Penile and Vulvar Intraepithelial Neoplasia

Penile and Vulvar Intraepithelial Neoplasia

Elsa F. Velazquez, MD

Vulvar intraepithelial neoplasia may appear as a raised, thickened white plaque image. This lesion is associated with an invasive component image that is exophytic. (Courtesy T. Quinn, MD.)

Enlarged keratinocytes with abundant eosinophilic cytoplasm throughout most of the epithelium are seen in differentiated PeIN/VIN. Characteristic keratin pearl formation is present image.



  • Penile intraepithelial neoplasia (PeIN)

  • Vulvar intraepithelial neoplasia (VIN)


  • Erythroplasia of Queyrat, Bowen disease, squamous cell carcinoma in situ (SCCis)


  • VIN and PeIN are considered intraepithelial (in situ) precursor lesions of invasive SCC



  • Bimodal pathway of tumor progression in vulvar and penile SCC (HPV-related and HPV-unrelated)

    • Basaloid, warty, and warty-basaloid (mixed) VIN and PeIN are HPV-related (especially HPV 16)

    • Differentiated (simplex) VIN and PeIN are HPV-unrelated

      • May be related to lichen sclerosus et atrophicus (LS&A)

      • May be associated with P53 mutations



  • Incidence

    • Real incidence is unknown

    • 2/3 associated with invasive SCC

  • Age

    • 5th and 6th decades

      • About 1/2 of patients with VIN are < 40 years old


  • Differentiated PeIN and VIN

    • Older patients

    • Usually arises in setting of chronic scarring, inflammatory dermatosis, especially lichen sclerosus et atrophicus (LS&A)

  • Warty, basaloid, and mixed PeIN and VIN (a.k.a. VIN of usual type in vulvar pathology)

    • Younger patients

    • Patients may have history of condyloma


  • Surgery, locally destructive treatments


  • Most studies are retrospective and real prognosis remains unknown


General Features

  • VIN and PeIN have heterogeneous gross appearance

  • Solitary or multifocal

  • Flat to slightly elevated hyperkeratotic or even condylomatous lesions

  • Pearly white, moist, erythematous, dark brown/black macules, papules, or plaques

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Penile and Vulvar Intraepithelial Neoplasia

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