Skip to main content
SpringerLink
Log in

A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream: clinical implications

  • Case Report
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

The authors report a case of usual-type (basaloid-type) vulvar intraepithelial neoplasia (VIN) 3 that failed to respond to imiquimod cream. A 51-year-old Japanese woman visited her local gynecologist complaining of vulvar itching. Atypical cells were noted in cytology smears, but nine vulvar biopsy specimens showed benign proliferation of epithelial tissue. The patient was placed under careful observation for 8 months, when the vulvar smears once again showed atypical cells and biopsy specimens revealed VIN3. The patient was then referred to our hospital where she was given a diagnosis of VIN 3, basaloid type of usual type. The biopsy specimens were positive for p16 and the lesions were confirmed to be human papilloma virus (HPV)-related. We recommended simple vulvectomy but the patient requested conservative treatment with imiquimod cream. With her written informed consent, we prescribed imiquimod cream to be self-administered 3 times a week. Colposcopy and pap smear test were performed every 2 weeks. Four weeks after the start of treatment, a fingertip-sized papule was detected at the patient’s vaginal introitus. By 6 weeks, the lesion had enlarged, and biopsy specimens revealed invasive squamous cell carcinoma. At 7 weeks, we performed simple vulvectomy. The surgical specimen showed stage pT1b keratinizing-type squamous cell carcinoma. HPV-16 DNA was detected in the specimen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Joura EA (2002) Epidemiology, diagnosis and treatment of vulvar intraepithelial neoplasia. Curr Opin Obstet Gynecol 14:39–43

    Article  PubMed  Google Scholar 

  2. Jones RW, Rowan DM, Stewart AW (2005) Vulvar intraepithelial neoplasia: aspects of the natural history and outcome in 405 women. Obstet Gynecol 106:1319–1326

    Article  PubMed  Google Scholar 

  3. van Seters M, van Beurden M, ten Kate FJ et al (2008) Treatment of vulvar intraepithelial neoplasia with topical imiquimod. N Engl J Med 358:1465–1473

    Article  PubMed  Google Scholar 

  4. Nader H, Christie R (1999) Frequency of invasive cancer in surgically excised vulvar lesions with intraepithelial neoplasia. Gynecol Oncol 73:119–120

    Article  Google Scholar 

  5. Sideri M, Jones RW, Wilkinson EJ et al (2005) Squamous vulvar intraepithelial neoplasia: 2004 modified terminology, ISSVD Vulvar Oncology Subcommittee. J Reprod Med 50:807–810

    PubMed  Google Scholar 

  6. Sabine R, Eduardo FN, Aida C et al (2004) p16INK4A expression as biomarker for HPV 16-related vulvar neoplasias. Hum Pathol 35:1477–1483

    Article  Google Scholar 

  7. Annelinde T, van Seters M, Alex K et al (2010) Imiquimod-induced clearance of HPV is associated with normalization of immune cell counts in usual type vulvar intraepithelial neoplasia. Int J Cancer 127:2831–2840

    Article  Google Scholar 

Download references

Conflict of interest

The authors have no conflicts of interest to report.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Takaya Shiozaki, Tsutomu Tabata, Kuniaki Toriyabe, Takashi Motohashi, Eiji Kondo, Kouji Tanida, Toshiharu Okugawa & Norimasa Sagawa

Authors
  1. Takaya Shiozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsutomu Tabata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kuniaki Toriyabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Motohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eiji Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kouji Tanida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toshiharu Okugawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Norimasa Sagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takaya Shiozaki.

About this article

Cite this article

Shiozaki, T., Tabata, T., Toriyabe, K. et al. A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream: clinical implications. Int J Clin Oncol 16, 610–612 (2011). https://doi.org/10.1007/s10147-010-0180-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-010-0180-4

Keywords

Search

Navigation