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Squamous Intraepithelial Lesions of the Vulva

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Vulvar Pathology

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Abstract

Vulvar intraepithelial lesions are known to develop along two distinct pathways, one of which is driven by human papillomavirus (HPV) infection and one of which has no association with HPV. HPV-induced lesions, now called squamous intraepithelial lesions of the vulva and formerly termed vulvar intraepithelial neoplasias, comprise a spectrum of epithelial alterations. Lesions that are exophytic, lack cytological atypia, and are associated with low-risk human papillomavirus (HPV) subtypes are classified as condyloma acuminata and have little to no propensity to progress to either high-grade lesions or invasive carcinoma. They are not specifically classified as vulvar squamous intraepithelial lesions (SIL). Vulvar low-grade squamous intraepithelial lesions (LSIL) are flat, macular, or papular. Microscopically they demonstrate epithelial keratinocyte maturation although nuclear pleomorphism and some atypia may be found in the lower one third of the epithelium. The more superficial epithelium often has koilocytosis without atypia. They are predominantly associated with low-risk HPV types, although oncogenic HPV types may be identified in less than a fifth of the cases. As compared to condyloma acuminata or high-grade squamous intraepithelial lesions (HSIL), vulvar LSIL lesions are uncommon. The high-grade lesions are associated with high-risk HPV types, especially type 16. They occur predominately in younger patients and typically present as flat, macular, or papular lesions, although confluent lesions may occasionally be identified. Microscopically they show a warty or basaloid morphology with cellular abnormalities extending into the upper layers of the epithelium and are classified as “high-grade squamous intraepithelial lesions.” The intraepithelial lesions of the vulva which are not related to HPV infection are known as the differentiated type of vulvar intraepithelial neoplasia (d-VIN) and comprise a minority of lesions, which usually occur in older patients, have a distinctive appearance with cellular abnormalities confined to the basal layers of the epithelium, and have the highest risk of progressing to invasive disease.

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Authors and Affiliations

  1. Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA

    Demaretta S. Rush

  2. Department of Pathology, Immunology, and Laboratory Medicine, Shands Hospital, University of Florida College of Medicine, Gainesville, FL, USA

    Edward J. Wilkinson

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  1. Demaretta S. Rush
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  2. Edward J. Wilkinson
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Correspondence to Demaretta S. Rush .

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Editors and Affiliations

  1. Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

    Mai P. Hoang

  2. Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA

    Maria Angelica Selim

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Rush, D.S., Wilkinson, E.J. (2015). Squamous Intraepithelial Lesions of the Vulva. In: Hoang, M., Selim, M. (eds) Vulvar Pathology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1807-2_9

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  • DOI: https://doi.org/10.1007/978-1-4939-1807-2_9

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