Definition / general

 Differentiated vulvar intraepithelial neoplasia (dVIN) is the putative

precursor lesion of HPV independent vulvar squamous cell carcinoma
o Subtypes: differentiated exophytic vulvar intraepithelial lesion (DEVIL)
and vulvar acanthosis with altered differentiation (VAAD) with currently
unknown prognosis but potential to develop carcinoma.
Microscopic (histologic) description
 Mild to moderate atypical cells in basal and parabasal layers with
hyperchromatic nuclei, lacks full thickness atypia
 Enlarged squamous cells with eosinophilic cytoplasm, vesicular
nuclei and prominent nucleoli, prominent intercellular bridges
 Acanthosis, parakeratosis, elongation and anastomosis of rete ridges
(Histopathology 2020;76:128)
 Rare basaloid differentiation with atypical cells in upper cell layers
(Am J Surg Pathol 2009;33:1659)
 DEVIL: exophytic verruciform lesion with acanthosis; no basal atypia,
no koilocytosis (Mod Pathol 2017;30:448)
 VAAD: verruciform acanthosis, parakeratosis, absence of nuclear atypia, cytoplasmaic pallor cells in upper layers (Am J Surg Pathol 2004;28:638)

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