1 / 16

Diagnosis & Management Of VAIN/VIN

Diagnosis & Management Of VAIN/VIN. Richard Hutson Gynaecological Oncologist St. James’s University Hospital. Definition. A condition where neoplastic cells are within the boundaries of surface epithelium Excludes:- Paget’s disease of the Vulva Melanoma-in-situ Maturation disorders.

jana-townsend
Télécharger la présentation

Diagnosis & Management Of VAIN/VIN

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diagnosis & Management Of VAIN/VIN Richard Hutson Gynaecological Oncologist St. James’s University Hospital

  2. Definition • A condition where neoplastic cells are within the boundaries of surface epithelium • Excludes:- • Paget’s disease of the Vulva • Melanoma-in-situ • Maturation disorders

  3. Classification • VIN/VAIN I :- mild dysplasia; lower 1/3 • VIN/VAIN II :- mod. dysplasia; lower 2/3 • VIN/VAIN III :- severe dysplasia; > 2/3

  4. Symptoms • Pruritus (38-73 %) • Vulval pain / soreness • A lump / lesion • Asymptomatic

  5. Physical Signs • Papular & rough surfaced (warts) • Macular with indistinct/irregular borders • Micropapillary/granular associated with acanthosis • Pigmentation (brown/black) • White lesions (hyperkeratosis)

  6. Diagnosis • Histologically; biopsy always required • Biopsy under LA; use of EMLA • Punch / scalpel

  7. Normal Epithelium with L.S.

  8. VIN II-III

  9. VIN II with Koilocytosis

  10. Paget’s Disease of the Vulva

  11. Aetiology • Strong association with STD’s • HPV (43-79 %) • Younger women condyloma and koilocytes • Older women no koilocytosis • Smoking • Immunosuppressed

  12. Natural History of VIN / VAIN • No established rates of progression or regression • Risk of invasion is small • Risk of invasion more likely women > 45; immunosuppressed; SLE; multifocal disease

  13. Management in Young Women • Risk of invasion is small • Recurrence rate up to 84 % • > 20 % recurrent disease after simple vulvectomy • Regresses after pregnancy

  14. Who to Treat ? • Post menopausal presentation • Immunosuppressed / immunodeficient • Histologically progressive lesions on serial biopsy • Excessively hyperkeratotic lesions

  15. Treatment Techniques • W.L.E. (8mm margin) • Skinning Vulvectomy; skin graft, 27% rec. • Vulvectomy; rarely employed • Topical 5 FU; failure rate = 38-100 % • Dinitrochlorobenzene; topical immunotherapy • CO2 laser; to upper reticular dermis

  16. Summary • HPV and multifocal disease commoner in young women • Unifocal and HPV neg. lesions in post-men. Women • CIN found in 33% of women with VIN • VIN assoc. with 25-33% vulval cancers • 50% vulval cancers assoc. with non-neoplastic disorders

More Related