title: Patients with usual vulvar intraepithelial neoplasia-related vulvar cancer have an increased risk of cervical abnormalities.
abstract: BACKGROUND
  Vulvar squamous cell carcinoma (SCC) originates the following two pathways, related to differentiated (d) vulvar intraepithelial neoplasia (VIN) or to human papillomavirus (HPV)-related usual (u) VIN. Multicentric HPV infections (cervix, vagina and vulva) are common. We hypothesise that patients with a uVIN-related vulvar SCC more often have cervical high-grade squamous intraepithelial lesions (HSILs) compared with women with dVIN-related vulvar SCC.
  
  
  METHODS
  All vulvar SCCs (201) were classified to be dVIN- (n=164) or uVIN related (n=37). Data with regard to the smear history and cervical histology were retrieved from PALGA, the nationwide Netherlands database of histo- and cytopathology. For HSIL cervical smears of which histology was taken, HPV DNA analysis on both the vulvar and cervical specimens was performed.
  
  
  RESULTS
  At least one smear was available in 145 (72%) of the 201 patients. Patients with a uVIN-related vulvar SCC more often had an HSIL compared with patients with a dVIN-related SCC (35 vs 2%, P<0.001). A total of 10 of the 13 HSILs were histologically assessed and identical HPV types were found in the vulva and cervix.
  
  
  CONCLUSIONS
  These data emphasise the necessity to differentiate between dVIN- and uVIN-related vulvar tumours and to examine the entire lower female ano-genital tract once an uVIN-related lesion is found.
authors.affiliation: Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. R.deBie@obgyn.umcn.nl
authors.forename: R P
authors.initials: RP
authors.lastname: de Bie
authors.forename: H P
authors.initials: HP
authors.lastname: van de Nieuwenhof
authors.forename: R L M
authors.initials: RL
authors.lastname: Bekkers
authors.forename: W J G
authors.initials: WJ
authors.lastname: Melchers
authors.forename: A G
authors.initials: AG
authors.lastname: Siebers
authors.forename: J
authors.initials: J
authors.lastname: Bulten
authors.forename: L F A G
authors.initials: LF
authors.lastname: Massuger
authors.forename: J A
authors.initials: JA
authors.lastname: de Hullu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052685:Alphapapillomavirus / Q000302:isolation & purification; D002278:Carcinoma in Situ / Q000473:pathology* / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000821:virology; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000473:pathology / Q000821:virology; D011230:Precancerous Conditions / Q000473:pathology* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology