WordNet

the pathological process that results in the formation and growth of a tumor
of or relating to the vulva (同)vulval
external parts of the female genitalia

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陰門,外陰部

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/10/02 15:45:49」(JST)

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The term Vulvar intraepithelial neoplasia (VIN) refers to particular changes that can occur in the skin that covers the vulva. VIN is not cancer, and in some women it disappears without treatment. If the changes become more severe, there is a chance that cancer might develop after many years, and so it is referred to as a precancerous condition.^[1]

ISSVD Classification

Medically speaking, the term denotes a squamous intraepithelial lesion of the vulva that shows dysplasia with varying degrees of atypia. The epithelial basement membrane is intact and the lesion is thus not invasive but has invasive potential.

The terminology of VIN evolved over several decades. In 1989^[2] the Committee on Terminology, International Society for the Study of Vulvar Disease (ISSVD) replaced older terminology such as vulvar dystrophy, Bowen's disease, and Kraurosis vulvae by a new classification system for Epithelial Vulvar Disease:

Nonneoplastic epithelial disorders of vulva and mucosa:
- Lichen sclerosus
- Squamous hyperplasia
- Other dermatoses
Mixed neoplastic and nonneoplastic disorders
Intraepithelial neoplasia
- Squamous vulvar intraepithelial neoplasia (VIN)
  - VIN I, mildest form
  - VIN II, intermediate
  - VIN III, most severe form including carcinoma in situ of the vulva
- Non-squamous intraepithelial neoplasia
  - Extramammary Paget's disease
  - Tumors of melanocytes, non invasive
Invasive disease (vulvar carcinoma)

The ISSVD further revised this classification in 2004, replacing the three-grade system with a single-grade system in which only the high-grade disease is classified as VIN. This is subdivided into: 1) usual-type VIN (including warty, basaloid and mixed subtypes)commonly associated with carcinogenic genotypes of HPV and/or HPV persistence factors such as cigarette smoking or immunocompromised states and 2) differentiated VIN, commonly associated with vulvar dermatoses such as lichen sclerosis. Differentiated VIN associated with lichen sclerosis, however, is more likely to be associated with squamous carcinoma than is usual-type VIN.^[3] ^[4]

Causes

The exact cause of VIN is unknown. Studies are being done to determine the cause of VIN. The following factors have been associated with VIN:

HPV (Human Papilloma Virus)
HSV-2 (Herpes simplex Virus - Type 2)
Smoking
Immunosuppression
Chronic vulvar irritation
Conditions such as Lichen Sclerosus

Diagnosis

Micrograph of vulvar intraepithelial neoplasia III. H&E stain.

Micrograph of differentiated vulvar intraepithelial neoplasia. H&E stain.

The patient may have no symptoms, or local symptomatology including itching, burning, and pain. The diagnosis is always based on a careful inspection and a targeted biopsy of a visible vulvar lesion.

The type and distribution of lesions varies among the two different types of VIN. In the Usual type VIN, seen more frequently in young patients, lesions tend to be multifocal over an otherwise normal vulvar skin. In the differentiated type VIN, usually seen in postmenopausal women, lesions tend to be isolated and are located over a skin with a vulvar dermatosis such as Liquen slerosus.^[3]

Prevention

Vaccinating girls with HPV vaccine before their initial sexual contact has been claimed to reduce incidence of VIN.^[5]

Additional images

Micrograph of vulvar intraepithelial neoplasia.

References

^ "Vulval intra-epithelial neoplasia (VIN)". Macmillan Cancer Support. Retrieved 2010-06-09.
^ Ridley CM, Frankman O, Jones IS, et al. (May 1989). "New nomenclature for vulvar disease: International Society for the Study of Vulvar Disease". Hum. Pathol. 20 (5): 495–6. doi:10.1016/0046-8177(89)90019-1. PMID 2707802.
^ ^a ^b http://www.issvd.org
^ Sideri M, Jones RW, Wilkinson EJ, Preti M, Heller D,. Scurry J, Haefner H, Neill S. 2004 Modified Terminology, ISSVD Vulvar Oncology Subcommittee. Journal of Reproductive Medicine. 2005;50:807-10.
^ "FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers". 2008-09-12. Retrieved 2010-02-13.

