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HPV-assoziierte Veränderungen an Vulva und Vagina

Morphologie und Molekularpathologie

HPV-associated alterations of the vulva and vagina

Morphology and molecular pathology

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Zusammenfassung

Nichtneoplastische, durch HPV bedingte Veränderungen an Vulva und Vagina sind häufig und teilweise mit einer kondylomatösen Läsion assoziiert. Die klassische Einteilung der Präkanzerosen der Vulva in vulväre intraepitheliale Neoplasien (VIN) 1–3 wird zunehmend durch die Definition einer klassischen und differenzierten VIN abgelöst. Die Einteilung der Präkanzerosen der Vagina (vaginale intrapepitheliale Neoplasie, VAIN) folgt dem Konzept wie bei der Cervix uteri. Zur Abgrenzung einer kondylomatösen Läsion gegenüber einer Präkanzerose ist der immunhistochemische p16-Nachweis hilfreich. HPV-assoziierte Karzinome der Vulva und Vagina sind das verruköse, das kondylomatöse („warty“) Karzinom und das (nicht)verhornende Plattenepithelkarzinom ohne besondere Differenzierung (NOS) sowie in der Vagina das sehr seltene squamotransitionelle Karzinom.

Abstract

Non-neoplastic HPV-induced alterations of the vulva and vagina are frequent. The traditional three-tier grading system of vulvar intraepithelial neoplasia (VIN) will be replaced by the definition of usual and simplex type of VIN. The usual type is characterized by a strong association to high-risk HPV infections, the occurrence at younger age and multifocality, mostly associated with non-keratinizing squamous cell carcinoma. The differentiated (or simplex) type is rare and shows an association to older age and p53 alterations and is typically diagnosed co-incidentally with keratinizing squamous cell carcinoma. Vaginal intraepithelial neoplasia (VAIN) is still graded into VAIN 1–3 where VAIN 1 and 2 are mostly associated with low-risk HPV infections and a high spontaneous regression rate whereas VAIN 3 represents a high-risk HPV-associated lesion with capable progression into (micro-)invasive carcinoma. The differential diagnosis between a non-neoplastic condylomatous lesion and VIN common type and VAIN may be aided by p16 immunohistochemistry. The HPV-associated invasive vulvo-vaginal cancers are verrucous carcinoma (low-risk HPV) and the high-risk HPV-induced (non-keratinizing) squamous cell carcinoma (NOS), the condylomatous (warty) carcinoma and the very rare vaginal squamo-transitional carcinoma.

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  1. Abteilung Mamma-, Gynäko- & Perinatalpathologie, Institut für Pathologie, Zemtrum für Diagnostik, Universitätsklinikum Leipzig, Liebigstr. 26, 04103, Leipzig, Deutschland

    L.-C. Horn & A.K. Höhn

  2. Dysplasiezentrum, Universitätsfrauenklinik Leipzig (Triersches Institut), Zentrum für Frauen- und Kindermedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland

    K. Klostermann

  3. Frauenklinik, Universität Erlangen, Erlangen, Deutschland

    S. Hautmann, M.W. Beckmann & G. Mehlhorn

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  1. L.-C. Horn
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L.-C. Horn und G. Mehlhorn sind Mitglieder in der Organkommission Vulva/Vagina der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO).

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Horn, LC., Klostermann, K., Hautmann, S. et al. HPV-assoziierte Veränderungen an Vulva und Vagina. Pathologe 32, 467–475 (2011). https://doi.org/10.1007/s00292-011-1476-5

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