Vulvar intraepithelial neoplasia

A chronic premalignant disorder of the for vulvar skin caused by the human papillomavirus, with type 16 being involved in more than 75% of cases.

Recurrence after surgical treatment is common.

Spontaneous regression occurs in less than 1.5% of cases.

Viral oncoproteins E6 and E7 Contribute to the development of genital lesions and their progressION and to invasive cancer.

Interferon gamma producing CD4 positive T cells and CD8 positive cytotoxic T lymphocytes are significant components to control chronic viral infections.

Patients with high-grade vulvar intraepithelial neoplasia lack the T cells directed against HPV-16 viral oncoproteins, E6 and E7.

Vaccination with a synthetic long-peptide vaccine against HPV-16 oncoproteins E6 and E7 in patients with vulvar intrepithelial neoplasia resulted in a 60% clinical response rate with relief of symptoms at three months, and a 79% response rate at 12 months of follow-up with 47% complete remission rate (Kenter G).

Imiquimod topical cream treatment associated with a complete remission of lesions of 35% in patients with grade 3 vulvar intraepithelial neoplasia (Nakagawa M).

The benefit of topical imiquimod was correlated with the presence of interferon-gamma-producing HPV-16 specific T cells (Nakagawa M).

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