oncopatОнкопатологияONCOPATHOLOGY2618-70193034-353410.17650/2618-7019-2025-8-3-35-40oncopat-50Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHВозможности цитологической диагностики при поражениях вульвыCapabilities of diagnostic cytology in vulvar lesionshttps://orcid.org/0000-0002-6743-9574КулешоваС. В.KuleshovaS. V.

Светлана Вячеславовна Кулешова

119146 Москва, ул. 2-я Фрунзенская, 4, стр. 1

125371 Москва, Волоколамское ш., 91

Svetlana Vyacheslavovna Kuleshova

Build. 1, 4 2 nd Frunzenskaya St., Moscow 119146

91 Volokolamskoye Shosse, Moscow 125371

svkul@list.ruМухараеваА. Д.MukharaevaA. D.

119146 Москва, ул. 2-я Фрунзенская, 4, стр. 1

Build. 1, 4 2 nd Frunzenskaya St., Moscow 119146

ДворецкаяЕ. В.DvoretskayaE. V.

119146 Москва, ул. 2-я Фрунзенская, 4, стр. 1

Build. 1, 4 2 nd Frunzenskaya St., Moscow 119146

https://orcid.org/0000-0002-4203-3586МинушкинаЛ. О.MinushkinaL. O.

119146 Москва, ул. 2-я Фрунзенская, 4, стр. 1

121359 Москва, ул. Маршала Тимошенко, 19, стр. 1А

Build. 1, 4 2 nd Frunzenskaya St., Moscow 119146

Build. 1A, 19 Marshala Timoshenko St., Moscow 121359

ФГБУ «Поликлиника № 2» Управления делами Президента РФ; Академия постдипломного образования ФГБУ «ФНКЦ специализированных видов медицинской помощи и медицинских технологий ФМБА России»РоссияPolyclinic No. 2, Administration of the President of the Russian Federation; Academy of Postgraduate Education, Federal Medical and Biological AgencyRussian FederationФГБУ «Поликлиника № 2» Управления делами Президента РФРоссияPolyclinic No. 2, Administration of the President of the Russian FederationRussian FederationФГБУ «Поликлиника № 2» Управления делами Президента РФ; ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФРоссияPolyclinic No. 2, Administration of the President of the Russian Federation; Central State Medical Academy, Administration of the President of the Russian FederationRussian Federation202521092026833540Copyright © Кулешова С.В., Мухараева А.Д., Дворецкая Е.В., Минушкина Л.О., 20262026Кулешова С.В., Мухараева А.Д., Дворецкая Е.В., Минушкина Л.О.Kuleshova S.V., Mukharaeva A.D., Dvoretskaya E.V., Minushkina L.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://oncopat.elpub.ru/jour/article/view/50

Несмотря на свою редкость, рак вульвы сохраняет высокий потенциал для ухудшения качества жизни пациенток и ставит серьезные клинические задачи перед специалистами.

Одной из центральных задач современной онкологии является повышение эффективности методов раннего выявления и мониторинга рака вульвы. Важнейшим инструментом для решения этой задачи выступает цитологическая диагностика, основанная на анализе клеточного материала, полученного непосредственно из зоны предполагаемого очага поражения. Цитологический метод занимает центральное место в арсенале инструментов диагностики благодаря высоким чувствительности и специфичности, позволяющим уверенно распознавать ранние признаки трансформации нормального эпителия в раковую ткань.

Despite its rarity, vulvar cancer retains a high potential for reducing the quality of life of patients and poses serious challenges for doctors.

One of the central tasks of modern oncology is to improve efficiency of methods of early detection and monitoring of vulvar cancer. The most important instrument in solving this problem is diagnostic cytology based on the analysis of cellular material obtained directly from the area of the suspected lesion. The cytologic method is the most important diagnostic tool due to its high sensitivity and specificity, allowing to confidently recognize early signs of the transformation of normal epithelium into cancerous tissue.

