[1197] 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)

* HRHPV detected either by positive HPV16 and/or positive HPVWS in conjunction with negative HPV6/11 (additional HPV ISH and HPV genotyping by PCR is ongoing)


Conclusions: The restriction of LRHPV to condylomatous components and HRHPV to high-grade VIN components of adjacent lesions suggests these are independent and a result of infection with multiple HPV types. A diffuse pattern of p16 expression can highlight small foci of high-grade VIN which may be overlooked in more abundant condylomatous tissue from immunosuppressed patients. The presence of HRHPV in lesions with prominent warty/condylomatous architecture supports their classification as forms of pure high-grade VIN and distinguishes them from condyloma acuminatum.
Category: Gynecologic & Obstetrics

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 182, Wednesday Afternoon