1. Department of Gynaecology and Obstetrics
HPV VACCINATION
Leonardo Micheletti, M.D.
Department of Gynaecology and Obstetrics
University of Torino
No disclosures or conflicts of interest

2. Garland et al. N Eng J Med 2007

3. LOWER FEMALE GENITO-ANAL TRACT Cervical Squamo-Columnar Junction
Starts from the
Cervical Squamo-Columnar Junction
Ends at the Anorectal Pectinate Line
Transition from Squamous to Columnar Epithelium

4. LOWER FEMALE GENITO-ANAL TRACT SAME SQUAMOUS EPITHELIUM
ANATOMOBIOLOGIC
UNIT
DIFFERENT ORGANS
SAME SQUAMOUS EPITHELIUM
MUCOSAL / CUTANEOUS
HPV
ACTION-FIELD
REGARDLESS OF
the SITE of the LESION

5. LOWER FEMALE GENITAL TRACT
a continuum of squamous epithelium from the cervix to the vulva
commonly infected by HPV
the outcome depends on
Viral Genotype
Low Risk HPV 6 and 11
Benigne Lesions
High Risk HPV 16, 18, …
Malignant Lesions
Site of infection
Cervical Squamocolumnar Junction
more susceptible to HPV disease
Vaginal cancer 20 times Vulval cancer 6 times
Less common than Cervical cancer
Cutaneous epithelium less susceptible to oncogenic HPV
compared to mucosal epithelium
CERVIX
> 95 %
VAGINA
80-95 %
VULVA
< 50 %

6. HPV interacts with squamous epithelia in 2 basic ways
Benigne Transient Lesions
Precancerous Lesions
Histopathologic Terminology of HPV-associated lesions
of the lower genito-anal tract
remains disparate, complex, and clinically confusing
low grade lesions,
grade 1 intraepithelial neoplasia
mild dysplasia
condyloma
high grade lesions
grade 2-3 intraepithelial neoplasia
moderate-severe dysplasia
carcinoma in situ
Bowen disease/papulosis
Erithroplasia of Queyrat
2 different interest groups
focusing on specific body sites
Gynaecologists
and
Gynaecologic Pathologists
Dermatologists
and
Dermatopathologists

7. International Journal of Gynecological Pathology
2012; 32:76-115
In 2012 a new terminology for HPV-associated lesions has been published in the International Journal of Gynecological Pathology

8. Lower Anogenital Squamous Terminology
LAST
Specifically created for human papillomavirus (HPV)-associated squamous lesions
of the lower anogenital tract
in order to
Overcome the disparate diagnostic terms derived from multiple specialties
Reflect the current HPV biology and pathogenesis knowledge
Facilitate clear communication across different medical specialties
This new terminology known as LAST has been Specifically created for human papillomavirus (HPV)-associated squamous lesions of the lower anogenital tract both for men and women
in order to
Overcome the disparate diagnostic terms derived from multiple specialties
Reflect the current HPV biology and pathogenesis knowledge and
Facilitate clear communication across different medical specialties
With the final goal to
Improve accuracy of histologic diagnosis and Provide optimal patient care
Facilitating
Communication between pathologists and their clinical colleagues
goal
Improve accuracy of histologic diagnosis and Provide optimal patient care
Facilitating
Communication between pathologists and their clinical colleagues

9. MULTICENTRIC INTRAEPITHELIAL NEOPLASIA
E. T. 36 years
LOWER GENITO-ANAL TRACT
MULTICENTRIC INTRAEPITHELIAL NEOPLASIA
HPV-Related
CIN 3
VIN 2 – 3
VHSIL
AIN 2 – 3
AHSIL
CHSIL
Lacking VaIN
VaHSIL

10. histologically, biologically, and clinically differents
2004 ISSVD terminology for vulvar intraepithelial neoplasia
2 types of VIN
histologically, biologically, and clinically differents
Usual type,
caused by HPV
Differentiated type,
not caused by HPV
Younger patient
Older patient
Less aggressive
More aggressive
Condylomatous aspect
Lichen sclerosus context
Multifocal
Unifocal

11. useful The outcome of HPV infection depends on
Viral Genotype and Site Infection
VAGINA
VULVA
Low Risk HPV 6 and 11
Benigne Lesions , Common
Low Risk HPV 6 and 11
GWs most commonly STI
per 100,000
High Risk HPV 16, 18, …
High Risk HPV 16, 18, …
Malignant Lesions, Rare,
20 times less common
than the cervix.
Malignant Lesions, Rare,
6 times less common
than the cervix
80-95 % HPV-related
50 % HPV-related
50 % Not HPV-related
Primary Prevention through HPV Vaccination
useful
Psychological distress control
Management economic burden

12. vaccination programme
Sex Transm Infect 2011;87:544-7
4 years after the
national HPV
vaccination programme
dramatic decline and
near disappearance
of GW
in women and men
under 21 years

13. Joura et al. 2015, ACIP 27 March 2015

14. can dramatically reduce diagnostic and treatment costs
The economic burden of noncervical HPV disease is substantial
HPV Vaccination, by protecting both female and male from HPV infection,
can dramatically reduce diagnostic and treatment costs