Coexisting High-Grade Vulvar Intraepithelial Neoplasia (VIN) and Condyloma Acuminatum: Independent Lesions Due to Different HPV Types
Kruti P Maniar, Brigitte M Ronnett, Robert J Kurman, Russell S Vang, Aleksandra Ogurtsova, Anna Yemelyanova. Johns Hopkins School of Medicine, Baltimore, MD
Background: The majority of vulvar intraepithelial neoplasia (VIN) is high-grade and high-risk human papillomavirus (HRHPV)-related (most commonly HPV16), and is considered the precursor of HRHPV-related squamous cell carcinoma of the vulva. Vulvar condyloma acuminatum is low-risk HPV (LRHPV)-related (most commonly types 6 and 11) and has virtually no risk of neoplastic progression. While infections with multiple high- and low-risk HPV types have been reported for cervical squamous intraepithelial lesions, coexisting vulvar condyloma and adjacent high-grade VIN have not been well-characterized.
Design: Eleven cases of concurrent condyloma acuminatum and adjacent flat high-grade VIN and four cases of high-grade VIN with prominent warty/condylomatous architecture were analyzed using immunohistochemical (IHC) analysis of p16 expression and in situ hybridization (ISH) for HPV detection (probes for HPV6/11, HPV16, and HPVWS [types 6,11,16,18,31,33,35,45,51,52]).
Results: All patients had underlying conditions with evidence of immunosuppression (human immunodeficiency virus infection, post-transplant therapy, or autoimmune disorder). Data are summarized in Table 1.
|Lesion Type||p16 (n/n tested)||HPV type (n positive/n tested)|
|Condyloma with adjacent high-grade VIN (n=11)|
|Condyloma||Negative (few focal/weak) (11/11)||HPV6/11 (10/10)|
|High-grade VIN||Positive (diffuse) (11/11)||HRHPV* (5/5)|
|High-grade VIN with warty/condylomatous features (n=4)||Positive (diffuse) (4/4)||HRHPV* (4/4)|