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HPV-negative vulvar intraepithelial neoplasia (VIN) with basaloid histologic pattern: an unrecognized variant of simplex (differentiated) VIN.
Am J Surg Pathol. 2009 Nov; 33(11):1659-65.AJ

Abstract

Vulvar intraepithelial neoplasia (VIN) is classified into 2 clinicopathologic subtypes, classic, related to human papillomavirus (HPV) infection and affecting relatively young women, and simplex (differentiated), negative for HPV and affecting elderly women. Histologically, classic VIN may be basaloid and characterized by a replacement of the whole epidermis by a homogeneous population of small, "undifferentiated" keratinocytes, which are diffusely positive for p16(INK4a) and negative for p53. Simplex VIN is characterized by atypia of the basal layer with high degree of cellular differentiation and shows negative staining for p16(INK4a) and frequent positivity for p53. Simplex VIN is frequently associated with squamous cell hyperplasia and lichen sclerosus. From a series of 110 invasive squamous cell carcinomas of the vulva negative for HPV by highly sensitive polymerase chain reaction, 51 had VIN lesions located at least 1 cm away from the tumor. In 4 (7.8%) cases, the VIN had basaloid histologic features. All cases showed obvious architectural disorganization with a homogeneous population of basaloid, undifferentiated keratinocytes with scanty cytoplasm replacing the whole epidermis. Immunohistochemically, all cases were negative for p16(INK4a) and strongly positive for p53 with suprabasilar extension of positive cells. All patients were postmenopausal (median age 61.0 y; range, 45-76). Squamous cell hyperplasia was identified in 1 case and lichen sclerosus in 1 case. The invasive squamous cell carcinoma was of keratinizing type in 3 cases and basaloid in 1 case. In conclusion, simplex, HPV-negative VIN may occasionally have basaloid morphology. Immunostaining for p16(INK4a) and p53 protein may be helpful in the identification of these lesions and the differential diagnosis with classic, HPV-positive basaloid VIN.

Authors+Show Affiliations

Department of Pathology, Hospital Clínic-IDIBAPS, University of Barcelona, Spain. jordi@clinic.ub.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19730361

Citation

Ordi, Jaume, et al. "HPV-negative Vulvar Intraepithelial Neoplasia (VIN) With Basaloid Histologic Pattern: an Unrecognized Variant of Simplex (differentiated) VIN." The American Journal of Surgical Pathology, vol. 33, no. 11, 2009, pp. 1659-65.
Ordi J, Alejo M, Fusté V, et al. HPV-negative vulvar intraepithelial neoplasia (VIN) with basaloid histologic pattern: an unrecognized variant of simplex (differentiated) VIN. Am J Surg Pathol. 2009;33(11):1659-65.
Ordi, J., Alejo, M., Fusté, V., Lloveras, B., Del Pino, M., Alonso, I., & Torné, A. (2009). HPV-negative vulvar intraepithelial neoplasia (VIN) with basaloid histologic pattern: an unrecognized variant of simplex (differentiated) VIN. The American Journal of Surgical Pathology, 33(11), 1659-65. https://doi.org/10.1097/PAS.0b013e3181b40081
Ordi J, et al. HPV-negative Vulvar Intraepithelial Neoplasia (VIN) With Basaloid Histologic Pattern: an Unrecognized Variant of Simplex (differentiated) VIN. Am J Surg Pathol. 2009;33(11):1659-65. PubMed PMID: 19730361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HPV-negative vulvar intraepithelial neoplasia (VIN) with basaloid histologic pattern: an unrecognized variant of simplex (differentiated) VIN. AU - Ordi,Jaume, AU - Alejo,Maria, AU - Fusté,Victòria, AU - Lloveras,Belen, AU - Del Pino,Marta, AU - Alonso,Immaculada, AU - Torné,Aureli, PY - 2009/9/5/entrez PY - 2009/9/5/pubmed PY - 2009/11/13/medline SP - 1659 EP - 65 JF - The American journal of surgical pathology JO - Am. J. Surg. Pathol. VL - 33 IS - 11 N2 - Vulvar intraepithelial neoplasia (VIN) is classified into 2 clinicopathologic subtypes, classic, related to human papillomavirus (HPV) infection and affecting relatively young women, and simplex (differentiated), negative for HPV and affecting elderly women. Histologically, classic VIN may be basaloid and characterized by a replacement of the whole epidermis by a homogeneous population of small, "undifferentiated" keratinocytes, which are diffusely positive for p16(INK4a) and negative for p53. Simplex VIN is characterized by atypia of the basal layer with high degree of cellular differentiation and shows negative staining for p16(INK4a) and frequent positivity for p53. Simplex VIN is frequently associated with squamous cell hyperplasia and lichen sclerosus. From a series of 110 invasive squamous cell carcinomas of the vulva negative for HPV by highly sensitive polymerase chain reaction, 51 had VIN lesions located at least 1 cm away from the tumor. In 4 (7.8%) cases, the VIN had basaloid histologic features. All cases showed obvious architectural disorganization with a homogeneous population of basaloid, undifferentiated keratinocytes with scanty cytoplasm replacing the whole epidermis. Immunohistochemically, all cases were negative for p16(INK4a) and strongly positive for p53 with suprabasilar extension of positive cells. All patients were postmenopausal (median age 61.0 y; range, 45-76). Squamous cell hyperplasia was identified in 1 case and lichen sclerosus in 1 case. The invasive squamous cell carcinoma was of keratinizing type in 3 cases and basaloid in 1 case. In conclusion, simplex, HPV-negative VIN may occasionally have basaloid morphology. Immunostaining for p16(INK4a) and p53 protein may be helpful in the identification of these lesions and the differential diagnosis with classic, HPV-positive basaloid VIN. SN - 1532-0979 UR - https://www.unboundmedicine.com/medline/citation/19730361/HPV_negative_vulvar_intraepithelial_neoplasia__VIN__with_basaloid_histologic_pattern:_an_unrecognized_variant_of_simplex__differentiated__VIN_ L2 - http://dx.doi.org/10.1097/PAS.0b013e3181b40081 DB - PRIME DP - Unbound Medicine ER -