Analysis of clinical treatment of 50 cases of vaginal intraepithelial neoplasia / 中华放射肿瘤学杂志

Objective To investigate the clinical features and treatment of vaginal intraepithelial neoplasia (VAIN).Methods Clinical data of 50 patients with VAIN,aged 33-76 years,were retrospectively analyzed.Among them,16 patients were diagnosed with grade Ⅰ VAIN,5 with grade Ⅱ VAIN and 29 with grade Ⅲ VAIN.Results A majority of VAIN patients presented with no clinical symptoms,whereas few cases were manifested with increased vaginal secretion.The lesions were located in the vaginal fornix or the upper 1/3 of the vagina in 82％ of patients,and in the middle and lower 1/3 of the vagina in the remaining 18％ cases.Patients with VAIN Ⅰ were observed during follow-up,VAIN Ⅱ patients were given with local administration of medication,and VAIN Ⅲ patients received three-dimensional high-dose rate after loading intracavitary radiotherapy.Human papilloma virus (HPV) infection was positively correlated with VAIN grade (P=0.028).Conclusions The VAIN grade is positively correlated with high-risk HPV infection.Afterloading intracavitary radiotherapy is an efficacious therapeutic approach for VAIN Ⅲ patients,which yields slight adverse events and high cure rate.

Clinical analysis of 56 cases with vaginal intraepithelial neoplasia after hysterectomy / 上海交通大学学报（医学版）

Objective · To investigate the relationship between the results of thin prep cytologic test (TCT), high-risk human papillomavirus (Hr-HPV) detection and vaginalintraepithelial neoplasia (VAIN) after hysterectomy. Methods · A retrospective study was conducted of 56 patients with VAIN after hysterectomy. The analysis included TCT and Hr-HPV examination, clinical data and the relationship between Hr-HPV examinenation and histopathological examination of colposcopy. Results · Postoperative follow-up of TCT and Hr-HPV parallel pathological examination showed that 56 patients had vaginal stump lesions, including cervical factor hysterectomy accounted for 5.81% (45/775) and non cervical factor hysterectomy accounted for 0.19% (11/5933). The difference was statistically significant (P=0.000). In 56 cases of patients with vaginal stump lesions, Hr-HPV infection were 40 cases (accounting for 71.43%), uninfected patients were 16 cases (accounting for 28.57%). The Hr-HPV infection rates of cervical hysterectomy and non cervical factor hysterectomy patients were 80.00% (36/45) and 36.36% (4/11) respectively, and the difference was statistically significant (χ2= 6.248, P=0.012). TCT results showed that the incidence of squamous intraepithelial lesions were 42.22% (19/45) and 9.09% (1/11) respectively. Conclusion · The Hr-HPV infection rate and the morbidity of VAIN of the patients undergone hysterectomy due to the cervical lesionfactors is higher than those who had none cervical lesion factors. In order to identify VAIN early, patients who have the history of hysterectomy should undergo careful evaluation of cervical and vaginal circumstance before surgery and the routine examinations of TCT and Hr-HPV in the follow-up.

Total vaginectomy for refractory vaginal intraepithelial neoplasia III of the vaginal vault

Vaginal intraepithelial neoplasia III, is a relatively rare disease. Consequently standard treatments for this disease were not established until recently. Although several convenient methods, such as laser ablation, 5-fluorouracil topical injection, and radiation therapy, have been applied for treating these lesions, surgical treatments, including vaginectomy, have not yet been attempted, as they would likely be accompanied by technical difficulties and various complications. Herein, we report a case of refractory vaginal intraepithelial neoplasia III in the vaginal vault that was successfully treated with a total vaginectomy.

