外阴上皮内瘤变的病理及临床处理

Pathology and Treatment of Vulvar Intraepithelial Neoplasia

外阴上皮内瘤变(VIN)是外阴癌的癌前病变,正确诊治VIN具有重要意义。由于1986年国际外阴疾病研究协会(ISSVD)对VIN的分类存在诸多问题,2004年ISSVD采用了新的分类系统,将VIN分为2类病变:普通型和分化型疣样型VIN主要病理特征有基底层区或基底层旁区的非典型鳞状细胞胞浆极少;基底细胞样型VIN主要病理特征有表皮由外形较一致的未分化的不典型基底样细胞构成;分化型VIN主要病理特征有在分化完全的外阴上皮细胞背景中出现不典型细胞,基底层及基底层旁具有过早角化的鳞状细胞、角化不全细胞,表皮突中可出现角化珠样改变。VIN的诊断必须根据活检病理检查才能明确 VIN可选用的治疗方法包括手术治疗、物理治疗、局部药物治疗等,以手术为主,选用治疗方法时需采用个体化的治疗措施。

Recently vulvar intraepithelial neoplasia （VIN） has been recognized as a precursor to vulvar cancer. It is very important to make a definitive diagnosis of VIN and to offer appropriate treatment. In 1986, the International Society for the Study of Vulvovaginal Disease （ISSVD） adopted VIN as a single diagnostic term that included all squamous and nonsquamous precancerous lesions of the vulva using a system of 3 grades. However, the 3-grade system of VIN was oversimplified. In 2004, ISSVD modified the terminology of VIN to include squamous vulvar intraepithelial neoplasia of the most common types that include the warty type of VIN, basaloid-type VIN, mixed VIN that is comprised of the warty/basaloid type, differentiated VIN, and pagetoid-type VIN. The etiological factor behind VIN remains unclear. The warty type of VIN displays an epidermal surface that has a ＂spike-like＂ arrangement, atypical squamous cells have scanty cytoplasm in basal and parabasal zones, basaloid-type VIN shows epidermis with a flat surface and relatively uniform basal-type cells through the epithelium, and differentiated VIN has atypical cells present among differentiated epithelial cells. In all types of VIN prominent eosinophilic cells are present in the basal and parabasal areas, often with keratin formation or ＂pearl-like＂ changes within the rete ridges. The diagnosis must be based on biopsy. The mode of treatment should include consideration of VIN type, localization, lesion size, symptoms, associated disease, psychological issues, and age of the patient.