[HPV-associated alterations of the vulva and vagina. Morphology and molecular pathology].
Non-neoplastic HPV-induced alterations of the vulva and vagina are frequent. The traditional three-tier grading system of vulvar intraepithelial neoplasia (VIN) will be replaced by the definition of usual and simplex type of VIN. The usual type is characterized by a strong association to high-risk HPV infections, the occurrence at younger age and multifocality, mostly associated with non-keratinizing squamous cell carcinoma. The differentiated (or simplex) type is rare and shows an association to older age and p53 alterations and is typically diagnosed co-incidentally with keratinizing squamous cell carcinoma. Vaginal intraepithelial neoplasia (VAIN) is still graded into VAIN 1-3 where VAIN 1 and 2 are mostly associated with low-risk HPV infections and a high spontaneous regression rate whereas VAIN 3 represents a high-risk HPV-associated lesion with capable progression into (micro-)invasive carcinoma. The differential diagnosis between a non-neoplastic condylomatous lesion and VIN common type and VAIN may be aided by p16 immunohistochemistry. The HPV-associated invasive vulvo-vaginal cancers are verrucous carcinoma (low-risk HPV) and the high-risk HPV-induced (non-keratinizing) squamous cell carcinoma (NOS), the condylomatous (warty) carcinoma and the very rare vaginal squamo-transitional carcinoma.
Abteilung Mamma-, Gynäko- & Perinatalpathologie, Institut für Pathologie, Zemtrum für Diagnostik, Universitätsklinikum Leipzig, Liebigstr. 26, 04103, Leipzig, Deutschland. hornl@medizin.uni-leipzig.de
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D000328:Adult; D000367:Age Factors; D002278:Carcinoma in Situ / Q000235:genetics / Q000473:pathology / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000473:pathology* / Q000821:virology*; D018289:Carcinoma, Verrucous / Q000235:genetics / Q000473:pathology* / Q000821:virology*; D002471:Cell Transformation, Neoplastic / Q000235:genetics* / Q000473:pathology*; D003218:Condylomata Acuminata / Q000235:genetics / Q000473:pathology* / Q000821:virology*; D003937:Diagnosis, Differential; D005260:Female; D016679:Genome, Viral / Q000235:genetics*; D052162:Human papillomavirus 16 / Q000235:genetics*; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D030361:Papillomavirus Infections / Q000235:genetics / Q000473:pathology* / Q000821:virology*; D011230:Precancerous Conditions / Q000235:genetics / Q000473:pathology / Q000821:virology; D014621:Vagina / Q000473:pathology / Q000821:virology; D014625:Vaginal Neoplasms / Q000235:genetics / Q000473:pathology* / Q000821:virology*; D014844:Vulva / Q000473:pathology / Q000821:virology; D014846:Vulvar Neoplasms / Q000235:genetics / Q000473:pathology* / Q000821:virology*