Molecular and immunological mechanisms of epithelial disorders of the vulva
(Moleculaire en immunologische mechanismen van epitheliale afwijkingen van de vulva)
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The vulva is the outer part of the female genital tract, bordered by the symphisis pubis, the labiocrural folds and the anus. It consists of the following structures: the mons pubis, the labia majora and minora, the clitoris, the vestibule of the vagina and the urethral orifice (Figure 1). Embryologically all three germ layers are present at the vulva; the cloacal endoderm, the urogenital ectoderm and the paramesonephric mesoderma. Different epithelia, from keratinized squamous epithelium on the labia majora and minora to squamous mucosa in the vestibule, cover the vulva. Dysplastic changes in the epithelium of the vulva are known as Vulvar Intraepithelial Neoplasia (VIN). In the past, various definitions have been used to describe these dysplastic vulvar lesions: morbus Bowen, Queyrat’s erythroplasia, carcinoma simplex, bowenoid papulosis, early vulvar cancer, vulvar atypia, hyperplastic dystrophy, carcinoma in situ and dysplasia (graded into mild dysplasia (VIN1), moderate dysplasia (VIN2) and severe dysplasia (VIN3)). To simplify this complexity of terms and to enhance diagnostic reproducibility, the International Society for the Study of Vulvovaginal Diseases (ISSVD) defined a new terminology in 2004.7 We nowadays classify two types of VIN: 1. Usual type VIN (uVIN), which is caused by a persistent Human Papilloma Virus (HPV) infection. 2. Differentiated type VIN (dVIN), which is not associated with HPV, but with chronic inflammatory and/or autoimmune processes, such as lichen sclerosus and lichen planus, involving vulvar mucosa and skin. Spontaneous regression of VIN lesions has been described, but malignant transformation into vulvar cancer has also been reported. Vulvar cancer is the fourth most common gynecological type of cancer.11 Worldwide the incidence rate is 1 to 2 per 100.000 women, and around 27.000 women are diagnosed each year.12 In the Netherlands about 200 new cases are identified each year.
Further support for this dissertation was kindly provided by: Astellas Pharma B.V., Café De Witte Aap, Café de Zondebok & ‘t ZwarteSchaap, Greiner Bio-One, GlaxoSmithKline, Supportgroup Lichen Planus Vereniging Nederland, Supportgroup Stichting Lichen Sclerosus, Medical Dynamics, Nederlandse Vereniging voor Vulva Pathologie, Olympus Nederland B.V., Philips Healthcare, Sanofi Pasteur MSD, Werkgroep Cervix Uteri
J.E. Jurriaanse Stichting.
Nederlandse Vereniging voor Obstetrie en Gynaecologie
- lichen planus
- lichen sclerosus