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Objective: The aim of the study was to describe the features required for diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM)., Materials and Methods: The International Society of the Study of Vulvovaginal Diseases tasked the difficult pathologic diagnoses committee to develop consensus recommendations for clinicopathologic diagnosis of vulvar lichen planus, lichen sclerosus, and dVIN. The dVIN subgroup reviewed the literature and formulated diagnostic criteria that were reviewed by the committee and then approved by the International Society of the Study of Vulvovaginal Diseases membership., Results: Differentiated vulvar intraepithelial neoplasia is the immediate precursor of human papillomavirus (HPV)-independent vulvar squamous cell carcinoma and shows a spectrum of clinical and microscopic appearances, some overlapping with HPV-related neoplasia. The histopathologic definition of dVIN is basal atypia combined with negative or nonblock-positive p16 and basal overexpressed, aberrant negative, or wild-type p53. The most common pattern of dVIN is keratinizing with acanthosis, aberrant rete ridge pattern, and premature maturation. The morphologic spectrum of keratinizing dVIN includes hypertrophic, atrophic, acantholytic, and subtle forms. A few dVIN cases are nonkeratinizing, with basaloid cells replacing more than 60% of epithelium. Vulvar aberrant maturation is an umbrella term for lesions with aberrant maturation that arise out of lichenoid dermatitis and lack the basal atypia required for dVIN., Conclusions: Evaluation of women at risk for dVIN and VAM requires a collaborative approach by clinicians and pathologists experienced in vulvar disorders. Close surveillance of women with lichen sclerosus and use of these recommendations may assist in prevention of HPV-independent squamous cell carcinoma through detection and treatment of dVIN and VAM., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASCCP.)

Objective: The aim of the study was to describe the clinical and histopathologic features required for a clinicopathologic diagnosis of vulvar lichen planus (LP), which is divided into 3 types: erosive, classic, and hypertrophic., Materials and Methods: The International Society of the Study of Vulvovaginal Diseases tasked the Difficult Pathologic Diagnoses committee with development of a consensus document for the clinicopathologic diagnosis of vulvar LP, lichen sclerosus, and differentiated vulvar intraepithelial neoplasia. The LP subgroup reviewed the literature and formulated diagnostic criteria, then approved by the International Society of the Study of Vulvovaginal Diseases membership., Results: The clinicopathologic diagnosis of erosive LP incorporates 5 criteria: (a) a well-demarcated, glazed red macule or patch at labia minora, vestibule, and/or vagina, (b) disease affects hairless skin, mucocutaneous junction, and/or nonkeratinized squamous epithelium, (c) evidence of basal layer damage, categorized as degenerative or regenerative, (d) a closely applied band-like lymphocytic infiltrate, and (e) absent subepithelial sclerosis. The clinicopathologic diagnoses of classic and hypertrophic LP each require a characteristic clinical appearance accompanied by hyperkeratosis, hypergranulosis, acanthosis, basal layer degeneration, a closely applied lymphocytic infiltrate, and absent dermal sclerosis, with hypertrophic LP showing marked epithelial abnormality compared with classic LP., Conclusions: Clinicopathological correlation yields the most reliable diagnosis of vulvar LP. Disease appearance overlaps with other physiologic, dermatologic, infectious, and neoplastic entities; a low threshold for biopsy at all morphologically distinct areas is recommended. Use of the histopathologic criteria described in this document may reduce the nondiagnostic biopsy rate for clinically diagnosed LP.