рак вульвыцитологическое исследованиевульварная интраэпителиальная неоплазия (VIN)дифференцированная вульварная интраэпителиальная неоплазия (dVIN )высокодифференцированное плоскоклеточное интраэпителиальное поражение (HSIL)vulvar cancerdiagnostic cytologyvulvar intraepithelial neoplasia (VIN )differentiated vulvar intraepithelial neoplasia (dVIN)high-grade squamous intraepithelial lesion (HSIL)ReferencesMoberg L., Sundqvist A., Holmberg E. et al. Vulvar cancer incidence and netsurvival in Sweden 1960 to 2019: a populationbased national study. Acta Obstet Gynecol Scand 2024;103:561–71. DOI: 10.1111/aogs.14747Moberg L., Sundqvist A., Holmberg E. et al. Vulvar cancer incidence and netsurvival in Sweden 1960 to 2019: a populationbased national study. Acta Obstet Gynecol Scand 2024;103:561–71. DOI: 10.1111/aogs.14747Berek J.S., Hacker N.F. Practical gynecologic oncology. Philadelphia: Lippincott Williams & Wilkins, 2015. Chapter 13. Pp. 313–332.Berek J.S., Hacker N.F. Practical gynecologic oncology. Philadelphia: Lippincott Williams & Wilkins, 2015. Chapter 13. Pp. 313–332.Пахарукова М.И., Южакова И.С., Лагерева Ю.Г., Бейкин Я.Б. Плоскоклеточный рак вульвы: значение определения ВПЧ-статуса опухоли. Вестник уральской медицинской академической науки 2021;18(2):147–60. DOI: 10.22138/2500-0918-2021-18-2-147-160Pakharukova M.I., Yuzhakova I.S., Lagereva Yu.G., Beykin Ya.B. Vulvar squamous cell carcinoma: the relevance of tumor HPV-status. Vestnik uralskoy meditsinskoy akademicheskoy nauki = Journal of Ural Medical Academic Science 2021;18(2):147–60. (In Russ.). DOI: 10.22138/2500-0918-2021-18-2-147-160Злокачественные новообразования в России в 2023 году (заболеваемость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой. М.: МНИОИ им. П.А. Герцена – филиала ФГБУ «НМИЦ радиологии» Минздрава России, 2024.Malignant neoplasms in Russia in 2023 (morbidity and mortality). Ed. by A.D. Kaprin, V.V. Starinskу, A.O. Shakhzadova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2024. (In Russ.).Bray F., Colombet M., Mery L. et al. Cancer incidence in five continents. Vol. XI. Lyon, France: International Agency for Research on Cancer, 2017. Available at: https://ci5.iarc.frBray F., Colombet M., Mery L. et al. Cancer incidence in five continents. Vol. XI. Lyon, France: International Agency for Research on Cancer, 2017. Available at: https://ci5.iarc.frFritz A., Percy C., Jack A. et al. International classification of diseases for oncology (ICD-O). 3rd ed. Lyon, France: International Agency for Research on Cancer, 2021. Available at: https://virtualtumourbank.kankerregister.org/media/docs/Projecten/Biobank/ICDO-3Englishfirstrevision-withupdate.pdfFritz A., Percy C., Jack A. et al. International classification of diseases for oncology (ICD-O). 