Detection and Identification of Human Papiliomavirus in Vulvar Intraepithelial Neoplasia

Objective： To evaluate the rate and types of human papillomavirus infection in vulvar intraepithelial neoplasia. Methods： We detected and identified HPV in 40 VIN cases with 67 lesions using PCR based reverse line blot hybridization and DNA sequencing. Among the 40 patients, 13 were diagnosed as VIN Ⅲ, 11 as VIN Ⅱ, and 16 as VIN Ⅰ. 31 patients had multifocal disease. First a fragment of 150 bp was amplified from the L1 region of HPV with GPS/GP6 primers. If the result was negative, a short fragment of 65 bp was amplified also from the LI region with SPFI/SPF2 primers. Results： Using general primer GPS/GP6, the positive rate was 52.2% （35167）. Using a short PCR fragment （SPF PCR）, the positive rate of the rest 32 lesions was 81.2% （26132）. The total positive rate was 91.0% （61/67）. 90% of the HPV types found in VIN were high risk types. All 35 GP PCR products were analyzed by sequencing. The gene types of 31 mono-infection lesions were in accordance with the reverse line blot results, while sequence results of the 4 multi-infection samples could not be analyzed. The SPF PCR products were also sequenced, 24 of the 26 SPF PCR products could be analyzed and 2 samples failed. 80.6% （25/31） cases with multifocal VIN displayed the identical type of HPV, suggesting monoclonality in different lesions from the same patient. Conclusion： The high risk type of HPV is associated with vulvar intraepithelial neoplasia and may be necessary for development of HPV-associated invasive vulvar carcinoma.

Surgical treatment of usual type vulvar intraepithelial neoplasia： a study at three academic hospitals

Vulvar intraepithelial neoplasia （VIN） is a relatively uncommon disease that includes all of the precancerous lesions of vulvar malignancies with an incidence of approximately 2.5 per 100 000 women.In 2004,the International Society for the Study of Vulvovaginal Diseases （ISSVD） abolished the old VIN grading system and introduced a two-tier classification for squamous VIN：the usual type and the differentiated type;the term VIN applied only to histologically ＆quot;high-grade＆quot; squamous lesions （old terms VIN 2 and VIN 3）.1 The two types of VIN differ in etiology,morphology,biology,clinical features and malignant potential.The usual type VIN （uVIN）,which is associated with HPV infection,is the most comrnon subtype,accounting for more than 80% of all VIN cases.Currently,the old 3-grade system of the VIN terminology is still used in most of the hospitals in China.In this presentation,we categorized the patients with the ISSVD 2004 classification standard and attempted to describe the clinical features and the outcome of surgical treatment of uVIN using the retrospective data from three academic hospitals in China.

The clinical significance of human papillomavirus and p16^(INK4a)in vulvar tumors

Vulvar cancer is the fourth most common gynecological malignancy,with a global incidence of an estimated 45,240 new cases and 17,427 deaths in 2022.1 The 5-year survival rate for vulvar cancer is about 70%based on data from the SEER database.2 More than 90%of vulvar cancer was vulvar squamous cell carcinoma(SCC),which included keratinizing,non-keratinizing,basaloid,warty,and verrucous carcinoma.

Clinicopathologic diagnosis of dVIN related vulvar squamous cell carcinoma:An extended appraisal from a tertiary women's hospital

Background:Differentiated vulvar intraepithelial neoplasia(dVIN)is a non-human papilloma virus(HPV)-related high-grade precursor lesion to vulvar squamous cell carcinoma(vSCCa).Although TP53 gene mutations have been identified in 80%of dVIN,its role in dVIN pathogenesis as well as malignant transformation is still being poorly understood.Poor reproducible diagnostic criteria and ambiguous p53 immunostaining patterns,along with morphologic discordance still pose a diagnostic challenge.Methods:A series of 60 cases of dVIN-related vSCCa along with adjacent dVIN were evaluated.Clinicopathological features as well as immunohistochemical results were recorded on the resection-confirmed dVIN-related vSCCa.Results:The average age of the patients was 71 years.Thirty-five cases(58.4%)of dVIN-related vSCCa were moderately differentiated,fourteen cases(23.3%)were poorly differentiated,and the remaining eleven cases(18.3%)were well-differentiated.Twenty-nine cases(48.3%)were found to have lichen sclerosus adjacent to dVIN.In terms of p53 and p16 expression in dVIN-related vSCCa and the adjacent dVIN,fifty-five(91.7%)dVIN showed mutant p53 immunostaining pattern with strong positive expression in 80%cases(basal/para-basal expression)and null pattern expression in 11.7%cases.Five(8.3%)dVIN showed p53 wild-type staining pattern.The wild-type pattern were seen in 5%of vSCCa and p53 null pattern were seen in 13.3%vSCCa.Six cases demonstrated atypical staining patterns:two cases showed p53 null expression in dVIN but p53 overexpression in invasive carcinoma;three cases exhibited p53 null expression in invasive carcinoma,with the adjacent dVIN showing basal and para-basal mutant(2 cases)and wild-type(1 case)p53 expression patterns.A single case demonstrated p53 wild-type pattern in dVIN and overexpression in invasive carcinoma.In addition,65%dVIN were p16 negative and 31.7%dVIN had patchy p16 staining.Conclusion:Clinical and prognostic value of the ambiguous/inconsistent patterns are uncertain and molecular studies are needed for further characterization.