Vaginal intraepithelial neoplasia: clinical-therapeutic analysis of 33 cases

Vaginal intraepithelial neoplasia (VAIN) represents 1% of all intraepithelial neoplasia of the lower genital tract. Our aim was to study the clinical-therapeutic characteristics of patients with VAIN. A retrospective study was made of all cases of patients, who attended within the outpatient service between 1993 and 2003, with a diagnosis of VAIN. During this period, 84,293 Papanicolaou smears (triple collection) were performed and a total of 33 (50.32+/-11.5 years old) patients with VAIN were diagnosed. Among these patients, twenty-six (78.8%) were white, 17 (51.5%) were smokers, and 23 (69.6%) had undergone hysterectomy previously. The indications for hysterectomy prior to the appearance of VAIN were found in 20 cases (87%) of cervical intraepithelial or invasive neoplasia (CIN), and in two (8.6%) cases after myoma uterine. The median time elapsed between the hysterectomy and the appearance of VAIN was 41 months. Thirteen (39.4%), 11 (33.3%) cases were, respectively, VAIN II and III. Twenty-eight patients (84.8%) presented a single lesion affecting the upper third of the vagina. The commonest finding was the presence of white epithelium in 17 patients (51.5%). Ten of 16 cases submitted to topical application of 5-fluorouracil (5-FU) achieved remission. Surgery was utilized for seven patients, of whom six achieved remission and one had persistence of the lesion. We conclude that VAIN may occur in patients who have undergone hysterectomy due to benign alterations. This justifies the use of routine Papanicolaou tests. Both surgical and 5-FU treatments are efficient.