Vulvar lesions

Gardasil was approved by the FDA in 2006. It is a quadrivalent recombinant vaccine against the human papilloma vims (HPV), more specifically against types 6, 11, 16 and 18. It is able to reduce pre-cancerous cervical, vaginal and vulvar lesions, associated with HPV types 16 and 18, as well as condylomas associated with HPV types 6 and 11. With the approval of the first HPV vaccine, cervical cancer now has a primary prevention tool. 

To avoid this problem, the application of MIB-1 antibody is useful in the differential diagnosis of benign exophytic vulvar lesions because HPV-associated lesions show... 

FIGURE 18.3 In exophytic vulvar lesions, MIBl is expressed above the basal layer in condyloma (A, B) but is confined to parabasal cells in squamous papilloma (C, D) and in fibroepithelial polyp (E, F). 

Interobserver variation in the grading of VIN has been observed when using hematoxylin-eosin only, MIB-1 monoclonal antibody alone, or combined hematoxylin-eosin and MIB-1 antibody (van Beurden et al., 1999). This antibody is the most versatile proliferation worker for the sections of formalin-fixed and paraffin-embedded tissues. Normal vulvar skin and VIN lesions are fixed with formalin and embedded in paraffin according to standard procedures. 

Classification of vulvar mesenchymal lesions is primarily based on morphologic criteria. 

The main differential diagnosis for papillary squamous lesions of the vulva includes condyloma, fibroepithelial polyp, and squamous papilloma. Vulvar condyloma demonstrates papillomatosis, acanthosis, parakeratosis, and dyskeratosis but often lacks koilocytes, which makes the differential difficult in occasional cases. MIBl is useful in this context. In normal vulvar epithelium, fibroepithelial polyp, and squamous papilloma, MIBl is... 

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