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Biopsy returned as vulvar intraepithelial neoplasia. Connection between PCOS and chronic itching?

I just had a biopsy done and it came back as vulvar intraepithelial neoplasia (my doctor said VIN 1). He wants to see me again in 6 months (he removed the entire lesion ). I had a similar biopsy done 3 or 4 years ago in the same area and was told that it was squamous cell hyperplasia . I would like to treat this more aggressively as I feel that the root cause is not really being addressed. I have suffered from chronic itching in my genital area throughout my life, but that issue has never been thoroughly addressed either. The information out there is a bit confusing. Should my doctor give me a colposcopy? Should I be treated with some kind of steroid cream? I also have PCOS ( polycystic ovarian syndrome ). Is there any connection between pcos and the chronic itching/irritation? Or is the irritation probably caused by HPV which seems to be the most common cause of VIN? If anyone could clear up the confusion, I would greatly appreciate it!
Asked On : Tue, 16 Oct 2012
Answers:  1 Views:  125
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Pathologist and Microbiologist 's  Response
Hello and welcome to HCM
The presence of chronic itching is definately a predisposing factor for development of squamous hyperplasia and subsequently intra-epithelial lesion.
For your understanding, vulval skin is covered by a layer of stratified squamous epithelium which is several layer thick. The lower most layer is called thae basal layer and is separated from the underlying stroma by a basement membrane.
VIN 1 (Vulvar intraepithelial lesion 1) is characterised by atypical features in the lower one third of the stratified squamous epithelium.
If the lesion is not removed and left in place for years, VIN 1 may progress to VIN 2, VIN3 and finally invasive squamous cell carcinoma.
Invasive squamous cell carcinoma is a malignant entity in which the atypical cells penetrate the basement membrane and invade the stroma.

Removal of the lesion was the best treatment option but a regular follow up is required.
Refarding your query regarding HPV, you can get HPV PCR done to find out the HPV status. If positive appropriate treatment can be started. If negative follow up will suffice.
VIN 1 is a low grade lesion so chances of developing VIN 2, 3 and invasive carcinoma are low.

Thanks and take care
Dr Shailja P Wahal
Answered: Tue, 16 Oct 2012
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