External links

VIN at DermNet.NZ
VIN at Macmillan Cancer Support

UpToDate Contents

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1. 外陰上皮内腫瘍 vulvar intraepithelial neoplasia
2. 外陰部の広範囲局所切除術、単純外陰部切除術、および外陰表皮切除術 vulvar wide local excision simple vulvectomy and skinning vulvectomy
3. HIVに感染した女性における外陰および膣上皮内腫瘍 vulvar and vaginal intraepithelial neoplasia in hiv infected women
4. 外陰部病変：形態に基づく鑑別診断 vulvar lesions differential diagnosis based on morphology
5. 外陰癌：臨床症状、診断、および病理 vulvar cancer clinical manifestations diagnosis and pathology

English Journal

Prior human papillomavirus-16/18 AS04-adjuvanted vaccination prevents recurrent high grade cervical intraepithelial neoplasia after definitive surgical therapy: Post-hoc analysis from a randomized controlled trial.

Garland SM1, Paavonen J2, Jaisamrarn U3, Naud P4, Salmerón J5, Chow SN6, Apter D7, Castellsagué X8, Teixeira JC9, Skinner SR10,11, Hedrick J12, Limson G13, Schwarz TF14, Poppe WA15, Bosch FX8, de Carvalho NS16, Germar MJ17, Peters K18, Del Rosario-Raymundo MR19, Catteau G20, Descamps D20, Struyf F20, Lehtinen M21, Dubin G22; HPV PATRICIA Study Group.
International journal of cancer.Int J Cancer.2016 Dec 15;139(12):2812-2826. doi: 10.1002/ijc.30391. Epub 2016 Sep 9.
We evaluated the efficacy of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine in preventing HPV-related disease after surgery for cervical lesions in a post-hoc analysis of the PApilloma TRIal against Cancer In young Adults (PATRICIA; NCT00122681). Healthy women aged 15-25 years were ran
PMID 27541373

Recommendations for symptom management in women with vulvar neoplasms after surgical treatment: An evidence-based guideline.

Kobleder A1, Raphaelis S2, Glaus A3, Fliedner M4, Mueller MD5, Gafner D6, Gehrig L7, Senn B8.
European journal of oncology nursing : the official journal of European Oncology Nursing Society.Eur J Oncol Nurs.2016 Dec;25:68-76. doi: 10.1016/j.ejon.2016.10.003. Epub 2016 Oct 22.
PURPOSE: To develop an evidence-based guideline for nurses and other health care professionals involved in pre- and postsurgical care of women with vulvar cancer (VC) or vulvar intraepithelial neoplasia (VIN).METHODS: This evidence-based guideline was developed according to six domains of the method
PMID 27865255

Usual-type vulvar intraepithelial neoplasia: report of a case and its dermoscopic features.

Maione V1, Errichetti E2, Dehen L3, Cavelier Balloy B4, Lebbé C3.
International journal of dermatology.Int J Dermatol.2016 Dec;55(12):e621-e623. doi: 10.1111/ijd.13370. Epub 2016 Jul 15.
PMID 27419656

Japanese Journal

A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream : clinical implications

SHIOZAKI Takaya,TABATA Tsutomu,TORIYABE Kuniaki,MOTOHASHI Takashi,KONDO Eiji,TANIDA Kouji,OKUGAWA Toshiharu,SAGAWA Norimasa
International journal of clinical oncology 16(5), 610-612, 2011-10-01
NAID 10030247135

A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream: clinical implications.

Shiozaki Takaya,Tabata Tsutomu,Toriyabe Kuniaki,Motohashi Takashi,Kondo Eiji,Tanida Kouji,Okugawa Toshiharu,Sagawa Norimasa
International Journal of Clinical Oncology 16(5), 610-612, 2011-10-00
… The authors report a case of usual-type (basaloid-type) vulvar intraepithelial neoplasia (VIN) 3 that failed to respond to imiquimod cream. … A 51-year-old Japanese woman visited her local gynecologist complaining of vulvar itching. … Atypical cells were noted in cytology smears, but nine vulvar biopsy specimens showed benign proliferation of epithelial tissue. …
NAID 120005228802

女性外陰部尖圭コンジローマとボーエン様丘疹症 : vulvar intraepithelial neoplasia : VIN

笹川寿之,山田里佳,井上正樹
日本性感染症学会誌 = Japanese archives of sexually transmitted diseases 16(1), 110-117, 2005-06-30
NAID 10020414704

Related Pictures

★リンクテーブル★

リンク元	「VIN」「外陰上皮内腫瘍」
関連記事	「neoplasia」「vulvar」「intraepithelial neoplasia」

「VIN」

Vulvar intraepithelial neoplasia
	Classification and external resources
	Micrograph of (classic) vulvar intraepithelial neoplasia III. H&E stain.
ICD-10	D07.1 (ILDS D07.120)
ICD-9	233.32