Prognostic factors for the development of vaginal intraepithelial neoplasia

Objective: To identify risk factors for the appearance of vaginal intraepithelial neoplasia (VAIN). Material and methods: A total of 485 women with abnormal cytologies were followed over three years (2003-2006). They underwent cytotology and colposcopy, and testing for human papillomavirus virus (HPV) infection. If the colposcopy was atypical, a biopsy was performed. Results: A total of 256 women were treated: 161 by cone biopsy, 103 by LLETZ, 12 by repeat conization, and 44 by total hysterectomy. In eight cases VAIN was diagnosed following hysterectomy. The average age at which VAIN appeared was 49.8 years (age range 39-61). Hysterectomy was indicated in two cases of cervical cancer, four cases of persistent high-grade cervical SIL, and two cases of recurrent high-grade cervical SIL. The mean time for the appearance of VAIN following hysterectomy was 3.8 years (range 1-9 years). Of these eight women, seven had HPV infections at high risk for carcinogenesis. Conclusions: Long-term follow-up cytology is necessary for women treated for high-grade SIL, even after hysterectomy, because of the increased risk of a primary vaginal VAIN lesion, especially in women with high-risk HPV infection.

Vaginal intraepithelial neoplasia; Human papillomavirus; Cervical SIL

[1] Murta E.F., Neves Junior M.A., Sempionato L.R., Costa M.C., Maluf P.J.: “Vaginal intraepithelial neoplasia: clinical-therapeutic analysis of 33 cases”. Arch. Gynecol. Obstet., 2005, 272, 261.

[2] Sillman F.H., Sedlis A., Boyce J.G.: “A review of lower genital intraepithelial neoplasia and the use of topical5-fluorouracil”. Obstet. Gynecol. Surv., 1985, 40, 190.

[3] Barzon L., Pizzighella S., Corti L., Mengoli C., Palu G.: “Vaginal dysplastic lesions in women with hysterectomy and receiving radiotherapy are linked to high-risk human papillomavirus”. J. Med. Virol., 2002, 67, 401.

[4] Ait Menguellet S., Collinet P., Debarge V.H., Nayama M., Vinatier D., Leroy J.L.: “Management of multicentric lesions of the lower tract”. Eur. J. Gynecol. Reprod. Biol., 2006, May 17 (Epub ahead of print).

[5] American College Obstetricians and Gynecologists Cervical cytology:” Evaluation and management of abnormalities”. Washington, American College of Obstetricians and Gynecologists, ACOG Tech. Bull. Aug., 1993, No. 183.

[6] Wade-Evans: “The aetiology and pathology of cancer of the vagina”. Clin. Obstet. Gynecol., 1976, 3, 229.

[7] Lee R.A., Symmonds R.E.: “Recurrent carcinoma in situ of the vagina in patients previously treated for in situ carcinoma of the cervix”. Obstet. Gynecol., 1984, 48, 61.

[8] Hoffman M.S., Roberts W.S., LaPolla J.P., Sterghos S., Cavanagh D.: “Neoplasia in vaginal cuff epithelial inclusion cysts after hysterectomy”. J. Reprod. Med., 1989, 34, 412.

[9] Kalogirou D., Antoniou G., Karakitsos P., Botsis D., Papadimitriou A., Giannikos L.: “Vaginal intraepithelial neoplasia (VAIN) following hysterectomy in patients treated for carcinoma in situ of the cervix”. Eur. J. Gynaecol. Oncol., 1997, 18, 188.

[10] Indermaur M.D., Martino M.A., Fiorica J.V., Roberts W.S., Hoffman M.S.: “Upper vaginectomy for the treatment of vaginal intraepithelial neoplasia”. Am. J. Obstet. Gynecol., 2005, 193, 577.

[11] Frega A., French D., Piazze J., Cerekja A., Vetrano G., Moscarini M.: “Prediction of persistent vaginal intraepithelial neoplasia in previous hysterectomized women by high-risk HPV DNA detection”. Cancer Lett., 2006, Oct. 27 (Epub ahead of print).

[12] Indraccolo U., Del Frate E., Cenci S., Ubertosi M., Donati Sarti R., Donati Sarti C., Baldoni A.: “Vaginal intraepithelial neoplasia and human papillomavirus infection: A report of 75 cases”. Minerva Ginecol., 2006, 58, 101.

[13] Ruiz-Moreno J.A., García-Gómez R., Vargas-Solano A., Alonso P.: “Vaginal intraepithelial neoplasia. Report of 14 cases”. Int. J. Gynaecol. Obstet., 1987, 25, 359.