Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Saint Barnabas Medical Center, Livingston, NJ, USA.
J Low Genit Tract Dis. 2012 Jan;16(1):56-8. doi: 10.1097/LGT.0b013e31822d93ee.
Vulvar intraepithelial neoplasia 3 (VIN 3)/vulvar carcinoma in situ is currently treated by surgical excision, laser ablation, or topically with 5-fluorouracil or imiquimod. The rate of progression of untreated VIN 3/vulvar carcinoma in situ to invasive cancer is significant, although difficult to assess, because most patients undergo treatment. The peak incidence of invasive carcinoma of the vulva occurs in the sixth decade, which may indicate that human papillomavirus (HPV)-related preinvasive disease in the younger population has a lower progression rate. However, the risk of invasive disease cannot be disregarded.
This is a case series of complete spontaneous resolution of untreated VIN 3/vulvar carcinoma in situ in 5 healthy women aged 20 to 36 years from a single community gynecologic oncologist practice from 2006 to 2010.
Complete spontaneous regression of acute VIN 3/vulvar carcinoma in situ was reported in 6 healthy young women aged 20 to 36 years. New sexual partners were reported in 2 of the 6 patients preceding the onset of vulvar lesions within 6 months. All patients were nonsmokers, healthy without known immunocompromise, and noted the acute onset of vulvar lesions. Vulvar intraepithelial neoplasia 3/vulvar carcinoma in situ was diagnosed on biopsy and confirmed on independent review. All lesions were multifocal in nature. Time to spontaneous regression was 6, 6, 8, 12, 18, and 20 weeks after initial biopsy. No patient received the HPV vaccine. Recurrence has not been noted in any of the patients within the follow-up period of 6 to 60 months.
Short-term follow-up with conservative management of acute-onset VIN 3/vulvar carcinoma in situ in this young patient population correlates with similar treatment strategies for HPV-related cervical intraepithelial neoplasia of the cervix and may prevent disfigurement, pain, and complications associated with the current recommended therapeutic modalities. The timing of intervention for VIN 3/vulvar carcinoma in situ in the young population needs clarification. Future studies are in order.
外阴上皮内瘤变 3 级（VIN3）/原位外阴癌目前采用手术切除、激光消融或局部应用 5-氟尿嘧啶或咪喹莫特治疗。未经治疗的 VIN3/原位外阴癌进展为浸润性癌的比例较高，尽管难以评估，但大多数患者都接受了治疗。外阴浸润性癌的发病高峰出现在第六个十年，这可能表明年轻人群中与人类乳头瘤病毒（HPV）相关的癌前病变进展速度较慢。然而，不能忽视发生浸润性疾病的风险。
本研究为单中心妇科肿瘤医生于 2006 年至 2010 年期间诊治的 5 例 20 至 36 岁健康女性 VIN3/原位外阴癌未经治疗完全自发消退的病例系列研究。
6 例 20 至 36 岁的健康年轻女性报告了急性 VIN3/原位外阴癌的完全自发消退。其中 2 例患者在出现外阴病变前的 6 个月内有新的性伴侣。所有患者均不吸烟，身体健康，无已知免疫功能低下，外阴病变为急性发作。VIN3/原位外阴癌通过活检诊断，并经独立审查证实。所有病变均为多灶性。初次活检后自发消退的时间分别为 6、6、8、12、18 和 20 周。所有患者均未接种 HPV 疫苗。在随访 6 至 60 个月期间，所有患者均无复发。
在年轻患者群体中，对急性发作的 VIN3/原位外阴癌进行短期随访并采取保守治疗与 HPV 相关的宫颈上皮内瘤变的治疗策略相似，可能预防当前推荐的治疗方法相关的畸形、疼痛和并发症。需要明确年轻人群中 VIN3/原位外阴癌的干预时机。未来还需要进一步研究。