3rd ed. Lyon, France: International Agency for Research on Cancer, 2021. Available at: https://virtualtumourbank.kankerregister.org/media/docs/Projecten/Biobank/ICDO-3Englishfirstrevision-withupdate.pdfZhou W.L., Yue Y.Y. Trends in the incidence of vulvar and vaginal cancers with different histology by race, age, and region in the United States (2001–2018). Int J Public Health 2022;67:1605021. DOI: 10.3389/ijph.2022.1605021Zhou W.L., Yue Y.Y. Trends in the incidence of vulvar and vaginal cancers with different histology by race, age, and region in the United States (2001–2018). Int J Public Health 2022;67:1605021. DOI: 10.3389/ijph.2022.1605021Li Zh., Liu P., Wang Z. et al. Prevalence of human papillomavirus DNA and p16INK4a positivity in vulvar cancer and vulvar intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol 2023;24(4):403–14. DOI: 10.1016/S1470-2045(23)00066-9Li Zh., Liu P., Wang Z. et al. Prevalence of human papillomavirus DNA and p16INK4a positivity in vulvar cancer and vulvar intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol 2023;24(4):403–14. DOI: 10.1016/S1470-2045(23)00066-9Ganovska A., Kovachev S. Мulvar intraepithelial neoplasia – terminology, symptoms and treatment. Akush Ginekol (Sofiia) 2015;54(7):36–40. (In Bulgarian). PMID: 27025107.Ganovska A., Kovachev S. Мulvar intraepithelial neoplasia – terminology, symptoms and treatment. Akush Ginekol (Sofiia) 2015;54(7):36–40. (In Bulgarian). PMID: 27025107.Пахарукова М.И., Южакова И.С., Горчаковская Е.С. и др. Особенности диагностики ВПЧ-статуса плоскоклеточной карциномы вульвы. Патогенез 2023;21(1):54–61. DOI: 10.25557/2310-0435.2023.01.54-61Pakharukova M.I., Yuzhakova I.S., Gorchakovskaya E.S. et al. Features of diagnostics of HPV status of squamous cell carcinoma of the vulva. Patogenez = Pathogenesis 2023;21(1):54–61. (In Russ.). DOI: 10.25557/2310-0435.2023.01.54-61Pakharukova M.I., Yuzhakova I.S., Gorchakovskaya E.S. et al. Features of diagnostics of HPV status of squamous cell carcinoma of the vulva. Patogenez = Pathogenesis 2023;21(1):54–61. (In Russ.). DOI: 10.25557/2310-0435.2023.01.54-61Darré T., Sama B., Djiwa T. et al. Factors associated with vulvar cancer from 2005 to 2021 in Togo, sub-Saharan Africa. BMC Women’s Health 2023;23(1):514. DOI: 10.1186/s12905-023-02669-6Darré T., Sama B., Djiwa T. et al. Factors associated with vulvar cancer from 2005 to 2021 in Togo, sub-Saharan Africa. BMC Women’s Health 2023;23(1):514. DOI: 10.1186/s12905-023-02669-6Van der Meijden W.I., Boffa M.J., Ter Harmsel B. et al. 2021 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2022;36(7):952–72. DOI: 10.1111/jdv.18102Van der Meijden W.I., Boffa M.J., Ter Harmsel B. et al. 2021 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2022;36(7):952–72. DOI: 10.1111/jdv.18102Hellman K., Holmberg E., Bjurberg M. et al. Primary treatmentand relative survival by stage and age in vulvar squamous cellcarcinoma: a population-based SweGCG study. Gynecol Oncol 2020;159(3):663–71. DOI: 10.1016/j.ygyno.2020.09.027Hellman K., Holmberg E., Bjurberg M. et al. Primary treatmentand relative survival by stage and age in vulvar squamous cellcarcinoma: a population-based SweGCG study. Gynecol Oncol 2020;159(3):663–71. DOI: 10.1016/j.ygyno.2020.09.027Kumar N., Ray M.D., Sharma D.N. et al. Vulvar cancer: surgical management and survival trends in a low resource setting. J Egypt Natl Canc Inst 2020;32(1):4. DOI: 10.1186/s43046-019-0015Kumar N., Ray M.D., Sharma D.N. et al. Vulvar cancer: surgical