This rare condition is important because it can be confused condyloma. A
correct diagnosis can save the patient an unecessary and potentially expensive
work up. Recent investigative work has found no substantial evidence that
this disease is related to Human Papilloma Virus (HPV) infection. It is best
considered a variant of the normal vulva anatomy and is a benign condition
with no known sinister associations.
| PATHOGENESIS |
CHARACTERIZATION |
| Considered a female homologue to pearly penile plaques |
On the penis, located on the corona of the glans penis and
are smooth, flesh colored elevations |
| ROLE OF HPV |
|
| In situ hybridization for Human Papilloma virus |
2/29 (6.9%) cases tested were positive which may represent
the background frequency of HPV DNA found in the normal vulva |
| |
Careful clinical and physical examination revealed no evidence
of HPV infection either in patients or partners |
| |
NOTE: Vulvar warts coexisted with papillae in 3/29 (10%)
of cases, but located out of the vestibular area |
|
What is vestibular papillomatosis? A study of its prevalence, aetiology
and natural history.
Welch JM, Nayagam M, Parry G, Das R, Campbell M, Whatley J, Bradbeer
C.
Department of Genitourinary Medicine, St. Thomas' Hospital, London,
UK.
|
Br J Obstet Gynaecol 1993 Oct;100(10):939-42 Abstract quote
OBJECTIVES: To clarify the prevalence, aetiology, symptoms and natural
history of vestibular papillomatosis.
DESIGN: Study in two parts: 1. prevalence assessed by colposcopic examination
of the vulva of unselected patients by one doctor (J.M.W.); 2. patients
selected by clinical appearance as having vestibular papillomatosis
(by J.M.W. and other doctors) assessed in a research clinic.
SETTING: Outpatient genitourinary medicine clinic in South London.
SUBJECTS: Part 1 study: 295 female clinic attenders; part 2 study:
18 women with clinical vestibular papillomatosis.
MAIN OUTCOME MEASURES: Part 1 study: number of unselected patients
found to have vestibular papillomatosis. Part 2 study: associated symptoms,
histology, DNA hybridisation and polymerase chain reaction on vulval
biopsies. Clinical regression of lesions. Cervical cytology and colposcopy.
RESULTS: Part 1 study: Vestibular papillomatosis was identified by
colposcopic examination of the vulva in 3/295 (1%) of women. Part 2
study: 9/18 (50%) women with vestibular papillomatosis were asymptomatic;
the other nine had intermittent mild symptoms. Thirteen (72%) had a
history of genital warts. Vulval biopsies had features suggestive of
wart virus infection on histology in 17/18 (94%) and HPV16 was found
by DNA hybridisation studies or polymerase chain reaction in 7/18 (39%).
On follow up (mean duration 9 months) the vulval lesions had regressed
in 9/12 patients. Ten patients had cervical wart virus infection or
intraepithelial neoplasia (CIN), or both, and five needed laser treatment
for this.
CONCLUSIONS: In this study vestibular papillomatosis was associated
with human papillomavirus (HPV) infection. This study suggests that
vestibular papillomatosis need not be treated, but patients with it
may be at increased risk for CIN.
|
|
Histologic and biomolecular aspects of papillomatosis of the vulvar
vestibule in relation to human papillomavirus.
de Deus JM, Focchi J, Stavale JN, de Lima GR.
Department of Gynecology, Escola Paulista de Medicina, Sao Paulo,
Brazil.
|
Obstet Gynecol 1995 Nov;86(5):758-63 Abstract quote
OBJECTIVE: To determine whether human papillomavirus (HPV) plays a
role in the genesis of papillomatosis of the vulvar vestibule.
METHODS: We conducted a study based on molecular hybridization and
histology of biopsy material obtained from the inner surface of the
labia minora of 25 women with papillomatosis of the vulvar vestibule
who presented no abnormal clinical, cytologic, or colposcopic changes
in the cervix or vagina. These women were compared with 24 women with
condyloma acuminatum of the vulvar vestibule and with ten women with
normal vulvar epithelium and no cervicovaginal changes. All patients
included in the study were 35 years or younger, and none was pregnant.
RESULTS: Papillomatosis of the vulvar vestibule was rarely found to
be HPV positive by molecular hybridization (one of 25, 4%, by dot blot
hybridization and one of 15, 6.67%, by polymerase chain reaction [PCR]).
This result did not differ significantly from that obtained for the
group with normal vulvar epithelium (none of 10 by dot blot and none
of six by PCR), but did differ (P = .001) from the result obtained for
the group with condyloma acuminatum of the vestibule (12 of 24, 50%,
by dot blot and six of six, 100%, by PCR). The biomolecular study of
vestibular papillomatosis showed that focal koilocytosis was not correlated
with HPV infection.
CONCLUSION: Papillomatosis of the vulvar vestibule is not associated
with HPV and should be considered a paraphysiologic formation of the
vulvar epithelium. The diagnosis of vulvar HPV infection should be avoided
in the absence of more explicit clinical-histologic evidence, with no
need for biopsies or unnecessary treatments.
|
|
Is vestibular micropapillomatosis associated with human papillomavirus
infection?
Gentile G, Formelli G, Pelusi G, Flamigni C.
1st Obstetrics and Gynecology Department, University of Bologna,
Italy.
|
Eur J Gynaecol Oncol 1997;18(6):523-5 Abstract quote
The aetiology and clinical significance of vulvar papillomatosis is
still controversial. To verify the association of micropapillomatosis
labialis with certain types of HPV-related lower genital tract infections,
25 patients with colposcopic aspects of vulvar papillomatosis were recruited
and vulvar biopsies were obtained for histologic examination and in
situ hybridization. Sixteen patients with vulvodynia, without any pathologic
vulvar aspects, served as a control group.
Histologic evidence of HPV was found in 20 cases (80%) of vulvar papillomatosis
while only one (4%) of the study patients was positive for HPV-DNA.
These results seem to confirm the scarse correlation between vestibular
papillomatosis and HPV.
In our opinion physicians must be cautions when treating these lesions
even in cases with positive histologic results. Colposcopy is, therefore,
of fundamental importance for an accurate diagnosis of vestibular papillomatosis
and successful management.
|
|
Human papillomavirus with co-existing vulvar vestibulitis syndrome
and vestibular papillomatosis.
Origoni M, Rossi M, Ferrari D, Lillo F, Ferrari AG.
Department of Obstetrics and Gynecology, University of Milano School
of Medicine, Italy.
|
Int J Gynaecol Obstet 1999 Mar;64(3):259-63 Abstract quote
OBJECTIVE: The role of HPV infection in cases of vulvar papillomatosis
and vulvar vestibulitis syndrome is still unclear and data from the
literature is controversial. In this study we intended to investigate
the prevalence of viral infection, with a multidisciplinary approach,
in cases with a co-existence of the two patterns.
METHOD: Sixteen consecutive cases with diagnosis of vulvar vestibulitis
syndrome and co-existence of vestibular papillomatosis were enrolled
in the study and investigated by the means of vulvar cytology, vulvoscopy,
histology, ViraPap and Polymerase Chain Reaction.
RESULT: Cytology, vulvoscopy and histology did not demonstrate suitable
accuracy for the diagnosis. Viral DNA identification revealed two (12.50%)
positive cases using PCR and one (6.25%) positive case with ViraPap.
CONCLUSION: The results of the present investigation indicate that
even in cases of co-existing vulvar papillomatosis and severe vulvar
vestibulitis syndrome, the prevalence of HPV infection is too low to
be considered causal.
|
