Clinicopathologic characterization of vulvar lesions among HIV infected women at the university teaching hospital in Lusaka, Zambia.

Abstract

A wide spectrum of vulvar lesions has been reported. However, few studies have characterized vulvar lesions among HIV infected women. HIV infected women have a higher risk of vulvar neoplasia than those who are not HIV infected. Furthermore, a rise in the incidence of vulvar cancer has been reported particularly among young women attributed to high risk human papillomavirus infection (HR HPV). In Zambia, vulvar lesions including cancer have not been previously characterized. The study set out to describe the clinical and histopathologic features of vulvar lesions and to determine the prevalence of HR HPV among HIV infected women with vulvar neoplasia among HIV infected women at the University Teaching Hospital (UTH) in Lusaka. The study enrolled 53 HIV infected women with vulvar lesions that were suspected to be cancer. The clinical features of the vulvar lesions were obtained using a questionnaire and focused clinical examination. Tissue for histologic evaluation of the lesions (Haematoxylin and eosin and immunohistochemistry- IHC), and determination of HR HPV (PCR) was collected by punch biopsy and fixed in 10% neutral buffered formalin and ATL buffer respectively. The histologic tissue samples were processed according to the standard protocol at the UTH and reported by two pathologists (including IHC for Ki67 and p53 for the invasive lesions). We analysed 38 samples histologically diagnosed as neoplastic, for HR HPV using X-pert® HPV after extraction of total deoxyribonucleic acid (DNA) using the NucliSens® easyMAG™ magnetic device. The data obtained was analysed using SPSS Version 22. The mean age of all respondents was 40 years (range 23-63, SD 9.5). The most frequent symptom reported was itching, the most frequent site involved was the labia majora and the most frequently reported lesion type was the warty type. Nine (17%) non- neoplastic lesions, three (5.7%) benign lesions, 20 (37.7%) vulvar intraepithelial lesions (VIN) and 21 (39.6%) invasive lesions were reported. Of the VINs, all were of the classic/ usual type. All the invasive lesions were of the SCC type. Of these, all were of the warty/ basaloid types. The prevalence of any type of HR HPV among all neoplastic lesions (in aggregate) and among invasive lesions was 81.6% and 88.9% respectively. The HIV infected women with vulvar lesions were young (mean 40 years); the lesions most frequently presented as itchy warty labia majora lesions including nonneoplastic and benign lesions, Classic VIN and Warty/basaloid type SCC. The prevalence of any type of HR HPV among all neoplastic lesions (in aggregate) and among invasive lesions was 81.6% and 88.9% respectively.