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EP1069 Vulvar and vaginal intraepithelial neoplasia: CO2laser ablative therapy at Ramón y Cajal University Hospital
  1. C del Valle Rubido1,
  2. C Martín Blanco1,
  3. E Díaz González1,
  4. M Salvador Osuna1,
  5. MC Sánchez Martínez1,
  6. E Moratalla Bartolomé1,
  7. C Miguel Bayo2,
  8. B Pérez Mies3 and
  9. J Lázaro- Carrasco1
  1. 1Obstetrics and Gynecology
  2. 2Hospital Universitario Ramón y Cajal
  3. 3Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain


Introduction/Background Laser vaporization is an alternative to excisional therapy in women with VIN and VAIN, especially with multifocal and extensive lesions.

Methodology Retrospective study of 12 cases of VIN or VAIN, treated with CO2 laser ablation at RamónYCajal University Hospital.

Results Nine patients with VAIN and 4with VIN have been selected for ablative therapy with CO2laser.

Mean age of the VAIN group is 41.9years and parity 0.66births per woman. 55%are Spanish, 22%South American and 22%from Eastern Europe. Half of the patients do not use any contraceptive method, 2use condoms, 1implant and 1DMPA. One third are active smokers, and two of them have inmunodepressant conditions:HIV and chronic lymphocitic leukemia. Only one patient has received HPV vaccination, 3have undergone cervical conization, 1vaginal ablation, 1exeresis of condylomas and one histerectomy.

Vaginoscopy and histology study has shown the following results:

- Positive HPV in all but one patient(the one with leukemia):66%HPV16 and 22%high-risk HPV(not16 or18).

- Pap-smear:55%LSIL, 33%HSIL, 11%ASCUS and 11%ASC-H.

- Vaginoscopy: condylomas in 4patients, negative Schiller test in 3, colpitis in 2 and acetowhite epithelium in another two.

- Vaginal biopsy:55% VAIN2/3 and 33%VAIN1.

At this moment,vaginal vaporization has been performed in 6cases,3 are pending and one has been lost.Complications have taken place in two cases:vulvar edema and vulvitis. Two patients have reached the six-months follow-up, with negative Pap-smears and vaginoscopy, but persistent HPV in one of them.

Mean age of the VIN group is 53.7 years-old and parity 0.5. 100%are Spanish. Two use condoms and the other 2 are postmenopausal. All have inmunodepressant conditions: 3 HIV and 1 CLL(with concomitant VAIN). HPV is positive in 50%. Vulvoscopic - histologic findings are:condyloma-VIN3, vulvar and vaginal warts-VAIN1, G1acetowhite epithelium-VIN3 and clitoris erythema-VIN3.

The patient that has reached follow-up has persistent VIN1 and re-vaporization is pending.

Conclusion VAIN and VIN lesions can be effectively treated with CO2 laser ablation.

Disclosure Nothing to disclose

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