외음부상피내종양 (vulvar intraepithelial neoplasia;VIN)

외음부의 피부에 생기는 전암 병변으로 치료없이 사라지기도 한다.

Usual type은 인유두종바이러스 (Human papilloma virus)감염에 의해 생긴다. Differentiated type은 인유두종바이러스 (Human papilloma virus)와 관련이 없다. 인유두종바이러스 (Human papilloma virus)에 감염되어 있다고 해서 다 발생하는 것은 아니고, 면역기능저하, 흡연, 면역억제제 등과 관련되어 있다.

SQUAMOUS VIN TERMINOLOGY (ISSVD 2004)

비교적 젋은 여성 (35–55)에서 usual type이 많고, 고령(55–85)에서 Differentiated type이 많다.

VIN, usual type
      VIN, warty type
      VIN, basaloid type
      VIN, mixed (warty/basaloid) type
 VIN, differentiated type

Note: The occasional example of VIN that cannot be classified into either of the above VIN categories (usual type and differentiated type) may be classified as VIN, unclassified type (or VIN, NOS). The rare VIN of pagetoid type may be classified as such, or placed in this category.

증상

  • 무증상
  • 가려움, 통증, 따끔거림 등의 증상이 있을 수 있다.
  • 외음부 피부의 융기 등이 보인다.

진단

조직검사

치료

크기와 위치, 암으로의 발전 가능성 등에 따라 치료를 결정한다.

수술

local surgical excision 을 시행한다. 범위가 넓은 경우, 전 외음부 절제술 (vulvectomy) 을 할 수도 있다.

Ablation

수술이 어렵거나 기능상 수술이 곤란한 부위는 레이져나, 고주파 등으로 치료할 수 있다.

Hairy and non-hairy areas. Approximately 75-85% of VIN lesions are found in non-hair bearing areas. In non-hair bearing areas of the vulva laser ablation should extend to a depth of only 1 to 2 mm. Eradication of lesions in hair bearing areas should go down at most 3 mm (Reid, 1985; Shatz, 1989).

Any genital bump due to HPV is in essence a 'genital wart'. This includes the papular, often pigmented, usually multifocal lesions caused most commonly by HPV 16; histology of these lesions will most often be high-grade and depending on the location called, vulvar intraepithelial neoplasia (VIN2,3), perianal intraepithelial neoplasia (PAIN2,3), and penile intraepithelial neoplasia (PIN2,3). The common name applied by dermatologists to singular or multiple HPV-induced papular lesions is Bowenoid papulosis. Despite the high-grade histologic appearance, these lesions may also resolve spontaneously and often resolve with the same treatments commonly used for condyloma acuminata and other HPV lesions caused by low-risk HPV types. Although some regress, since progression to cancer can occur, all high grade intraepithelial neoplasia should be treated.

High-grade precancer at-risk for invasion (VIN3, PAIN3, and PIN3) is most commonly a solitary lesion that is larger than the more "acute" multifocal papules described above, or may cover large areas of the external genitalia with thickened, flat, often multicolored (red, white and pigmented) epithelium. Such lesions require either multiple biopsies to rule out invasion prior to laser ablation, or excised in their entirety. Increasing evidence supports the use of topical imiquimod for VIN3.

http://www.asccp.org/PracticeManagement/HPV/TreatmentofHPVinducedDisease/tabid/8028/Default.aspx

http://www.asccp.org/PracticeManagement/Vulva/HPVInfectionsandVIN/VINTreatments/tabid/7464/Default.aspx

연결문서

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