Vaginal intraepithelial neoplasia: clinical-therapeutic analysis of 33 cases

Abstract

Vaginal intraepithelial neoplasia (VAIN) represents 1% of all intraepithelial neoplasia of the lower genital tract. Our aim was to study the clinical-therapeutic characteristics of patients with VAIN. A retrospective study was made of all cases of patients, who attended within the outpatient service between 1993 and 2003, with a diagnosis of VAIN. During this period, 84,293 Papanicolaou smears (triple collection) were performed and a total of 33 (50.32+/-11.5 years old) patients with VAIN were diagnosed. Among these patients, twenty-six (78.8%) were white, 17 (51.5%) were smokers, and 23 (69.6%) had undergone hysterectomy previously. The indications for hysterectomy prior to the appearance of VAIN were found in 20 cases (87%) of cervical intraepithelial or invasive neoplasia (CIN), and in two (8.6%) cases after myoma uterine. The median time elapsed between the hysterectomy and the appearance of VAIN was 41 months. Thirteen (39.4%), 11 (33.3%) cases were, respectively, VAIN II and III. Twenty-eight patients (84.8%) presented a single lesion affecting the upper third of the vagina. The commonest finding was the presence of white epithelium in 17 patients (51.5%). Ten of 16 cases submitted to topical application of 5-fluorouracil (5-FU) achieved remission. Surgery was utilized for seven patients, of whom six achieved remission and one had persistence of the lesion. We conclude that VAIN may occur in patients who have undergone hysterectomy due to benign alterations. This justifies the use of routine Papanicolaou tests. Both surgical and 5-FU treatments are efficient.

Micronucleus induction by metronidazole in rat vaginal mucosa

“…5-Fu was used as the positive control in this study because of its well-known ability to induce micronuclei [Nagae et al, 1991;Ohuchida et al, 1992; Nakamura , 1993;Stopper et al, 1994;Zúñiga-González et al, 2003b], and because it is used topically for the treatment of vaginal diseases [Maiman et al, 1999;Maneo et al, 1999;Syed et al, 2000;Bendesky et al, 2002;Dalrymple et al, 2004;Murta et al, 2005]. Although it is typically used in an ointment for human applications, we treated rats with an aqueous solution of 5-Fu to facilitate the preparation of smears for scoring micronuclei and to avoid interference from 5-Fu ointment residues.…”

Vulväre und vaginale intraepitheliale Neoplasie (VIN/VAIN) 3

“…Vaginale Neoplasien sind sehr selten und häufig mit zervikalen oder vulvären Neubildungen assoziiert [17,18,19]. Die VAIN Abb.…”

“…4 8 Multifokale VIN 3 mit CO 2 -Laser; a Multifokale VIN 3. b Befund nach Behandlung mittels CO 2 -Laser ist mit einer Inzidenz von 0,2-0,3/100.000 Frauen etwa 100-mal seltener als die CIN und macht nur 0,5-1% der intraepithelialen Neoplasien des unteren Genitaltraktes aus [18,19,20]. Das durchschnittliche Erkrankungsalter liegt zwischen 35 und 55 Jahren [18,19,20,21]. Nach externer oder lokaler Bestrahlung aufgrund von Zervixund Endometriumkarzinomen entwickelt sich im weiteren Verlauf in etwa 20% der Fälle eine VAIN [21].…”

“…Nach externer oder lokaler Bestrahlung aufgrund von Zervixund Endometriumkarzinomen entwickelt sich im weiteren Verlauf in etwa 20% der Fälle eine VAIN [21]. Weitere Risikofaktoren sind HPV-oder HIV-Infektionen [19,20]. Ähnlich wie bei der VIN 3 sind fast 90% der VAIN 3 HPV-positiv; HPV 16 wird in etwa 65% der Läsionen gefunden [7].…”

Vaginal Intraepithelial Neoplasia

“…23 In general, because of concern for vaginal ulcer formation, use of 5-FU has fallen out of favor despite evidence indicating this to be an effective topical agent. [23][24][25][26] …”