title: Vaginal Intraepithelial Neoplasia: Histopathological Upgrading of Lesions and Evidence of Occult Vaginal Cancer.
abstract: OBJECTIVE
  The aim of this study was to analyze women treated with excisional procedures for vaginal high-grade squamous intraepithelial lesions (HSILs). The histopathological upgrading of the lesions previously detected on vaginal biopsy and the presence of occult invasive vaginal cancer in the specimens excised were investigated, to identify a higher risk subset of women.
  
  
  METHODS
  A retrospective analysis of the medical records of 86 women with a biopsy histopathologic diagnosis of vaginal HSIL (vaginal intraepithelial neoplasias [VaINs]: VaIN2 and VaIN3) and subsequent excisional therapy, consecutively referred to the Aviano National Cancer Institute (Aviano, Italy) from January 1991 to April 2014, was performed.
  
  
  RESULTS
  Of the 86 patients, 4 cases (4.6%) of occult vaginal cancer were detected, all of them in women previously diagnosed with VaIN3 on biopsy (4/39 cases, 10.3%). Women with diagnosis of VaIN2 on biopsy showed an upgrading of lesions, with diagnosis of VaIN3 on the final specimen in 5 (10.6%) of 47 cases, with no cases of VAIN2 upgraded to invasive cancer. In 33.3% of the women initially diagnosed with VaIN2 and with previous hysterectomy for human papillomavirus-related disease, a final histopathological upgrading of lesions emerged. Furthermore, tobacco use was significantly related to the histopathological upgrading of lesions previously detected on vaginal biopsy.
  
  
  CONCLUSIONS
  Women diagnosed with VaIN3 should be treated with excisional procedures as first-line surgical approach, given the risk of occult invasive disease in 10% of the cases. Women diagnosed with VaIN2 and with previous hysterectomy for human papillomavirus-related cervical diseases should always be carefully evaluated and possibly excised, given the higher risk of histopathological upgrading of lesions and thus the potential risk of occult vaginal cancer. Tobacco users should be considered as high-risk group.
authors.affiliation: 1Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano; 2Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona; and 3Pathology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sopracordevole
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Piero
authors.forename: Nicolò
authors.initials: N
authors.lastname: Clemente
authors.forename: Monica
authors.initials: M
authors.lastname: Buttignol
authors.forename: Francesca
authors.initials: F
authors.lastname: Mancioli
authors.forename: Jacopo
authors.initials: J
authors.lastname: Di Giuseppe
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Canzonieri
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.forename: Andrea
authors.initials: A
authors.lastname: Ciavattini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D008875:Middle Aged; D012189:Retrospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D014625:Vaginal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D055815:Young Adult