management and survival trends in a low resource setting. J Egypt Natl Canc Inst 2020;32(1):4. DOI: 10.1186/s43046-019-0015Singh N., Gilks C.B. Vulval squamous cell carcinoma and its precursors. Histopathology 2020;76(1):128–38. DOI: 10.1111/his.13989Singh N., Gilks C.B. Vulval squamous cell carcinoma and its precursors. Histopathology 2020;76(1):128–38. DOI: 10.1111/his.13989Heller D.S., Day T., Allbritton J.I. et al. Diagnostic criteria for differentiated vulvar intraepithelial neoplasia and vulvar aberrant maturation. J Low Genit Tract Dis 2021;25(1):57–70. DOI: 10.1097/LGT.0000000000000572Heller D.S., Day T., Allbritton J.I. et al. Diagnostic criteria for differentiated vulvar intraepithelial neoplasia and vulvar aberrant maturation. J Low Genit Tract Dis 2021;25(1):57–70. DOI: 10.1097/LGT.0000000000000572Steinkasserer L., Hachenberg J., Hillemanns P., Jentschke M. Characterization of patients with vulvar lichen sclerosus and association to vulvar carcinoma: a retrospective single center analysis. Arch Gynecol Obstet 2023;307(6):1921–8. DOI: 10.1007/s00404-022-06848-ySteinkasserer L., Hachenberg J., Hillemanns P., Jentschke M. Characterization of patients with vulvar lichen sclerosus and association to vulvar carcinoma: a retrospective single center analysis. Arch Gynecol Obstet 2023;307(6):1921–8. DOI: 10.1007/s00404-022-06848-yPils S., Gensthaler L., Alemany L. et al. HPV prevalence in vulvar cancer in Austria. Wien Klin Wochenschr 2017;129(21–22):805–9. DOI: 10.1007/s00508-017-1255-2Pils S., Gensthaler L., Alemany L. et al. HPV prevalence in vulvar cancer in Austria. Wien Klin Wochenschr 2017;129(21–22):805–9. DOI: 10.1007/s00508-017-1255-2Cohen P.A., Anderson L., Eva L., Scurry J. Clinical and molecular classification of vulvar squamous pre-cancers. Int J Gynecol Cancer 2019;29(4):821–8. DOI: 10.1136/ijgc-2018-000135Cohen P.A., Anderson L., Eva L., Scurry J. Clinical and molecular classification of vulvar squamous pre-cancers. Int J Gynecol Cancer 2019;29(4):821–8. DOI: 10.1136/ijgc-2018-000135Bigby S.M., Eva L.J., Fong K.L., Jones R.W. The natural history of vulvar intraepithelial neoplasia, differentiated type: evidence for progression and diagnostic challenges. Int J Gynecol Pathol 2016;35(6):574–84. DOI: 10.1097/PGP.0000000000000280Bigby S.M., Eva L.J., Fong K.L., Jones R.W. The natural history of vulvar intraepithelial neoplasia, differentiated type: evidence for progression and diagnostic challenges. Int J Gynecol Pathol 2016;35(6):574–84. DOI: 10.1097/PGP.0000000000000280Leis M., Singh A., Li C. et al. Risk of vulvar squamous cell carcinoma in lichen sclerosus and lichen planus: a systematic review. J Obstet Gynaecol Can 2022;44(2):182–92. DOI: 10.1016/j.jogc.2021.09.023Leis M., Singh A., Li C. et al. Risk of vulvar squamous cell carcinoma in lichen sclerosus and lichen planus: a systematic review. J Obstet Gynaecol Can 2022;44(2):182–92. DOI: 10.1016/j.jogc.2021.09.023McAlpine J.N., Leung S.C.Y., Cheng A. et al. Human papillomavirus (HPV)-independent vulvar squamous cell carcinoma has a worse prognosis than HPV-associated disease: a retrospective cohort study. Histopathology 