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Diagnosis & Management Of VAIN/VINRichard Hutson Gynaecological Oncologist St. James’s University Hospital
Definition A condition where neoplastic cells are within the boundaries of surface epithelium Excludes:- Paget’s disease of the Vulva Melanoma-in-situ Maturation disorders
Classification VIN/VAIN I :- mild dysplasia; lower 1/3VIN/VAIN II :- mod. dysplasia; lower 2/3 VIN/VAIN III :- severe dysplasia; > 2/3
Symptoms Pruritus (38-73 %) Vulval pain / soreness A lump / lesionAsymptomatic
Physical Signs Papular & rough surfaced (warts)Macular with indistinct/irregular borders Micropapillary/granular associated with acanthosis Pigmentation (brown/black) White lesions (hyperkeratosis)
Diagnosis Histologically; biopsy always requiredBiopsy under LA; use of EMLA Punch / scalpel
Normal Epithelium with L.S.
VIN II with Koilocytosis
Paget’s Disease of the Vulva
Aetiology Strong association with STD’s HPV (43-79 %)Younger women condyloma and koilocytes Older women no koilocytosis Smoking Immunosuppressed
Natural History of VIN / VAINNo established rates of progression or regression Risk of invasion is small Risk of invasion more likely women > 45; immunosuppressed; SLE; multifocal disease
Management in Young WomenRisk of invasion is small Recurrence rate up to 84 % > 20 % recurrent disease after simple vulvectomy Regresses after pregnancy
Who to Treat ? Post menopausal presentationImmunosuppressed / immunodeficient Histologically progressive lesions on serial biopsy Excessively hyperkeratotic lesions
Treatment Techniques W.L.E. (8mm margin)Skinning Vulvectomy; skin graft, 27% rec. Vulvectomy; rarely employed Topical 5 FU; failure rate = % Dinitrochlorobenzene; topical immunotherapy CO2 laser; to upper reticular dermis
Summary HPV and multifocal disease commoner in young womenUnifocal and HPV neg. lesions in post-men. Women CIN found in 33% of women with VIN VIN assoc. with 25-33% vulval cancers 50% vulval cancers assoc. with non-neoplastic disorders
Detection and Treatment of Non-Melanoma Skin Cancers
Transitional Cell Carcinoma of the Urinary Tract
Ischaemic Heart Disease- Implications of Gender Dr Kaye Birks School of Rural Health Monash University Australia Gender Competency Training for Medical.
CANCER OF THE VAGINA Dr Samar Sarsam
In the name of God Isfahan medical school Shahnaz Aram MD.
MANAGEMENT OF THE ABNORMAL PAP SMEAR
Cervical Cancer. Dr. Swapna Chaudhary M.S. (MUM) Consultant Obstetrician & Gynaecologist Infertility Specialist.
Cervical Cancer DR KHALID H. WALI SAIT (FRCSC) ASSOCIATE PROFESSOR OF GYNECOLOGICAL ONCOLOGY King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Evolution of Neoplasia The Uterine Cervix As a Model Raj C. Dash, MD Duke University Medical Center Durham, North Carolina.
Carcinoma of the Vulva.
ONCOLOGY OF VULVA AND VAGINA
Cervix Dr. Raid Jastania. Cervical Cancer Screening HPV infection Pre- Cancerous Dysplasia Cancer years.
Cervical Cancer Cervical dysplasia Cervical cancer Causes Risk factors
Bowenoid Papulosis S. Pala, A. Spataro, I. Poleva University School “La Sapienza”, Rome Cutaneous and Venereal Deseases Department.
Screening for Cervical Cancer
Malignant lesion of the Vulva
Vulvar Diseases: Can be divided to non-neoplastic and neoplastic diseases. The neoplastic diseases are much less common. Of those, squamous cell.
Benign and premalignant disease of the cervix
Diseases of the vulva.
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