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Vulväre intraepitheliale Neoplasie (VIN)

  • Sven Ackermann
  • Christian Dannecker
  • Lars-Christian Horn
  • Friederike Gieseking
  • Monika Hampl
  • Grit Mehlhorn
  • Alexander Luyten
  • Karl Ulrich Petry
Chapter

Zusammenfassung

Vulväre intraepitheliale Neoplasien (VIN) sind überwiegend plattenepithelial und HPV-assoziiert. Zwei Unterformen werden unterschieden: die HPV-assoziierte uVIN und die seltenere HPV-unabhängige dVIN. Neben der HPV-Infektion gelten Immunsuppression und Nikotinabusus sowie ein Lichen sclerosus als Risikofaktoren. Damit bieten sich die HPV-Impfung und das Nichtrauchen zur primären Prävention an. Therapieresistente Symptome vermeldet die Hälfte der Patientinnen. Die Diagnose kann histologisch zumeist an Stanzbiopsaten gestellt werden. Die Behandlung hat die Entfernung der Läsion im Gesunden zum Ziel. Als wesentliche Verfahren gelten die Exzision und die Laserdestruktion. Bei uVIN können Immunmodulatoren lokal in speziellen Fällen eingesetzt werden (“off-label use”). Die Rezidivraten liegen bei 25 %, davon sind etwa 3 % invasiv. VIN-Patientinnen sollen nach der Behandlung regelmäßig in einer qualifizierten Nachsorge verbleiben, im besten Fall lebenslang. Als Sonderform einer intradermalen potenziellen Präneoplasie gilt der Morbus Paget der Vulva. Die Therapie bestand über lange Zeit in der chirurgischen Entfernung der Haut. In neuerer Zeit werden die Läsionen – insbesondere bei wiederholten Rezidiven nach operativer Therapie – erfolgreich lokal mit immunmodulatorischen Substanzen behandelt (“off-label use”).

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Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Sven Ackermann
    • 1
  • Christian Dannecker
    • 2
  • Lars-Christian Horn
    • 3
  • Friederike Gieseking
    • 4
  • Monika Hampl
    • 5
  • Grit Mehlhorn
    • 6
  • Alexander Luyten
    • 7
  • Karl Ulrich Petry
    • 8
  1. 1.FrauenklinikKlinikum DarmstadtDarmstadtDeutschland
  2. 2.Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität MünchenMünchenDeutschland
  3. 3.Arbeitsgruppe Mamma-, Gynäko- & Perinatalpathologie, Institut für PathologieUniversitätsklinikum LeipzigLeipzigDeutschland
  4. 4.Frauenarztpraxis HeußwegHamburgDeutschland
  5. 5.Klinik für Frauenheilkunde und GeburtshilfeUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  6. 6.FrauenarztpraxisErlangenDeutschland
  7. 7.Kolposkopie-Einheit abts+partner in der Park-Klinik KielKronshagenDeutschland
  8. 8.FrauenklinikKlinikum WolfsburgWolfsburgDeutschland

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