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

Sasagasako,Nanayo; Kosaka,Kenzo; Sagae,Yusuke; Itoh,Kunitoshi; Aratake,Junichi; Yamada,Kaori; Inayama,Yoshihide; Gou,Rei; Kawamura,Atsuko; Yamanishi,Megumi; Yamanishi,Yukio; Suzuki,Makoto; Arai,Kazumori

doi:10.3892/mco.2020.2089

September-2020 Volume 13 Issue 3

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September-2020 Volume 13 Issue 3

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Case Report

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

Authors:
- Nanayo Sasagasako
- Kenzo Kosaka
- Yusuke Sagae
- Kunitoshi Itoh
- Junichi Aratake
- Kaori Yamada
- Yoshihide Inayama
- Rei Gou
- Atsuko Kawamura
- Megumi Yamanishi
- Yukio Yamanishi
- Makoto Suzuki
- Kazumori Arai
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Affiliations: Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka 420‑8527, Japan, Department of Pathology, Shizuoka General Hospital, Shizuoka 420‑8527, Japan
Article Number: 19
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Published online on: July 13, 2020

https://doi.org/10.3892/mco.2020.2089
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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.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

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

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