HPV VACCINATION
Leonardo Micheletti, M.D.
Department of Gynaecology and Obstetrics
University of Torino
No disclosures or conflicts of interest
Garland et al. N Eng J Med 2007
LOWER FEMALE GENITO-ANAL TRACT
Starts from the
Cervical Squamo-Columnar Junction
Ends at the Anorectal Pectinate Line
Transition from Squamous to Columnar Epithelium
LOWER FEMALE GENITO-ANAL TRACT
ANATOMOBIOLOGIC
UNIT
DIFFERENT ORGANS
SAME SQUAMOUS EPITHELIUM
MUCOSAL / CUTANEOUS
HPV
ACTION-FIELD
REGARDLESS OF
the SITE of the LESION
LOWER FEMALE GENITAL TRACT
a continuum of squamous epithelium from the cervix to the vulva
commonly infected by HPV
the outcome depends on
Viral Genotype
Low Risk HPV 6 and 11
Benigne Lesions
High Risk HPV 16, 18, …
Malignant Lesions
Site of infection
Cervical Squamocolumnar Junction
more susceptible to HPV disease
Vaginal cancer 20 times
Vulval cancer 6 times
Less common than Cervical cancer
Cutaneous epithelium less susceptible to oncogenic HPV
compared to mucosal epithelium
CERVIX
> 95 %
VAGINA
80-95 %
VULVA
< 50 %
HPV interacts with squamous epithelia in 2 basic ways
Benigne Transient Lesions
Precancerous Lesions
Histopathologic Terminology of HPV-associated lesions
of the lower genito-anal tract
remains disparate, complex, and clinically confusing
low grade lesions,
grade 1 intraepithelial neoplasia
mild dysplasia
condyloma
high grade lesions
grade 2-3 intraepithelial neoplasia
moderate-severe dysplasia
carcinoma in situ
2 different interest groups
focusing on specific body sites
Gynaecologists
and
Gynaecologic Pathologists
Bowen disease/papulosis
Erithroplasia of Queyrat
Dermatologists
and
Dermatopathologists
International Journal of Gynecological Pathology
2012; 32:76-115
Lower Anogenital Squamous Terminology
LAST
Specifically created for human papillomavirus (HPV)-associated squamous lesions
of the lower anogenital tract
in order
to
Overcome the disparate diagnostic terms derived from multiple specialties
Reflect the current HPV biology and pathogenesis knowledge
Facilitate clear communication across different medical specialties
goal
Improve accuracy of histologic diagnosis and Provide optimal patient care
Facilitating
Communication between pathologists and their clinical colleagues
E. T. 36 years
LOWER GENITO-ANAL TRACT
MULTICENTRIC INTRAEPITHELIAL NEOPLASIA
HPV-Related
VIN 2 – 3
VHSIL
AIN 2 – 3
CIN 3
AHSIL
Lacking VaIN
VaHSIL
CHSIL
2004 ISSVD terminology for vulvar intraepithelial neoplasia
2 types of VIN
histologically, biologically, and clinically differents
Usual type,
caused by HPV
Differentiated type,
not caused by HPV
Younger patient
Older patient
Less aggressive
More aggressive
Condylomatous aspect
Lichen sclerosus context
Multifocal
Unifocal
The outcome of HPV infection depends on
Viral Genotype and Site Infection
VAGINA
Low Risk HPV 6 and 11
High Risk HPV 16, 18, …
VULVA
Benigne Lesions , Common
GWs most commonly STI
160-289 per 100,000
Malignant Lesions, Rare,
20 times less common
than the cervix.
80-95 % HPV-related
Low Risk HPV 6 and 11
High Risk HPV 16, 18, …
Malignant Lesions, Rare,
6 times less common
than the cervix
50 % HPV-related
50 % Not HPV-related
Primary Prevention through HPV Vaccination
useful
Psychological distress control
Management economic burden
Sex Transm Infect 2011;87:544-7
4 years after the
national HPV
vaccination programme
dramatic decline and
near disappearance
of GW
in women and men
under 21 years
Joura et al. 2015, ACIP 27 March 2015
The economic burden of noncervical HPV disease is substantial
HPV Vaccination, by protecting both female and male from HPV infection,
can dramatically reduce diagnostic and treatment costs