Vulvar squamous cell carcinoma development after diagnosis of VIN increases with age

van de Nieuwenhof, Hedwig P.; Massuger, Leon F.A.G.; van der Avoort, Irene A.M.; Bekkers, Ruud L.M.; Casparie, Mariel; Abma, Wim; van Kempen, Léon C.L.T.; de Hullu, Joanne A.

doi:10.1016/j.ejca.2008.11.037

« Previous Next »European Journal of Cancer
Volume 45, Issue 5 , Pages 851-856, March 2009

Vulvar squamous cell carcinoma development after diagnosis of VIN increases with age

Hedwig P. van de Nieuwenhof
- Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Corresponding author: Tel.: +31 24 3666455; fax: +31 24 3668597.
Leon F.A.G. Massuger
- Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
Irene A.M. van der Avoort
- Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
Ruud L.M. Bekkers
- Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
Mariel Casparie
- Foundation PALGA, Nationwide Netherlands Database of Histo- and Cytopathology, The Netherlands
Wim Abma
- Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
Léon C.L.T. van Kempen
- Department of Pathology, Radboud University Nijmegen Medical Centre, The Netherlands
Joanne A. de Hullu
- Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands

Received 2 September 2008; received in revised form 20 November 2008; accepted 25 November 2008. published online 31 December 2008.

Abstract

Objective

The purpose of the present study is to investigate the trends in incidence of both usual (u) and differentiated (d) vulvar intraepithelial neoplasia (VIN) separately, their malignant potential and the relation with other HPV related anogenital lesions in the Netherlands during a 14-year-period.

Methods

The incidences of both types of VIN and vulvar SCC were retrieved from the Nationwide Netherlands Database of Histo- and Cytopathology. Population data were retrieved from the Database of Statistics Netherlands.

Results

In the study period, the incidence of uVIN and dVIN increased, while the incidence of vulvar SCC remained stable. The overall percentage of uVIN patients that were later diagnosed with vulvar SCC was 5.7%, which was significantly lower than the percentage for dVIN patients (32.8%). In addition to this 5.6-fold increased conversion rate, the time of progression from dVIN to SCC development was significantly shorter than that of uVIN (p=0.005). Percentage of uVIN patients that were later diagnosed with SCC significantly increased with age (p=0.005), whereas the time to SCC significantly shortened with age (p=0.05). Forty-one percent of uVIN patients had a past, concomitant or future HPV-associated lesion of the lower genital tract, which is in contrast to the 3% for dVIN patients.

Conclusions

An increase in diagnoses of both uVIN and dVIN has not led to an increase in vulvar SCC incidence. The malignant potential of dVIN is higher than that for uVIN. For uVIN the malignant potential increases with age.

Keywords: Usual VIN, Differentiated VIN, Vulvar squamous cell carcinoma, Incidence, Malignant potential