Complete clinical and histopathological regression of human papillomavirus-associated vulvar high-grade squamous intraepithelial lesion following imiquimod therapy in an elderly monogamous woman
DOI:
https://doi.org/10.5327/2237-4574-246Keywords:
Vulvar HSIL, Neoplasia Intraepitelial Vulvar, HPV 16, HPV 18, HPV 45, ImiquimodeAbstract
Vulvar high-grade squamous intraepithelial lesion (vulvar HSIL) is a premalignant condition strongly associated with high-risk human papillomavirus (HPV), particularly genotypes 16, 18, and 45. Although it predominantly affects younger women, it may also occur in elderly patients due to persistent or reactivated latent HPV infection. This article describes the case of a 73-year-old woman, married for 52 years to a single lifetime partner and G3P3, who presented with persistent vulvar pruritus for eight months. Examination revealed an extensive multifocal erythroleukoplastic lesion involving the periclitoral region, labia minora, and vulvar midline. Histopathological analysis confirmed vulvar HSIL without stromal invasion, and immunohistochemistry demonstrated diffuse p16 expression. PCR testing identified concomitant infection with HPV types 16, 18, and 45. Due to the lesion's extent and the patient's desire to preserve vulvar anatomy, topical imiquimod 5% was administered three times weekly for six months. Progressive regression was observed, resulting in complete clinical remission and a negative post-treatment biopsy. After 24 months of follow-up, no clinical or histological recurrence has been detected. Topical imiquimod achieved complete clinical and histological remission of vulvar HSIL in the elderly woman, supporting its role as an effective conservative treatment option that may preserve vulvar anatomy and avoid potentially mutilating surgery.
References
Day T, Scurry J, Parra-Herran C, Fragomeni SM, Berry LK, Bevilacqua F, et al. 2026 International Society for the Study of Vulvovaginal Disease (ISSVD) terminology for vulvar intraepithelial neoplasia and squamous intraepithelial lesions. Am J Obstet Gynecol. 2026. https://doi.org/10.1016/j.ajog.2026.05.017
Ayala M, Fatehi M. Vulvar Intraepithelial Neoplasia. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2026.
Preti M, Scurry J, Marchitelli CE, Micheletti L. Vulvar intraepithelial neoplasia. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1051-62. https://doi.org/10.1016/j.bpobgyn.2014.07.010
Gravitt PE, Winer RL. Natural History of HPV Infection across the Lifespan: Role of Viral Latency. Viruses. 2017;9(10):267. https://doi.org/10.3390/v9100267
Rositch AF, Burke AE, Viscidi RP, Silver MI, Chang K, Gravitt PE. Contributions of cquisi and past sexual partnerships on cquisiti human cquisitions detection: cquisition and reactivation in older women. Cancer Res. 2012;72(23):6183-90. https://doi.org/10.1158/0008-5472.can-12-2635
van Seters M, van Beurden M, ver Kate FJ, Beckmann I, Ewing PC, Eijkemans MJ, et al. Treatment of vulvar intraepithelial neoplasia with topical imiquimod. N Engl J Med. 2008;358(14):1465-73. https://doi.org/10.1056/nejmoa072685
Lawrie TA, Nordin A, Chakrabarti M, Bryant A, Kaushik S, Pepas L. Medical and surgical interventions for the treatment of usual-type vulval intraepithelial neoplasia. Cochrane Database Syst Rev. 2016;2016(1):CD011837. https://doi.org/10.1002/14651858.CD011837.pub2
Pepas L, Kaushik S, Nordin A, Bryant A, Lawrie TA. Medical interventions for high-grade vulval intraepithelial neoplasia. Cochrane Database Syst Rev. 2015;2015(8):CD007924. https://doi.org/10.1002/14651858.cd007924.pub3
