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Re: GYN/OB: 22 y/o VIN III now pregnantFrom: Georgi Kostadinov (gekgionk@nic.mpt.com.mk)Thu Aug 6 15:38:22 1998
At Wed, 5 Aug 1998, Geffrey Klein wrote:
>22 y/o presented to my office 3 weeks ago with vulvar pruritus. A red area on the posterior forchette was biopsied and returned VIN III. Pt was referred to gyn oncologist who recommended skinning vulvectomy and My comment: 1. Very young woman for VIN 3. A second HP opinion is necessary, especially because VIN 3 is commonly multifocal. (Dif. Dg of Red vulvar lesion: Psoriasis = dilated and twisted capillary loops in the papillary apex, very similar to erythroblastic variety of VIN 3; Paget's disease) 2. The peak incidence of VIN 3 is about 35 years, but the peak incidence of invasive carcinoma is about 68 years. There is possibility these two conditions not to be directly related in all circumstances. The behavior of VIN 3 does not seem to be comparable with that of CIN 3. The possibility of progression to malignancy is between 2% and 4%. I'm agree with Dr. Savaris that PAP smear must be checked, because of possible common etiopathogenesis (HPV) with CIN. But it is not necessary the treatment to be performed immediately. 3. Skinning vulvectomy with skin grafting is not appropriate for young women. There is significant morbidity in respect of postoperative healing, pain, hospitalization and cosmetic result. If the simple wide local excision is not appropriate in this case (because of largeness of the lesion), the technique of "Wide local excision with vaginal advancement" is most adequate in this case, but after the termination of pregnancy. 4. About sever vulvar pruritus: maybe Prometazine if the pruritus is unendurable.
-- Georgi Kostadinov, MD, Specialist in Obs&Gyn Privat practice, E-mail: gekgionk@nic.mpt.com.mk Address: Georgi Kostadinov,MD str. "Dr. Ribar" 33 91300 Kumanovo FYR of MACEDONIA (Europe) tel: +389 901 415-440 fax: +389 901 33-348 (office) 09-17 h
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