Derya KILIÇ, Ayhan ATIGAN, Erkan ALATAŞ, Yeliz ARMAN KARAKAYA, Tolga GÜLER

Vulvar İntraepitelyal Neoplazi Olgularının Klinik ve Patolojik Verilerinin Retrospektif Analizi

Amaç: Bu çalışma kliniğimizde Vulvar İntraepitelyal Neoplazi (VIN) tanısı alan vakaların klinik ve patolojik verilerini retrospektif olarak değerlendirmek için planlandı. Gereç ve Yöntemler: Pamukkale Üniversitesinde Ocak 2016- Haziran 2020 tarihleri arasında VIN tanısı almış olan 68 hastanın dosyası retrospektif olarak değerlendirildi. Patolojik preparatlar mikroskop ile tekrar değerlendirildi. Vakalara ait sosyodemografik veriler, biyopsi ve histopatolojik veriler elde edildi. VIN vakalarına eş zamanlı olarak alınmış olan servikal Pap-smear, HPV ve servikal biyopsi sonuçları gruplandırılarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 68 hastanın 48’i düşük dereceli (vLSIL), 20’si yüksek dereceli (vHSIL)’ idi. Düşük dereceli grupta ortalama yaş 48,60±16,02; gravida 2,54±1,92; parite 2,02±1,60 iken; yüksek dereceli grupta sırasıyla 44,80±14,71; 2,40±1,81; 1,70±1,49 idi. Yüksek dereceli grupta; lezyon alanı (p=0,008), Ki-67 (p=0,001), p53 (p=0,036), p16 (p=0,034) immünhistokimya boyanmaları istatistiksel olarak anlamlı şekilde daha yüksekti. HPV boyanması açısından fark yoktu (p>0,05). Eş zamanlı servikal Pap-smear, HPV-pcr ve servikal biyopsi açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu (p>0,05). Sonuç: Çalışmamızda, literatüre paralel olarak servikal intraepitelyal lezyonlarda (CIN) ve yapılmış VIN çalışmalarında olduğu gibi immünohistokimyasal belirteçler yüksek dereceli grupta daha yüksek bulunmuştur. CIN ile ortak risk faktörleri içermesine rağmen, VIN için toplum tabanlı bir tarama henüz mevcut değildir. Bu nedenle şüpheli vulvar lezyonların araştırılmasında tanı için altın standart prosedür biyopsidir. VIN hastalarının tanı ve tedavileri için algoritma oluşturacak çok merkezli ileri çalışmalara ihtiyaç vardır.

Retrospective Analysis of Clinical and Pathological Data of Vulvar IntraepitheliaI Neoplasia Cases

Aim: This study was designed to retrospectively evaluatethe clinical and pathological data of cases diagnosed with Vulvar Intraepithelial Neoplasia (VIN) in ourclinic. Material and Methods: 68 patients diagnosed with VIN at Pamukkale University between January 2016 and June 2020 were analyzed retrospectively. Pathological slides were examined with a microscope. Socio demographic data, biopsy and histopathological data of the cases were obtained. Cervical Papsmear, HPV and cervical biopsy results taken simultaneously to VIN cases were grouped and evaluated Results: Of the 68 patients included in the study, 48 were low grade (vLSIL) and 20 were high grade (vHSIL). The mean age in the vLSIL group was 48,60±16,02; gravida 2,54±1,92; parity 2,02±1,60 while; 44,80±14,71; 2,40±1,81; 1,70±1,49 in the vHSIL group, respectively. In the vHSIL group; lesion area (p=0,008), Ki-67 (p=0,001), p53 (p=0,036), p16 (p=0,034) immunohistochemistry staining were statistically significantly higher. There was no difference in HPV staining (p>0,05). There was no statistically significant difference between the groups in terms of simultaneous cervical Pap-smear, HPV-pcr and cervical biopsy (p>0,05). Conclusion: In our study, in accordance with the literature, immunohistochemical markers were found to be higher in the vHSIL group, as in cervical intraepithelial lesions (CIN) and VIN studies. Although it contains common risk factors with CIN, population-based screening for VIN is not yet available. Therefore, the gold standard procedure for diagnosis in the investigation of suspicious vulvar lesions is biopsy. Multi center advanced studies are needed to create algorithms for the diagnosis and treatment of VIN patients.

