Scurry James, Campion Michael, Scurry Bonnie, Kim Soo Nyung, Hacker Neville
Gynaecological Cancer Centre, Royal Hospital for Women, and University of New South Wales, Sydney, New South Wales, Australia.
Int J Gynecol Pathol. 2006 Apr;25(2):176-81. doi: 10.1097/01.pgp.0000189238.19027.df.
There are 2 types of vulvar intraepithelial neoplasia (VIN): warty-basaloid and differentiated. Differentiated VIN is uncommon and seldom diagnosed prior to carcinoma and, traditionally, is not graded. There are currently 3 grading systems for warty-basaloid VIN: the World Health Organization (WHO) 3 grade system of VIN 1-3, a 2 grade system of low and high grade vulvar intraepithelial lesions, and the revised International Society for the Study of Vulvovaginal Disease (ISSVD) classification which has no grading of VIN. According to the ISSVD, VIN 1 should be abolished and VIN 2 and 3 combined into a single category, simply termed warty-basaloid VIN. To determine the best system for grading warty-basaloid VIN and learn more about differentiated VIN, we reviewed the pathology of 164 consecutive women with VIN. Of these, 134 (82.3%) had warty-basaloid VIN, 29 (18.2%) had differentiated VIN, and 1 had both. Of warty-basaloid VIN cases, 4 had VIN 1, 13 VIN 2, and 118 VIN 3 when graded according to the WHO. All VIN 1 occurred in condylomata acuminata. VIN 2 and 3 were distinguished only by degree of abnormality. Differentiated VIN was diagnosed before SCC in only 7 cases (26.7%). Because the only VIN 1 cases seen were in condylomata acuminata and because VIN 2 and 3 were difficult to distinguish and there appears little clinical reason to do so, our study supports the ISSVD proposal that VIN 1 be abolished and VIN 2 and 3 be combined. There needs to be more clinical awareness of vulvar conditions, so that differentiated VIN is biopsied before cancer has supervened.
外阴上皮内瘤变（VIN）有两种类型：疣状-基底样型和分化型。分化型VIN并不常见，在癌变前很少被诊断出来，传统上也不进行分级。目前，疣状-基底样型VIN有3种分级系统：世界卫生组织（WHO）的VIN 1 - 3三级系统、低级别和高级别外阴上皮内病变的二级系统，以及修订后的国际外阴阴道疾病研究学会（ISSVD）分类，该分类没有对VIN进行分级。根据ISSVD的分类，VIN 1应被废除，VIN 2和3应合并为一个单一类别，简称为疣状-基底样型VIN。为了确定疣状-基底样型VIN的最佳分级系统，并更多地了解分化型VIN，我们回顾了164例连续的VIN女性患者的病理情况。其中，134例（82.3%）为疣状-基底样型VIN，29例（18.2%）为分化型VIN，1例同时患有这两种类型。在疣状-基底样型VIN病例中，按照WHO分级，4例为VIN 1，13例为VIN 2，118例为VIN 3。所有VIN 1均发生在尖锐湿疣中。VIN 2和3仅通过异常程度来区分。分化型VIN仅在7例（26.7%）患者中在鳞状细胞癌（SCC）之前被诊断出来。由于所见到的唯一VIN 1病例都在尖锐湿疣中，且VIN 2和3难以区分，并且似乎没有什么临床理由要进行区分，我们的研究支持ISSVD提出的废除VIN 1并将VIN 2和3合并的提议。需要提高对外阴疾病的临床认识，以便在癌症发生之前对分化型VIN进行活检。