Clinical analysis of 15 cases with vaginal intraepithelial neoplasia and vaginal cancer after operations of cervical cancer or cervical intraepithelial neoplasia / 医学研究生学报

Objective Although the correlation between high risk human papilloma virus (hrHPV) infection and cervical cancer ( CC ) or cervical intraepithelial neoplasia ( CIN ) is well known , vaginal cancer ( VC ) or vaginal intraepithelial neoplasia ( VAIN) also caused by hrHPV has not received enough attention .This article aims to explore the clinical characteristics of VC or VAIN after operations of CC or CIN in order to provide evidence for the treatment of these diseases . Methods The clinical charac-teristics and treatment of 15 cases with VC or VAIN after operations of CC or CIN were reviewed from Jan 2010 to May 2013 in our hos-pital. Results The mean age was (53.6 ±10.82) years, ranged from 39 to 73 years.The duration from the first operation to devel-oped VAIN or VC was (25.07 ±18.31) months, ranged from 1 to 60 months.There are 4 cases developed VC, 4 cases VAINⅢand 2 cases VINⅡfrom 10 CC patients;and 3 cases developed VC , 2 cases VAINⅢfrom 5 CINⅢpatients.hrHPV test were positive in all 15 patients.Treatment in these series were performed including total vaginectomy in 8 patients (3 VC, 4 VAINⅢ and 1 VAINⅡpatients), pelvic lymphonectomy in 1;upper vaginectomy in 2 patients (1 VC, 1 VAINⅢ), radiation or chemo-radiation therapy in 3 (3 VC), interferon muscle injection combined with topical application of estrogen and acyclovir gel in 2 (1 VC, 1 VAINⅡ). Conclusion Careful follow-up after CC or CIN operations are very important because continued hrHPV infection may result VC and VAIN lesions.Vaginectomy may be the best therapy .Interferon muscle injection combined with topical application of estrogen and acyclovir gel are also alternatively therapy , especially for hard to operate patients . Radiation therapy seems to be not very adaptable for VAIN patients .

Exploration of clinical value of colposcopy directed biopsy in diagnosis of vaginal intraepithelial neoplasia / 中国医师进修杂志

Objective To explore the clinical value of colposcopy directed biopsy in diagnosis of vaginal intraepitheal neoplasia (VaIN).Methods The clinical data of 106 VaIN patients diagnosed by colposcopy directed biopsy were reviewed and analyzed retrospectively.In the past medical history of 106 patients,46 patients had cervical cancer history,43 patients had cervical intraepithehal neoplasia history,13 patients had previous hysterectomy because of benign disease and 4 patients had uncertain past medical history.Results Among 106 patients,97 patients(91.51％,97/106) had abnormal pap smears of vagina,9 patients (8.49％,9/106) had abnormal pap smears of cervix.Histological analysis revealed that 69 patients were VaIN Ⅰ,24 patients were VaIN Ⅱ,13 patients were VaIN Ⅲ.The high-risk human papilloma virus (HPV) test at diagnosis were positive in 98 patients (92.45％,98/106),negative in 8 patients (7.55％,8/106).Eighty-seven patients VaIN were localized in the upper one third of the vagina,19 patients VaIN were localized in other parts of vaginal wall.Ninety-eight patients VaIN affected to the multifocal vaginal wall,8 patients VaIN affected to the focal vaginal wall.Conclusions It has highly therapeutic value of colposcopy directed biopsy in diagnosis of VaIN.But should closely correlated to past medical history,colposcopy should performed on the whole vagina wall and multiple punch biopsy to elevated positive rate.

