Low grade squamous intraepithelial lesion (LSIL) of the vulva

by Emily Goebel, MD FRCPC
June 2, 2022


What is low grade squamous intraepithelial lesion (LSIL) of the vulva?

Low grade squamous intraepithelial lesion (LSIL) is a non-cancerous, sexually transmitted disease caused by infection with human papillomavirus (HPV). This condition may affect both women and men. In addition to the vulva, LSIL can also affect the cervix and vagina. In both women and men, LSIL may also involve the anal canal and peri-anal skin.

How does low grade squamous intraepithelial lesion of the vulva start?

Low grade squamous intraepithelial lesion (LSIL) develops after the specialized squamous cells on the surface of the vulva become infected by human papillomavirus (HPV). Infected cells show an abnormal pattern of development called dysplasia.

Is low grade squamous intraepithelial lesion of the vulva a type of cancer?

Low grade squamous intraepithelial lesion (LSIL) is not a type of cancer but there is a very small risk that it will turn into a type of vulvar cancer called squamous cell carcinoma over time. However, for most patients with LSIL, the immune system will remove the infected cells and the tissue will return to normal. High-grade squamous intraepithelial lesion (HSIL) is a related condition that is also caused by HPV. However, compared to LSIL, the risk of developing cancer from HSIL is much higher.

How do pathologists make the diagnosis of low grade squamous intraepithelial lesion of the vulva?

The diagnosis of LSIL of the vulva is usually made after a small sample of tissue is removed in a procedure called a biopsy. The affected areas are usually treated with topical or laser therapy. A larger biopsy or excision may be performed to look for features of related, but more serious conditions called high-grade intraepithelial lesion (HSIL) and squamous cell carcinoma.

What does low grade squamous intraepithelial lesion of the vulva look like under the microscope?

Low grade squamous intraepithelial lesion (LSIL) starts when the squamous cells on the surface of the vulva become infected with human papillomavirus (HPV). When examined under the microscope, the infected squamous cells in LSIL are much larger than normal squamous cells and the nucleus of the cell (the part that holds the genetic material) is darker and surrounded by a clear space called a halo. Pathologists describe these infected cells as koilocytes.

low grade squamous intraepithelial lesion vulva

The microscopic appearance of low grade squamous intraepithelial lesion (LSIL) of the vulva. Koilocytes can be seen at the surface of the tissue.

A+ A A-