Vulvar intraepithelial neoplasia

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Classification according to ICD-10
N90.0 Low grade vulvar dysplasia, Grade I [VIN]
N90.1 Moderate dysplasia of the vulva, [VIN] grade II
N90.2 Severe vulvar dysplasia, not elsewhere classified
D07.1 Intraepithelial neoplasia of the vulva [VIN] III. Degree, with or without indication of severe dysplasia
N90.3 Vulvar dysplasia, unspecified
ICD-10 online (WHO version 2019)

The vulvar intraepithelial neoplasia (VIN) is a disease of the squamous epithelium of the vulva of the light dysplasia to carcinoma in situ .

Historically, a distinction was made between the following levels, which are still represented in the ICD-10 today:

  • Slight dysplasia of the squamous epithelium (VIN 1): The histological specimen contains basal cells with increased proliferation and atypical cells, squamous epithelia with preserved atypical nuclei and a marked increase in the nuclear-plasma ratio. Dyskeratocytes with mild to moderate nuclear atypia are found in the vulva smear.
  • Moderate dysplasia of the squamous epithelium (VIN 2): The histological specimen shows a hyperkeratotic keratinizing epidermis with incomplete maturation, dyskeratotic single-cell keratinization and mitoses up to the upper third of the skin. Melanophages are found in the superficial dermis.
  • severe squamous epithelial dysplasia (VIN 3): carcinoma in situ . In the histological specimen, maturation is only superficial or completely absent. Squamous epithelia with atypical nuclei and a marked increase in the nuclear-plasma ratio can be seen in the vulva smear.

VIN 1 and 2 represented an optional precancer , while VIN 3 was an obligatory precancer.

As the understanding of the pathophysiology of vulvar intraepithelial dysplasias increased, the classification was adjusted. The previous designation VIN 1 was replaced by LSIL (Low-grade squamous intraepithelial lesion) of the vulva, is HPV -associated and is no longer considered a precancerous disease. So it does not require any mandatory therapy. VIN 2 & 3 have been combined to form HSIL (high-grade squamous intraepithelial lesion) of the vulva and are synonymous with uVIN (usual type VIN). Here, too, there is a high correlation with an HPV infection with viruses from the high risk group. HSIL and uVIN are responsible for approx. 20% of all squamous cell carcinomas of the vulva. In addition, the dVIN (differentiated type VIN) was defined, which is more likely to occur in older women on the basis of lichen sclerosus and which is usually not associated with HPV. Your risk of progression is higher than with a uVIN.

literature

  • Haag, Hanhart, Müller: Gynecology and urology for study and practice . 3rd edition Med. Verlags- und informationsdienste, Breisach 2007/2008, ISBN 3-929851-72-5
  • Gieseking F., Kühn W .: Differential diagnosis of the vulva - WHO nomenclature and clinical examples , AGCPC 2015 [1]