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Judson PL, Habermann EB, Baxter NN, Durham SB, Virnig BA. Trends in the incidence of inva- sive and in situ vulvar carcinoma. Obstet Gynecol. 2006;107:1018–22.
S.Kaushik,L.Pepas,A.Nordin,A.Bryant,H.O.Dickinson,CochraneDatabase:Surgi- cal Interventions for High Grade Vulval Intraepithelial Neoplasia (Review), 1, The Cochrane Collaboration. John Wiley & Sons, Ltd., Copyright 2011 30, https://doi. org/10.1002/14651858.CD007928.pub3.  
Committee Opinion No. 675 Summary: Management of Vulvar Intraepithelial Neoplasia. Obstet Gynecol. 2016;128(4):937-938. doi:10.1097/AOG.0000000000001704.
M. Sideri, R.W. Jones, E.J. Wilkinson, M. Preti, D.S. Heller, J. Scurry, et al., Squamous vulvar intraepithelial neoplasia: 2004 modified terminologyISSVD Vulvar Oncology Subcommittee J. Reprod. Med. 50 (2005) 80716419625.  
J. Bornstein, F. Bogliatto, H.K. Haefner, C.K. Stockdale, M. Preti, T.G. Bohl, et al., The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) terminol- ogy of vulvar squamous intraepithelial lesions, J. Low. Genit. Tract Dis. 20 (1) (2016 Jan) 11–14, https://doi.org/10.1097/AOG.0000000000001285.  
VanSeters,M,vanBeurdenM,deCraenAJ.Is the assumed natural history of vulvar intraepithelial neoplasia III based on enough evidence? A systematic review of 3322   published patients. Gynecol. Oncol. 2005;97:645. doi: https://doi.org/10.1016/j. ygyno.2005.02.012. 
Kowalewska M, Szkoda MT, Radziszewski J, Ptaszynski K, Bidzinski M, Siedlecki JA. The frequency of human papillomavirus infection in polish patients with vulvar squamous cell carcinoma. Int J Gynecol Cancer. 2010;20(3):434-7. doi: 10.1111/IGC.0b013e3181d320f1
Edwards SK, Bates CM, Lewis F, Sethi G, Grover D. 2014 UK national guideline on the management of vulval conditions. Int J STD AIDS. 2015;26(9):611-24. doi: 10.1177/0956462414554271.
Linxweiler M, Bochen F, Wemmert S, Lerner C, Hasenfus A, Bohle RM, Al-Kadah B, Takacs ZF, Smola S, Schick B. Combination of p16(INK4a) /Ki67 immunocytology and HPV polymerase chain reaction for the noninvasive analysis of HPV involvement in head and neck cancer. Cancer Cytopathol. 2015;123(4):219-29. doi: 10.1002/cncy.21512.
Petry KU, Schmidt D, Scherbring S, Luyten A, Reinecke-Lüthge A, Bergeron C, Kommoss F, Löning T, Ordi J, Regauer S, Ridder R. Triaging Pap cytology negative, HPV positive cervical cancer screening results with p16/Ki-67 Dual-stained cytology. Gynecol Oncol. 2011;121(3):505-9. doi: 10.1016/j.ygyno.2011.02.033.
Takacs FZ, Radosa JC, Bochen F, Juhasz-Böss I, Solomayer EF, Bohle RM, Breitbach GP, Schick B, Linxweiler M. Sec62/Ki67 and p16/Ki67 dual-staining immunocytochemistry in vulvar cytology for the identification of vulvar intraepithelial neoplasia and vulvar cancer: a pilot study. Arch Gynecol Obstet. 2019;299(3):825-833. doi: 10.1007/s00404-018-5021-0.
Chulvis do Val IC, Almeida Filho GL, Valiante PM, Gondim C, Takiya CM, Carvalho Mda G. Vulvar intraepithelial neoplasia p53 expression, p53 gene mutation and HPV in recurrent/progressive cases. J Reprod Med. 2004;49(11):868-74.
Garland SM, Insinga RP, Sings HL, Haupt RM, Joura EA. Human papillomavirus infections and vulvar disease development. Cancer Epidemiol Biomarkers Prev. 2009;18(6):1777-84. doi: 10.1158/1055-9965.EPI-09-0067.
Insinga RP, Liaw KL, Johnson LG, Madeleine MM. A systematic review of the prevalence and attribution of human papillomavirus types among cervical, vaginal, and vulvar precancers and cancers in the United States. Cancer Epidemiol Biomarkers Prev. 2008;17(7):1611-22. doi: 10.1158/1055-9965.EPI-07-2922.
Satmary W, Holschneider CH, Brunette LL, Natarajan S. Vulvar intraepithelial neoplasia: Risk factors for recurrence. Gynecol Oncol. 2018;148(1):126-131. doi:10.1016/j.ygyno.2017.10.029
Modesitt SC, Waters AB, Walton L, Fowler WC Jr, Van Le L. Vulvar intraepithelial neoplasia III: occult cancer and the impact of margin status on recurrence. Obstet Gynecol. 1998;92(6):962-6. doi: 10.1016/s0029-7844(98)00350-0.
Wallbillich JJ, Rhodes HE, Milbourne AM, Munsell MF, Frumovitz M, Brown J, Trimble CL, Schmeler KM. Vulvar intraepithelial neoplasia (VIN 2/3): comparing clinical outcomes and evaluating risk factors for recurrence. Gynecol Oncol. 2012;127(2):312-5. doi: 10.1016/j.ygyno.2012.07.118.
Committee Opinion No.675: Management of Vulvar Intraepithelial Neoplasia. Obstet Gynecol. 2016;128(4):e178-e182. doi: 10.1097/AOG.0000000000001713. Erratum in: Obstet Gynecol. 2017 Jan;129(1):209.
Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7-30. doi: 10.3322/caac.21387.