Histologic characteristics and terminology of vulvar squamous intrapeithelial lesions

Low-grade squamous intraepithelial lesions (LSIL) of the vulva (vulvar LSIL, flat condyloma, or human papillomavirus [HPV] effect)

Cytologic atypia is most often represented by koilocytosis or basal cell hyperplasia and increased mitotic activity, with squamous maturation occurring in the upper two-thirds of the epithelium.

High-grade squamous intraepithelial lesions (HSIL) of the vulva (vulvar HSIL, VIN usual type [uVIN])

Loss of maturation includes the middle (formerly VIN 2) and upper third to full thickness (formerly VIN 3) of the squamous epithelium. Cytologic changes may be significant with bizarre mitotic figures and significant pleomorphism. Stromal invasion is not present.

Vulvar intraepithelial neoplasia differentiated type (dVIN)

Differentiated VIN lesions affect the parabasal layer and exhibit keratin formation. The epithelium is generally thickened and parakeratotic with elongated and anastomosing rete ridges. The abnormal cells have prominent eosinophilic cytoplasm and are confined to the parabasal and basal portion of the rete pegs with little or no atypia above.

VIN: vulvar intrapeithelial neoplasia.

Adapted from: Bornstein J, Bogliatto F, Haefner HK, et al. The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions. J Low Genit Tract Dis 2016; 20:11.

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Histologic characteristics and terminology of vulvar squamous intrapeithelial lesions