This article will help you read and understand your pathology report for differentiated vulvar intraepithelial neoplasia (dVIN).
by Emily Goebel, MD FRCPC, updated December 23, 2020
The vulva is the external part of the female genital tract. It forms the opening of the vagina and includes the mons pubis, labia majora, labia minora and clitoris. The vulva is made of skin. The surface of the skin is called the epidermis and is mostly made up of squamous cells. The tissue beneath the epidermis is called the dermis, it contains blood vessels and connective tissue.
Differentiated vulvar intraepithelial neoplasia (dVIN) is a pre-cancerous disease that develops in the vulva. It is called a pre-cancerous disease because over time it can turn into a type of cancer called squamous cell carcinoma.
Unlike squamous cell carcinoma, the abnormal cells in dVIN are found only in the epidermis. If the abnormal cells spread beyond the epidermis and into the dermis below, the diagnosis changes to squamous cell carcinoma. The spread of abnormal cells from the epidermis into the dermis is called invasion.
Differentiated vulvar intraepithelial neoplasia is often associated with an inflammatory condition called lichen sclerosus. People who develop this condition have usually had lichen sclerosus for many years. Unlike other pre-cancerous diseases in the vulva, dVIN is not caused by human papillomavirus (HPV).
The first diagnosis of dVIN is usually made after a small sample of tissue is removed in a procedure called a biopsy. A larger surgical procedure (for example, an excision or vulvectomy) may be later performed to remove the disease and look for abnormal cells in the dermis.
Larger tissue samples called excisions or resections are usually sent for pathological examination as a single piece of tissue and the tissue is then divided into multiple sections before being examined under the microscope.
A margin is any tissue that has to be cut by the surgeon in order to remove the tumour from your body. A negative margin means that no tumour cells were seen at the cut edge of the tissue. In contrast, a positive margin means that tumour cells were seen at the cut edge of the tissue. A positive margin increases the risk that the tumour will grow back in that location.