Mature women often present with symptomatic vulvovaginal atrophy and vulvar dermatoses, causing noncoital pain, dyspareunia, and sexual changes. Diagnosis of these conditions can be challenging, and long-term management is required to decrease morbidity and enhance quality of life. Vaginal estrogen therapies remain safe and effective for treating symptomatic vulvovaginal atrophy. A vulvar biopsy is easy to perform and generally well tolerated when indicated for the diagnosis of lichen simplex chronicus, lichen sclerosus, and lichen planus. Therapy with moderate- to high-potency corticosteroids is effective for these frequently debilitating conditions., (Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: The purpose of this article is to provide an update for the GP on selected common vulvar concerns in prepubertal girls. Presentation, diagnostic criteria, and management of common vulvar conditions will be described. The following conditions are frequently encountered and may pose diagnostic or management challenges if unrecognized., Recent Findings: The article is a review of current literature on pediatric vulvar conditions and was conducted through searching PubMed and published books on this topic. Areas of interest frequently encountered by providers are presented, including vulvovaginitis, genital ulcers, lichen sclerosus, and labial adhesions along with the most recent North American Society for Pediatric and Adolescent Gynecology recommendations for diagnosis and management., Summary: Vulvar complaints in prepubertal girls are common. Many present with nonspecific symptoms and consequently, the diagnosis may be missed or delayed. Prompt recognition improves long-term outcomes and importantly, provides a positive introduction to longitudinal women's health for young girls.

In this study, we aimed to explore the associations between HLA-A\B\DRB1 polymorphisms and the risks of vulvar lichen sclerosus (VLS) or squamous cell hyperplasia of the vulva (SCHV) in Han Chinese women. We enrolled 76 Han Chinese women with VLS (Group A), 74 with SCHV (Group B), and 66 healthy women (control group) in this study. Polymerase chain reaction amplification with sequence specific primers (PCR-SSP) was used to determine HLA-A\B\DRB1 polymorphisms. Compared with the control group, HLA-A*11, -B*15, and -DRB1*12 were present at a higher frequency in groups A and B, while HLA-B*13 was present at a higher frequency in group A. Fewer women in group A carried HLA-A*31, -DRB1*01, and -DRB1*03 genotypes and fewer women in group B carried HLA-B*40 and -DRB1*03 genotypes. Significant differences were found between group B and the control group for HLA-A*11, -B*15, -B*40, and -DRB1*03, and between group A and the control group for HLA-B*15 and -DRB1*12. The HLA-A*11, HLA-B*13, HLA-B*15, and HLA-DRB1*12 genotypes were associated with a higher risk of VLS, while the HLA-A*31, HLA-DRB1*01, and HLA-DRB1*03 genotypes were associated with a lower risk of VLS. In addition, carrying HLA-A*11, HLA-B*15, HLA-B*35, and HLA-DRB1*12 genotypes, and carrying HLA-B*40 and HLA-DRB1*03 genotypes were found to be risk or protective factors for SCHV, respectively.

Unlabelled: Lichen sclerosus (LS) is a chronic skin disease of the vulva which affects mostly women in the postmenopausal period. The disease affects also men and children. Its frequency is from 1/70 up to 1/1000, whereas for women it is 10 times more frequently. The disease has unknown etiology. Due to the high frequency of accompanying, autoimmune diseases, it is presumed that this disease is a result of immunological processes. Some of patients diagnosed with LS have vulvar intraepithelial neoplasia, while 0.3% - 4.9% of them have squamous cell carcinoma. The aim of this review is to summarize our knowledge regarding the frequency, clinical features, diagnosis and therapy of LS in view of the prevention of the complications that may occur., Material and Methods: We researched the available literature and Medline on the topic for the period of 1971 until 2014 year. We summarized the most interesting, contemporary and scientifically substantiated facts regarding this disease., Discussion: Early diagnosis, the proper and timely treatment, as well as the continuous follow up the patients with LS is mandatory due to the fact that the spontaneous remission is extremely rare and the complications may lead to significant deterioration of the quality of life.

Numerous cutaneous lesions are located in the region of the female genital organs, occasionally presenting a diagnostic and therapeutic challenge. The most common cases include: eczema vulvae, lichen simplex chronius, lichen sclerosus et atrophicus or lichen planus. Clinical presentation of these lesions is not always characteristic for certain dermatoses. Thus, it is important to conduct proper tests, including histopathological or contact allergy examination. Only thorough diagnostics allows to implement correct therapy. This paper shows a detailed description of dermal lesions located in the region of the female genital organs of the allergic and lichenoid origin, together with the literature review on diagnosis and treatment.

