Classic Vulvar Intraepithelial Neoplasia With Superimposed Lichen Simplex Chronicus: A Unique Variant Mimicking Differentiated Vulvar Intraepithelial Neoplasia

International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists
Jaclyn C WatkinsMarisa R Nucci

Abstract

High-grade vulvar intraepithelial neoplasia, a precursor lesion to vulvar squamous cell carcinoma, is subdivided into 2 types, classic or usual vulvar intraepithelial neoplasia (CVIN) and differentiated vulvar intraepithelial neoplasia (DVIN). CVIN, which is a human papilloma virus (HPV)-dependent lesion, is typically distinguished from DVIN, a p53 mutation-dependent process, by its distinct histomorphologic and immunohistochemical characteristics. However, distinguishing between the 2 entities becomes challenging in cases of CVIN with superimposed inflammatory changes, especially lichen simplex chronicus (LSC). Twelve cases of DVIN, 9 cases of LSC, and 9 cases of CVIN with superimposed LSC were assessed for a number of morphologic features, including hyperkeratosis, hypergranulosis, acanthosis, hypercellularity, abnormal maturation (i.e. abnormal keratinization close to the base and/or dyskeratosis), hyperchromasia, and basal atypia. Immunohistochemistry for p53, p16, and MIB-1 was performed for all cases. When sufficient tissue was available, HPV genotyping was performed for cases of CVIN with superimposed LSC. DVIN uniformly demonstrated abnormal maturation, and atypia involving the basal cell layer; they were all p16 negati...Continue Reading

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Aug 17, 2019·Current Oncology Reports·Anthony WilliamsRaji Ganesan
Aug 15, 2020·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·Basile Tessier-CloutierLynn N Hoang
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Sep 15, 2020·International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists·Laurie M GriesingerStephanie L Skala

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Methods Mentioned

BETA
biopsies
genotyping

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