Preinvasive disease of vagina and vulva

Preinvasive Disease of the
Vagina and Vulva
Fred Ueland, MD
Division of Gynecologic Oncology
University of Kentucky


Juneau, Alaska


Examining…
the External Genitalia
Dorsal lithotomy position
 Clitoris and frenulum
 Urethra and anus
 Labia majora and minor
 Introitus
 Perineum


Vulva


Conditions…
the Labia and Perineum
 Infection
– HPV, HSV
– Chancroid, LGV, syphilis
– Molluscum contagiosum

 Dermatologic

– Lichen sclerosus, hyperplasia


Vulvar HPV


Non-neoplastic Conditions
Syphilis


Non-neoplastic Conditions
Condyloma lata


Non-neoplastic Conditions
Molluscum Contagiosum


Non-neoplastic Conditions
 Squamous hyperplasia
 Lichen sclerosus
 Other dermatoses
– Psoriasis
– Lichen simplex chronicus
– Lichen planus
– Tinea


Non-neoplastic Conditions
Lichen Sclerosus

Lichen Sclerosus








Hyperkeratosis
Flattened rete pegs
Cytoplasmic vacuoles
in basal layer
“Pink staining”
beneath epidermis
Inflammatory infiltrate


Hubbard Glacier


Vulvar Intraepithelial Neoplasia




Same culprit, HPV
50% asymptomatic

Increasing incidence
– 2 to 3 fold increase



Declining age (mean = 40 years)
– Tripled in white ♀ under age 35



Appearance
–
–

White, red, or pigmented
Flat, raised, macular, papillary, solitary or multifocal


Vulvar Intraepithelial Neoplasia


VIN


VIN 3


VIN

Vulvar Intraepithelial Neoplasia


Vulvar Intraepithelial Neoplasia


Vulvar Intraepithelial Neoplasia


VIN 3


Pigmented Lesion


Location of Multifocal CIS

70%
20%
45%
60%
40%
92%

30%


Vulvar CIS
Judson, Obstet Gynecol 2006

 13,176 women with CIS and cancer
 Vulvar CIS increased 400% from 1973 to

2000
 CIS increases with age until 50, then ↓
 CA increases with age, more rapidly > 50