2017;71(2):238–46. DOI: 10.1111/his.13205McAlpine J.N., Leung S.C.Y., Cheng A. et al. Human papillomavirus (HPV)-independent vulvar squamous cell carcinoma has a worse prognosis than HPV-associated disease: a retrospective cohort study. Histopathology 2017;71(2):238–46. DOI: 10.1111/his.13205De Luca D.A., Papara C., Vorobyev A. et al. Lichen sclerosus: the 2023 update. Front Med (Lausanne) 2023;10:1106318. DOI: 10.3389/fmed.2023.1106318De Luca D.A., Papara C., Vorobyev A. et al. Lichen sclerosus: the 2023 update. Front Med (Lausanne) 2023;10:1106318. DOI: 10.3389/fmed.2023.1106318Krapf J.M., Mitchell L., Holton M.A., Goldstein A.T. Vulvar lichen sclerosus: current perspectives. Int J Women’s Health 2020;12:11–20. DOI: 10.2147/IJWH.S191200Krapf J.M., Mitchell L., Holton M.A., Goldstein A.T. Vulvar lichen sclerosus: current perspectives. Int J Women’s Health 2020;12:11–20. DOI: 10.2147/IJWH.S191200Kaderly Rasmussen E.L., Hannibal C.G., Hertzum-Larsen R. et al. Biopsy-verified vulvar lichen sclerosus and the risk of non-vulvar cancer: a nationwide cohort study. Int J Cancer 2024;155(10):1714–20. DOI: 10.1002/ijc.35101Kaderly Rasmussen E.L., Hannibal C.G., Hertzum-Larsen R. et al. Biopsy-verified vulvar lichen sclerosus and the risk of non-vulvar cancer: a nationwide cohort study. Int J Cancer 2024;155(10):1714–20. DOI: 10.1002/ijc.35101Pakharukova M.I., Yushkov B.G., Beykin Ya.B. Precursors, pathways of carcinogenesis and molecular markers of squamous cell carcinoma of the vulva. Literature review. Acta Biomed Sci 2023;8(1):117–26. (In Russ.). DOI: 10.29413/ABS.2023-8.1.13Пахарукова М.И., Юшков Б.Г., Бейкин Я.Б. Предшественники, пути канцерогенеза и молекулярные маркеры плоскоклеточной карциномы вульвы. Литературный обзор. Acta Biomed Sci 2023;8(1):117–26. DOI: 10.29413/ABS.2023-8.1.13Eva L.J., Sadler L., Fong K.L. et al. Trends in HPV-dependent and HPV-independent vulvar cancers: the changing face of vulvar squamous cell carcinoma. Gynecol Oncol 2020;157(2):450–5. DOI: 10.1016/j.ygyno.2020.01.029Eva L.J., Sadler L., Fong K.L. et al. Trends in HPV-dependent and HPV-independent vulvar cancers: the changing face of vulvar squamous cell carcinoma. Gynecol Oncol 2020;157(2):450–5. DOI: 10.1016/j.ygyno.2020.01.029Hartsough E.M., Nazarian R.M., Watkins J.C. CK17 immunohistochemistry is a useful adjunct in the diagnosis of HPV-independent, TP53-wild-type verruciform/acanthotic vulvar intraepithelial neoplasia (vaVIN). Am J Surg Pathol 2025;49(7):658–62. DOI: 10.1097/PAS.0000000000002383Hartsough E.M., Nazarian R.M., Watkins J.C. CK17 immunohistochemistry is a useful adjunct in the diagnosis of HPV-independent, TP53-wild-type verruciform/acanthotic vulvar intraepithelial neoplasia (vaVIN). Am J Surg Pathol 2025;49(7):658–62. DOI: 10.1097/PAS.0000000000002383Hartsough E.M., Nazarian R.M., Watkins J.C. CK17 immunohistochemistry is a useful adjunct in the diagnosis of HPV-independent, TP53-wild-type verruciform/acanthotic vulvar intraepithelial neoplasia (vaVIN). Am J Surg Pathol 2025;49(7):658–62. DOI: 10.1097/PAS.0000000000002383

The authors declare that there are no conflicts of interest present.