ASCCP - Practice Recommendations - Practice Management Materials

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PRACTICE RECOMMENDATIONS: Practice Management Materials

• Vulva • Vagina • Cervix • Anus

VULVA: HUMAN PAPILLOMAVIRUS INFECTIONS & VULVAR INTRAEPITHELIAL NEOPLASIA

• Cases/Examples

Human Papillomavirus and External Genital Warts:
• Definitions & Epidemiology	• Clinical Presentation & Diagnosis	• Management	• Special Concerns in Pregnant Women	• References
Vulvar Intraepithelial Neoplasia (VIN) and Squamous Cell Carcinoma of the Vulva:
• Definitions & Epidemiology	• Clinical Presentation & Diagnosis	• Management	• Special Concerns in Pregnant Women	• References

HPV & VIN CASES EXAMPLES

1.	This slide shows subclinical HPV infection. No lesion was visible prior to the application of acetic acid. The patient had been experiencing pruritus. Biopsies of the rounded surface in the right intralabial fold revealed VIN III with viral changes.

2.	HPV manifests itself in this patient as florid condyloma acuminata of the vestibule with scattered acuminata lesions in the near by skin and anal region. Topical therapy with an immune modulator reseated in complete and sustained regression

3.	Benign HPV infection. This patient has flat condyloma. The surface is micropapillomatous; the infection is diffuse around the introitus.

4.	Condyloma acuminata involving the labia majora, labia minora, and vestibule.

5.	HPV involves clitoris and the right labium minus and the upper perineum. Lesions are red gray and white. Histology showed VIN III and typing revealed HPV type 16.

6.	HPV may manifest itself as rough plaque similar to basal cell carcinoma in some cases. This plaque in left intralabial fold showed VIN III with viral changes. *Note: the hyper pigmentation as a result of “pigmentary incontinence”.

7.	HPV infection may present as a lesion with hyperkeratosis similar to hyperkeratoic changes in lichen planus or lichen sclerosus. The lesion involving inner aspect of right labium minus extending to the surface of that structure as a red macular lesion. Histology after excision showed VIN III.

8.	This is more or less a flat lesion gray in color and not associated with lesions. Histology in other locations revealed VIN III. Viral studies were positive for HPV type 16.

9.	Example of subclinical HPV infection showing full thickness atypia. *Note: diffuse plaque-like lesion and associated satellite lesions. Histology revealed VIN III and HPV infection.

10.	HPV infection presenting as pigmented samples. This mixed infection involves HPV type II at periphery and HPV type 16 at perineum. Histology revealed condyloma acuminata and VIN III in gray warty plaque at introitus.

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