Achdiat Pati Aji, Widjaya Muhamad Radyn Haryadi, Rowawi Rasmia, Usman Hermin Aminah, Maharani Retno Hesty
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia.
Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia.
Int J Womens Health. 2024 Jan 5;16:9-16. doi: 10.2147/IJWH.S439825. eCollection 2024.
Vulvar intraepithelial neoplasia (VIN), the precursor lesion of vulvar squamous cell carcinoma (VSCC), may present as pruritic or asymptomatic lichenified plaques surrounded by single or multiple discrete or confluent macules or papules. VIN is divided into high-grade squamous intraepithelial lesion (HSIL), which is human papillomavirus (HPV)-driven, and differentiated VIN (DVIN), which develops independently of HPV. Histopathological examination and HPV genotyping polymerase chain reaction (PCR) tests should be performed to distinguish between HSIL and DVIN. Lichenified plaques surrounded by multiple papules are found not only in VIN but also in vulvar lichen simplex chronicus (LSC). This chronic inflammatory skin disease mostly appears in labia majora and is triggered by sweating, rubbing, and mental stress. IHC staining of p16 and p53 are recommended as the most commonly used biomarkers for VIN in diagnostically challenging cases. IHC staining is also beneficial to confirm the accuracy of the HPV detection technique, as p16-negative staining may also represent a false-positive result. We report a case of the importance of p16 and p53 IHC staining in diagnosing vulvar LSC mimicking VIN with false-positive HPV-66. The patient was previously diagnosed with VIN based on clinical examination. HPV-66 was detected by PCR from a vulvar biopsy sample. Histopathological examination revealed stromal lymphocytic infiltration with non-specific chronic dermatitis; neither atypia nor koilocyte was observed. Both p16 and p53 IHC staining were negative. The patient was diagnosed and treated as vulvar LSC with 10 mg cetirizine tablet, emollient, and 0.1% mometasone furoate cream. Clinical improvement was observed as the lesions became asymptomatic hyperpigmented macules in the 4 weeks of follow-up, without recurrence after 3 years of follow-up. Both p16 and p53 IHC staining might help distinguish HSIL and DVIN mutually and from other vulvar mimics in diagnostically challenging cases.
外阴上皮内瘤变（VIN）是外阴鳞状细胞癌（VSCC）的前驱病变，可表现为瘙痒性或无症状的苔藓化斑块，周围有单个或多个离散或融合的斑疹或丘疹。VIN分为高级别鳞状上皮内病变（HSIL），由人乳头瘤病毒（HPV）驱动，以及分化型VIN（DVIN），其独立于HPV发生。应进行组织病理学检查和HPV基因分型聚合酶链反应（PCR）检测以区分HSIL和DVIN。不仅在VIN中，而且在外阴慢性单纯性苔藓（LSC）中也发现有多个丘疹围绕的苔藓化斑块。这种慢性炎症性皮肤病大多出现在大阴唇，由出汗、摩擦和精神压力引发。在诊断具有挑战性的病例中，p16和p53的免疫组化染色被推荐为VIN最常用的生物标志物。免疫组化染色也有助于确认HPV检测技术的准确性，因为p16阴性染色也可能代表假阳性结果。我们报告了一例p16和p53免疫组化染色在诊断模仿VIN且HPV - 66呈假阳性的外阴LSC中的重要性的病例。该患者先前根据临床检查被诊断为VIN。通过PCR在外阴活检样本中检测到HPV - 66。组织病理学检查显示有基质淋巴细胞浸润伴非特异性慢性皮炎；未观察到异型性或空泡细胞。p16和p53免疫组化染色均为阴性。该患者被诊断为外阴LSC，并使用10毫克西替利嗪片、润肤剂和0.1%糠酸莫米松乳膏进行治疗。在随访的4周内，病变变为无症状的色素沉着斑，临床症状改善，随访3年无复发。在诊断具有挑战性的病例中，p16和p53免疫组化染色可能有助于相互区分HSIL和DVIN以及与其他外阴类似病变。
