected is 45 years (VAIN 1-2) or 61 years (VAIN 3). Usually the change is in the upper third of the vagina. The development of a VAIN is favored by infections with papillomaviruses .

According to the degree of atypia, neoplasms are divided:

  • VAIN 1: Minor dysplasia (cells atypically changed, epithelial stratification intact).
  • VAIN 2: Moderate dysplasia.
  • VAIN 3: Severe dysplasia, carcinoma in situ . Risk of developing into vaginal carcinoma .

diagnosis

All VAIN patients in a large study had a pathological Pap test at the same time . The Pap test could therefore also be suitable for screening for VAIN. As a rule, however, the diagnosis is carried out by means of colposcopy and a 40-fold magnification of the vagina, whereby the surface of the mucous membrane is treated with reagents:

  • Whitish areas visible 60 s after application of 3% acetic acid indicate dysplasia;
  • for the Collins sample, toluidine blue solution is applied and washed off with 2% acetic acid. Blue areas are dysplastic;
  • An iodine tincture is brushed on for the Schiller iodine test. While healthy surface cells of the vagina produce glycogen , which turns red-brown in color, the suspicious areas remain light.

treatment

VAIN 1 and 2 can initially only be observed, treated with cryosurgery or laser surgery or with topical 5-fluorouracil . Surgical partial removal of the vagina offers the greatest security. Untreated lesions can degenerate further, but they can also normalize spontaneously. VAIN 3 is synonymous with carcinoma in situ , a real (albeit limited) cancer, and must therefore always be completely operated on or irradiated.

Individual evidence

  1. ↑ F. Sillman, A. Stanek et al .: The relationship between human papillomavirus and lower genital intraepithelial neoplasia in immunosuppressed women. In: Am J Obstet Gynecol. 1984; (150), p. 300. PMID 6091459 .
  2. ↑ E. Diakomanolis, K. Stefanidis and others: Vaginal intraepithelial neoplasia: report of 102 cases. In: Eur J Gynaecol Oncol. 2002; (23), pp. 457-459. PMID 12440826
  3. ^ P. Audet-Lapointe, G. Body et al .: Vaginal intraepithelial neoplasia. In: Gynecol Oncol . 1990; (36), pp. 232-239; PMID 2404839 .
  4. ↑ JA Dodge, GH Eltabbakh et al .: Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia. In: Gynecol Oncol. 2001 (83), pp. 363-369; PMID 11606098 .
  5. ↑ M. Aho, E. Vesterinen et al.: Natural history of vaginal intraepithelial neoplasia. In: Cancer. 1991; (68), pp. 195-197; PMID 2049744 .