Biomarker Expression in Multifocal Vulvar High-Grade Squamous Intraepithelial Lesions

Abstract

In patients with high-grade squamous intraepithelial lesion (HSIL) of the vulva, the presence of multiple lesions, called multifocal HSIL, is common. The aim of this exploratory study was to investigate biomarker expression profiles in multifocal HSIL. In total, 27 lesions from 12 patients with high-risk human papillomavirus (HPV)-positive multifocal HSIL were tested for HPV genotype, expression of p16INK4a and Ki-67, and DNA methylation of six genes. HPV16 was found most commonly in 21 (77.8%) HSILs. In two (16.4%) patients, HPV genotype differed between the lesions. All lesions demonstrated diffuse p16INK4a staining, of which three (11.1%) were combined with patchy staining. One patient (8.3%) demonstrated markedly different DNA methylation levels between lesions. Generally, heterogeneity in methylation profiles was observed between different patients, even when other biomarkers showed similar expression. In conclusion, this study is the first to demonstrate heterogeneity of individual lesions in patients with multifocal HSIL. The studied biomarkers have the potential to refine prognostic and predictive diagnostics. Future prospective, longitudinal studies are needed to further explore the potential of a biomarker profile for management of patients with multifocal HSIL.

Assessment of Vulvar Intraepithelial Neoplasia (VIN) Grades Based on Dermoscopic Features: A Diagnostic Study

“…It is known that it is possible to find multiple sites and different degrees of intrahepitelial neoplasia in the same patient. Several biopsies or a so-called vulvar mapping are commonly performed in patients with multifocal VIN to confirm the clinical diagnosis and to exclude the presence of underlying invasive neoplasia [12]. We believe that the identification of specific dermoscopic features that allow for differentiation between grades of intraepithelial neoplasia could help minimize the number of unneeded genital biopsies and guide topical treatment with imiquimod.…”

The Utility of Pre-Treatment Inflammation Markers as Associative Factors to the Adverse Outcomes of Vulvar Cancer: A Study on Staging, Nodal Involvement, and Metastasis Models

“…Numerous biomarkers have been examined on cancer patients to ascertain the patients' clinicopathological status [6][7][8], one of which is pre-operative systemic inflammatory markers. This immune-inflammatory response to the neoplastic process is reflected by increased circulating pro-inflammatory cytokines, abundant leukocyte migration, and an elevated platelet count [9][10][11][12][13].…”