In this chapter, examination techniques are first recommended, and then terminology for genital injuries that may occur after child sexual abuse or rape (e.g. lacerations, notch, transaction) are described. Current evidence for these injuries is provided. Areas of controversy (e.g. hymenal diameter, hymenal width) are described and completed with cautionary notes on inflammation, bruising, abrasions, bumps and mounds, tags, labial fusion, lichen sclerosis). The chapter concludes with a debate on normal findings that are reported to occur in up to 99% of children referred for examination., (Copyright © 2012. Published by Elsevier Ltd.)

The evaluation of a child presenting with an anogenital complaint or lesion can be challenging for both the clinician and the patient. The doctor met the real possibility that a diagnosis of a condition caused by sexual abuse will affect significantly the child and the family. A misdiagnosis of abuse or failure to recognize a treatable condition can also have detrimental consequences. Most primary care physicians are not trained to recognize the variety of systemic and dermatologic problems that affect the anogenital area. Dermatologists and other specialists often do not appreciate the possibility of sexual abuse. In this article we present a systematic approach to the child with anogenital complaints which may mimic sexual abuse.

Aim: To analyse p53 immunoreactivity in 207 biopsy specimens of lichen sclerosus (LS) and "differentiated vulvar intraepithelial neoplasia" (d-VIN), a postulated precursor lesion for LS-associated vulvar squamous cell carcinoma (SCC), which is characterized by atypical basal keratinocyte proliferations with p53+ basal/suprabasal keratinocyte nuclei., Methods and Results: Forty early, 78 classic, 30 hypertrophic vulvar LS, 26 paediatric vulvar and penile LS, 33 vulvar LS-associated SCC and 30 vulvar/penile control specimens were examined for p53 expression and the presence of d-VIN. Nuclear p53 staining was observed in 175/207 LS biopsy specimens. Eighty percent of early and 69% of paediatric LS showed discontinuous/continuous p53 staining in basal keratinocytes. Classic LS showed no p53 staining in 17%, discontinuous basal keratinocyte staining in 20%, continuous basal keratinocyte staining in 58%, basal/suprabasal staining in 5%. Hypertrophic LS revealed basal keratinocyte staining in 32% and basal/suprabasal staining in 61%. p53 staining was associated with sclerosis of blood vessels and dermis, lymphoid infiltrates, vasculitis and hypertrophic LS. d-VIN was seen in 2% of LS alone and in 24% of LS-associated SCC., Conclusion: d-VIN in LS is rare, while p53 staining is common and best explained as an ischaemic stress response due to poor oxygenation, vasculitis and inflammation rather than as a marker of a precancerous lesion in LS.

Objectives: The aim of this study was to investigate a possible relationship between fetal cell microchimerism and lichen sclerosus of the vulva. We searched for the presence of male cells and DNA in vulval tissue samples., Methods: Paraffin-embedded skin biopsy samples from 15 women affected with vulval lichen sclerosus who gave birth to at least one son were analyzed for the presence of microchimeric male cells using fluorescence in situ hybridization (FISH) and fluorescent PCR. We included three lichen sclerosus samples originating from women without male offspring, six vulval specimens without pathological finding originating from autopsies and seven male gingival specimens as controls., Results: Nucleated cells containing Y-chromosome specific sequences were neither detected at any site of the lesions nor in normal vulval specimens by using FISH. These results were confirmed by the use of PCR amplification demonstrating only DNA sequences specific for the X chromosome. No female microchimerism was detected in the male gingival samples., Conclusion: Despite the limited number and size of the samples, we conclude that persistent male fetal cells are not involved in the pathogenesis of lichen sclerosus of the vulva, since we consistently could not detect Y-chromosome specific sequences by using two molecular techniques., (Copyright 2006 John Wiley & Sons, Ltd.)