Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia.
J Low Genit Tract Dis. 2020 Oct;24(4):392-398. doi: 10.1097/LGT.0000000000000569.
The aim of the study was to describe the demographic, clinical, and histopathologic features of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM).
Specimens from 2010 to 2020 reported as dVIN or VAM were reviewed. Clinical data included age, rurality, symptoms, and evidence of lichen sclerosus (LS). Histopathologic data included epithelial thickness, keratinization, architectural and dyskeratotic features, stroma, p16, and p53. Differentiated vulvar intraepithelial neoplasia and VAM were distinguished by assessment of basal nuclear chromatin, enlargement, pleomorphism, and mitoses.
One hundred twenty women with a median age of 71 years had 179 examples of dVIN and VAM. Squamous cell carcinoma was concurrent in 66% and associated with rurality. Ten percent were asymptomatic, and all but 3 had evidence of LS. Differentiated vulvar intraepithelial neoplasia showed a range of thickness, architecture, and dyskeratosis; its unifying !feature was basal atypia. Differentiated vulvar intraepithelial neoplasia displayed hyperchromasia in 83% and easily observed mitoses in 70%. Nonkeratinizing morphology, subcategorized into basaloid and intermediate, occurred in 24% of women with dVIN. Traditional dVIN represented 62% of keratinizing cases; the remainder were atrophic (13%), hypertrophic (13%), acantholytic (8%), or subtle (5%). Vulvar aberrant maturation had abnormal stratum corneum, acanthosis, premature maturation, and enlarged vesicular nuclei. Null p53 helped distinguish dVIN from VAM and dermatoses.
The morphology of dVIN encompasses nonkeratinizing and keratinizing types, the latter subdivided into traditional, acantholytic, atrophic, hypertrophic, and subtle. Diagnosis relies on basal atypia with supportive p16 and p53. Atypia exists on a biologic spectrum with mild abnormalities of VAM and reactive change. Identification of dVIN and VAM requires collaboration between clinicians and pathologists experienced in vulvar disorders.
本研究旨在描述分化型外阴上皮内瘤变（dVIN）和外阴异常成熟（VAM）的人口学、临床和组织病理学特征。
回顾 2010 年至 2020 年报告的 dVIN 或 VAM 标本。临床资料包括年龄、农村地区、症状和硬化性苔藓（LS）证据。组织病理学数据包括上皮厚度、角化、结构和非典型性、基质、p16 和 p53。通过评估基底核染色质、增大、多形性和有丝分裂来区分分化型外阴上皮内瘤变和 VAM。
120 名中位年龄为 71 岁的女性有 179 例 dVIN 和 VAM 。66%合并鳞状细胞癌，与农村地区有关。10%无症状，除 3 例外均有 LS 证据。分化型外阴上皮内瘤变表现为厚度、结构和非典型性范围广泛；其统一特征是基底异型性。83%的分化型外阴上皮内瘤变显示着色过深，70%容易观察到有丝分裂。非角化形态，分为基底细胞样和中间型，见于 24%的 dVIN 女性。传统的 dVIN 占角化病例的 62%；其余为萎缩性（13%）、肥厚性（13%）、棘层松解性（8%）或细微型（5%）。VAM 具有异常角质层、棘皮症、过早成熟和增大的泡状核。阴性 p53 有助于区分 dVIN 和 VAM 以及皮肤病。
dVIN 的形态包括非角化和角化类型，后者可细分为传统型、棘层松解型、萎缩性、肥厚性和细微型。诊断依赖于基底异型性，伴有支持性 p16 和 p53。异型性存在于一个生物学谱中，与 VAM 和反应性改变的轻度异常有关。dVIN 和 VAM 的识别需要临床医生和在外阴疾病方面有经验的病理学家之间的合作。
