International Journal of Gynecological Cancer | 2019
EP1153\u2005Skinning Vulvectomy and Conization together in the treatment of Vulvar Intraepithelial Neoplasia (VIN) 3 of the vulva and High Squamous Intraepithelial Neoplasia (HSIL) of the uterine cervix: oral presentation
Introduction/Background Vulvar intraepithelial neoplasia (VIN) is termed premalignant situation of the vulva.1 VIN incidence is about 1.4/100.000. Risk factors for VIN are Human Papilloma Virus (HPV) infection, HIV(Human İmmunodeficiency Virus) infection, other sexual transmitted diseases, smoking and other neoplasms.2 In 2015, İnternational Society for the Study of Vulvovaginal Disease(ISSVD) released that describes VIN; Low-grade squamous intraepithelial lesion(LSIL) of the vulva(HPV effect), High grade squamous intraepithelial lesion(HSIL) of the vulva (VIN usual type) and VIN differentiated type(dVIN).3 The increase of VIN usual type among younger patients is generally due to the infection of high risk HPV.4 The dVIN is seemed commonly in older women with a median age of 67,5 and is usually associated with skin disases like lichen sclerosus.Suspicious for malignancy or-premalignant lesions of the vulva may be excised in a conservative fashion, protecting as much of the vulvar architecture as possible.6 Cervical intraepithelial neoplasia is termed premalignant situation of the uterine cervix.7 HPV infection is considered the most important factor for the development of CIN and cervical cancer. High grade lesions have significant risk of disease progression to the cervical cancer and should be managed with conization. This will be therapeutic as well as diagnostic. Methodology Our patient was 42-years old and multiparous patient with main complaint of vulvar pruritus and genital condyloma.Her outer hospital vulvar and cervical-biopsy result was squamous carcinoma in situ for vulva and HSIL for cervix.We re-evaluated the pathology in our hospital. The biopsy revealed for cervix VIN 3. Then she underwent conization and vulvectomy with a 2 cm disease free-margin. Results After the excision procedure patient´s skinning vulvectomy pathology was VIN3, psoriasis, lichen sclerosis and conization pathology was LGSIL.Both surgical margins were clear. After the surgery there wasn´t any wound dehiscence, infection or abscess. Conclusion In VIN3 lesions skinning vulvectomy appears to be a favourable and safe treatment however the recurrence of VIN is frequent.8 It should-be applied carefully evaluated patients. Disclosure Thanks for your concern. References Reyes MC,Cooper K. Anupdateonvulvarintraepithelialneoplasia:terminologyand a practicalapproachtodiagnosis. J Clin Pathol 2014; 67:290. Iavazzo C,Pitsouni E,Athanasiou S,Falagas ME.Imiquimod for treatment of vulvar and vaginal intraepithelial neoplasia. Int J Gynecol Obstet 2008; 101:3–10. CrumCP,HerringtonCS,McCluggageWG,et al. Tumours of the vulva; epithelial tumours. In: WHO Classification of Tumours of Female Reproductive Organs, 4th ed, Kurman RJ, CarcangiuML,HerringtonCS,et al (Eds), IARC Press, Lyon 2014. ,et al. Tan J, Chetty N, Kondalsamy-Chennakesavan S, Crandon A, Garrett A, Land R. Validation of the FİGO 2009 staging system for carcinoma of the vulva. Int J Gynecol Cancer. 2012;22(3):498–502. JouraEA,GarlandSM,PaavonenJ,FerrisDG, Perez G, Ault KA, et al. Effect of the human papilloma virüs (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ. 2012;344:e1401. von GruenigenVE,GibbonsHE,GibbinsK,et al. Surgical treatments for vulvar and vaginal dysplasia: a randomized controlled trial. 2007Obstet Gynecol; 109:942. MontzFJ.Management of high-grade cervical intraepithelial neoplasia and low-grade squamous intraepithelial lesion and potential complications. 2000Clin Obstet Gynecol;43:394. WallbillichJJ,RhodesHE,MilbourneAM,et al.Vulvar intraepithelial neoplasia (VIN 2/3): comparing clinical outcomes and evaluating risk factors for recurrence. 2012Gynecol Oncol;127:312.