Recurrent vaginal intraepithelial neoplasia successfully treated with topical imiquimod: A case report

Abstract

Vaginal intraepithelial neoplasia (VAIN) is a rare disease associated with human papillomavirus infection. High-grade VAIN is typically treated with either excisional or ablative therapy. However, recurrent VAIN lesions are common and these treatments cause vaginal scarring. Recent studies have indicated that 5% imiquimod is an effective treatment for VAIN. The present report describes a case of a woman diagnosed with recurrent VAIN 3 who was treated with a 5% topical imiquimod cream and achieved a complete response after excision and CO₂ laser vaporization. A 53-year-old, gravida 5, para 2 postmenopausal woman who was diagnosed with papillary squamous cell carcinoma by biopsy underwent conization, total abdominal hysterectomy and bilateral salpingo-oophorectomy. A histological examination revealed grade 3 cervical intraepithelial neoplasia with free surgical margins. At 3 years after the hysterectomy, the vaginal smear revealed atypical squamous cells, leading to a pathological diagnosis of VAIN 3. Partial vaginectomy was performed, and VAIN 3 was detected in the lesion with positive margins. At 4 months into follow-up, the vaginal smear revealed a high-grade squamous intraepithelial lesion (HSIL), and subsequent biopsy during colposcopy revealed a pathological diagnosis of VAIN 3. At 3 months after CO₂ laser vaporization, the vaginal smear revealed HSIL with suspected recurrence and imiquimod treatment was initiated. One sachet of 5% imiquimod cream (0.25 g) was placed in the entire vagina three times per week for 14 weeks with no apparent complications. At 3 years after the treatment, there has been no recurrence. This case demonstrated that topical imiquimod with careful follow-up is an effective treatment for VAIN and is well-tolerated. Further clinical evidence of the effectiveness and safety of imiquimod in patients diagnosed with VAIN is required.

Keywords: imiquimod; non-surgical treatment; recurrence; side effects; vaginal intraepithelial neoplasia.

Figure 1

Biopsy of the cervical tumor. Papillary squamous cell carcinoma was observed. (A) Hematoxylin and eosin staining. Magnification, x4. (B) Hematoxylin and eosin staining. Magnification, x10.

Figure 1

Biopsy of the cervical tumor. Papillary squamous cell carcinoma was observed. (A) Hematoxylin and eosin staining. Magnification, x4. (B) Hematoxylin and eosin staining. Magnification, x10.

Figure 2

Sagittal T2-weighted MRI imaging of the pelvis. No lesion was identified.

Figure 3

Vaginal biopsy revealing atypical cells of vaginal intraepithelial neoplasia 3. (A) Hematoxylin and eosin staining in a low magnification image. Scale bar, 500 µm. (B) Hematoxylin and eosin staining in a high magnification image. Scale bar, 100 µm.

Figure 3

Vaginal biopsy revealing atypical cells of vaginal intraepithelial neoplasia 3. (A) Hematoxylin and eosin staining in a low magnification image. Scale bar, 500 µm. (B) Hematoxylin and eosin staining in a high magnification image. Scale bar, 100 µm.