What’s new in gynecologic pathology 2021: vulva, cervix, and uterus

Abstract

https://doi.org/10.4132/jptm.2021.03.09 https://jpatholtm.org/ 161 mal carcinomas have been associated with worse progression-free and overall survival compared to HPV-associated carcinomas as well as p16 negative / p53 normal carcinomas. • HPV-associated squamous intraepithelial lesions (formerly known as vulvar intraepithelial neoplasia of the usual / classic type) represent the majority (90%) of precursors. They are referred to as low-grade (LSIL, equivalent to uVIN1) and high-grade (HSIL, equivalent to uVIN2 and uVIN3). HSIL is characterized by p16 overexpression and wild-type p53 (with strong staining in mid-epithelial layers and negative or patchy basal / parabasal staining). • The most common HPV-independent lesion is differentiated vulvar intraepithelial neoplasia (dVIN). Its presumed rapid progression to invasive carcinoma and the difficulties in its diagnosis likely explain why dVIN represents only <10% of squamous intraepithelial lesions. dVIN is characterized by negative or patchy p16 and mutant-type p53 expression (the latter could be full-thickness strong, basal strong, completely negative or cytoplasmic staining). • Another, far less common form of HPV-independent lesion is the now called differentiated exophytic vulvar intraepithelial lesion (DE-VIL). This lesion demonstrates verruciform acanthosis, hypogranulosis and cytoplasmic pallor (Figure 1). Unlike HSIL and dVIN, DE-VIL lacks cytologic atypia. NEWSLETTER