Neoplasia vaginal intraepitelial / Vaginal intraepithelial neoplasia

Objetivo: actualizar los conocimientos disponibles sobre la neoplasia vaginal intraepitelial (VAIN) especialmente en el diagnóstico y tratamiento. Métodos: revisión de la literatura en Pubmed de los últimos 20 años, especialmente de los publicados desde 2005 hasta la actualidad y considerando sobre todo los ensayos clínicos aleatorizados. Resultados: su prevalencia real es desconocida, aunque es una patología rara generalmente en mujeres posmenopaúsicas. Su fisiopatología es similar a la neoplasia cervical intraepitelial, con el HPV como principal factor de riesgo, sobre todo el serotipo 16, pero su progresión a cáncer es menor. Un grupo importante es el de VAIN tras histerectomía, que supone el 48-70 por ciento del total de las VAIN. La colposcopia para el diagnóstico no es sencilla y se aconseja preparación con estrógenos en las pacientes menopáusicas y utilización de ácido acético y lugol para identificar las zonas sospechosas. Las tres opciones terapéuticas son la cirugía (excisional, láser, ultrasonidos), braquiterapia y tratamiento médico (imiquimod, 5-fluorouracilo, ácido tricloroacético). Se expone la técnica y las ventajas e inconvenientes de cada uno de ellos. Conclusión: aunque la VAIN es una entidad rara, es preciso tenerla en cuenta ante un diagnóstico de lesión citológica. Su diagnóstico a veces no es sencillo y el tratamiento dependerá del grado, la localización y el tamaño de la lesión y las circunstancias personales de la paciente. Se necesitan más ensayos aleatorizados que comparen la eficacia entre las distintas opciones terapéuticas y su repercusión en la calidad de vida de las pacientes.

Aims: update the knowledge about vaginal intraepithelial neoplasia (VAIN) with special emphasis on diagnosis and therapeutic management. Method: electronic search of Pubmed of all kinds of articles about the VAIN, for the last 20 years with special attention to those published from 2005 to the present and considering especially randomized clinical trials. Results: its prevalence is unknown, although it is a rare condition that usually occurs in postmenopausal women. The physiopathology is similar to cervical intraepithelial neoplasia, being HPV the main risk factor, particularly serotype 16, but its progression to cancer is lower. An important group is VAIN after hysterectomy, 48-70 percent of total VaIN. Colposcopy for the diagnosis is not easy and in patients with postmenopausal the preparation with local estrogen is necessary and use both of acetic acid and lugol to identify suspicious areas. The three treatment options are surgery (excisional, laser, ultrasound), brachytherapy and medical management (imiquimod, 5-fluorouracil, tricholoroacetic acid). The technique and the advantages and disadvantages of each are explained. Conclusion: although VAIN is rare, it must take it into account before a cytological diagnosis of dysplasia. Its diagnosis is sometimes not easy and the treatment depends on the extent, location and size of the lesion and the individual preferences of the patient. We need more randomized trials comparing different treatment options and also their impact on quality of life of patients.

Management of gynecologic patients with precancerous disease / 대한산부인과학회지

Cervical cancer of gynecologic cancer is considered a preventable disease because it has a long preventive state, cervical cytology screening programs are currently available, and treatment of precancerous lesions is effective. Proper management of precancerous disease is important because improper management of precancerous disease can increase risk of invasive cancer on the one hand and can result in complications from overtreatment on the other. The decision as to which therapeutic option to use in an individual patient depends on considerations such as patient age, parity, desire for future childbearing, preferences, prior cytology and treatment history, and history of default from follow-up, operator experience, and nonvisualization of the transformation zone.

The utility of the human papillomavirus DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia / 부인종양

OBJECTIVE: We evaluated the human papillomavirus (HPV) DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia (VAIN). METHODS: A retrospective review of the medical records of patients with a pathological diagnosis of VAIN was performed. Eligible women (N=48) were followed for cytology and HPV DNA test, and colposcopic biopsies were taken at 3- to 6-month intervals. Thirty-seven patients were followed for more than 6 months; their HPV DNA test results were compared to the cytology results for the prediction of disease prognosis. RESULTS: The degree of VAIN was more severe in patients with a high initial HPV DNA load (p=0.009). Patients with VAIN 2 and VAIN 3 were older than those with VAIN 1 (p=0.005 and 0.008, respectively). In 26 out of 37 patients (70.3%), the VAIN resolved. The other patients had persistent lesions with no progression to invasive vaginal carcinoma. The last follow-up HPV DNA load was significantly higher in the group with persistent VAIN compared to the group with resolved VAIN (p<0.0001). Negative cytology was observed in 25 out of 26 patients in the VAIN resolved group and in nine out of 11 patients in the VAIN persistent group (p=0.205). CONCLUSION: These results suggest that the HPV DNA test, especially for viral load, was more effective for the diagnosis and prediction of persistent VAIN than cytology.