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Pathology
Histologic Classification of Vaginal Neoplasia
VAIN (VAginal Intraepithelial Neoplasms)
These are pre-malignant lesions of the vaginal squamous epithelium that can develop primarily in the vagina or as an extension from the cervix. Histologically, VAIN is defined in the same way as cervical intraepithelial neoplasia (CIN). Classification includes three grades: Grade 1 (VAIN I = mild dysplasia); Grade 2 (VAIN II = moderate dysplasia); and Grade 3 (VAIN III = severe dysplasia or carcinoma in situ)
Invasive carcinoma:
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Work-up
VAIN (vaginal intraepithelial neoplasia):
H&P, including bimanual examination, palpation, and colposcopic examination of the vagina, vulva, and cervix
Multiple site-directed biopsies, including cervical and vulvar biopsies, to rule out invasive disease and metastatic lesions
Invasive carcinoma:
H&P including bimanual examination and palpation of vagina
Multiple site-directed biopsies, including cervical biopsies to rule out invasive disease and primary cervical cancer
Studies allowable for staging as per FIGO✫ guidelines: chest X-ray, cystoscopy, proctosigmoidoscopy, and intravenous pyelogram. Although not part of staging, pelvic MRI or CT scan may aid in planning of patient care
If clinically warranted, barium enema and CAT scan or MRI
Staging is best performed by gynecologic and radiation oncologists with the patient under general anesthesia. Additional biopsies of the vagina should be done to determine the limits of abnormal vaginal mucosa
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