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Correlation of histopathologic findings with clinical predictors of disease recurrence and progression to vulvar carcinoma in patients with differentiated vulvar intraepithelial neoplasia (dVIN)

•dVIN has a high risk of recurrence/persistence and progression to vulvar cancer regardless of treatment.•p53 and GATA 3 immunohistochemical stains may be useful adjuncts for the diagnosis and clinical course of dVIN.•Isolated dVIN with adjacent LSA (lichen sclerosus et atrophicus) merits considerat...

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Published in:Gynecologic oncology reports 2024-04, Vol.52, p.101358-101358, Article 101358
Main Authors: Roberts, Jill N.T., Bentz, Jessica L., LeBlanc, Robert E., Cass, Ilana
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Language:English
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Summary:•dVIN has a high risk of recurrence/persistence and progression to vulvar cancer regardless of treatment.•p53 and GATA 3 immunohistochemical stains may be useful adjuncts for the diagnosis and clinical course of dVIN.•Isolated dVIN with adjacent LSA (lichen sclerosus et atrophicus) merits consideration of topical steroid treatment. To evaluate predictors of recurrence and the risk of progression to carcinoma in patients with dVIN. 36 self-identified White patients with dVIN from 2011 to 2022 were identified. Demographics, treatment and clinical course were abstracted. Histopathologic features and IHC stains were reviewed by 2 subspecialty pathologists. Standard statistical analyses were applied. Median cohort age was 70 years (range 39–91). Median follow-up was 29.5 months (range 1–123). All patients were Caucasian. 67% had lichen sclerosus (LS) adjacent to dVIN. 56% of patients had recurrent dVIN a median of 11 months from diagnosis. 14 patients had invasive squamous cell carcinoma of the vulva (SCCV) during the study period: 9 (25%) with synchronous dVIN, 5 (14%) developed SCCV after a median of 21.5 months (range 8–57). Patients treated with surgery were more likely to have recurrent/persistent dVIN (p = 0.04) and synchronous or progression to SCCV (p = 0.02) than patients treated with topical therapy. Excluding 9 women with synchronous SCCV, no initial treatment (observation, topical therapy, surgery) was superior at preventing recurrent/ progressive disease in isolated dVIN. Mutation-type p53 expression was identified in 18 (64%) and aberrant GATA3 staining/expression in 20 (56%) of cases. Aberrant GATA3 expression was associated with a higher frequency of synchronous/progression to SCCV (p 
ISSN:2352-5789
2352-5789
DOI:10.1016/j.gore.2024.101358