Vaginal intraepithelial neoplasia: Risky and underrecognized
Hysterectomy for cervical neoplasia, radiation for cervical carcinoma, and chronic immunocompromise heighten risk—and both diagnosis and treatment can be tricky.
Effects of 5-FU. Following a course of 5-FU cream, vaginal mucosal ulcerations may persist for several weeks. Occasionally, these may lead to partial coaptations.27 In addition, subsequent islands of columnar epithelium have been described.28 Keep these factors in mind during the follow-up of women who have been treated with transvaginal 5-FU cream.
Long-term annual follow-up is reasonable, since these women are probably at increased risk for developing a second primary vaginal lesion and/or lower anogenital tract neoplasia at other sites.
When extra vigilance is warranted. Some patients merit closer follow-up, such as the chronically immunosuppressed women described; also, women who have been treated for vaginal apical disease without resection of the vaginal cuff scar, previously radiated patients, and women whose VAIN was treated with brachytherapy.
Dr. Hoffman reports no financial relationships relevant to this article.
