A case report of vulvar carcinoma in situ treated with sinecatechins with complete response
A 45-year-old female with myelodysplastic syndrome, 10 months after stem cell transplant (CD4 count 143 cell/mcL), presented her primary care physician complaining of pruritic lesions on her vulva. She had no other pertinent risk factors. Physical exam revealed erythematous papules, plaques and ulcerated lesions on the vulva. An office biopsy was obtained which showed high grade VIN and squamous cell carcinoma in situ (CIS). The patient was then referred to the gynecologic oncology service at our institution for further workup and management. She was noted to have extensive multifocal and multicentric disease (). After performing further biopsies in the operating room, all biopsy specimens were then reviewed by our gynecologic pathologists and diagnosed as Usual-type VIN, warty subtype, with HPV changes and CIS. Initially, our recommendations included wide local excision of the lesions. However, due to its multifocal involvement and need for excision of the clitoris with extensive reconstruction, more conservative alternatives were considered. We prescribed topical Imiquimod 5% ointment, twice weekly. Patient was followed every two weeks in clinic and after 8 weeks of treatment, she failed to show any clinical response. In addition, due to extreme pain with application, patient was unable to tolerate the full course, despite use of narcotics and pudendal block.\nConsequently, we prescribed Veregen® ointment, to be used three times a day for six weeks. Four weeks after start of therapy, visible improvement in the vulvar lesions was noted. The patient reported some pain and discomfort at the application sites, but stayed motivated to complete the treatment, as her lesions appeared to be resolving. At the end of 6 weeks, examination revealed complete resolution of all lesions, with mild scarring on the vulva (). Confirmatory biopsies of the scarred areas were taken and determined to be negative for dysplasia or carcinoma. She remains in remission after eleven follow up months and has resumed normal sexual function since then.