| Lower genital tract intraepithelial neoplasia refers to vulval intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN). It is a term according to the pathological features of the lower genital tract diseases. It was named by the international genital diseases Association (ISSVD) in 1986. There are three levels : mild dysplasia (grade 1), moderate dysplasia (grade 2), severe dysplasia, or carcinoma in situ (grade 3). At present, the clinical research of vulval and vaginal cancer base on the development of the pathology of intraepithelial neoplasia-situ-invasive. Although there may be over 10 years of sustainable disease, but once the invasive lesions appeared and lymphoid interstitial infiltration, tumors will progress rapidly. So intraepithelial neoplasia is regard as premalignant lesions. This has caused great alarm to patients, resulting in the disorders of treatment. To establish the norms of diagnosis, treatment and follow-up of VIN and VAIN, becomes the focus of prevention and treatment of reproductive tract tumors. The average age of such diseases becomes younger. Young patients require a higher quality of life on the basis of precise effects in the treatment. Some treatment measures, such as operation or physical therapy, which affect the appearance and function of the vulva and vagina, are not used easily. Local conservative treatment becomes the first choice of the two precancerous lesions.The etiological factors are still not very clear. Previous study found that chronic vulvar dystrophy lesions had increased metabolic rate and the 32P absorption test showed the equal absorption rate to the cancer in situ. It wasthought there was an imbalance between kolyone and the stimulus of metabolism. More and more evidence shows VAIN, CIN ,VIN and primary genital squamous cell carcinoma has close relationship with HPV infection and these diseases may also coexist. E6 and E7 genes are transforming genes in the HPV open reading frame. They can intagrat with the host cell DNA. Then HPV E6 and E7 gene's expression will be out of control. E6 protein combines P53 gene's product and make it deactivated. These developments cause anti-oncogene function disappear and lead to a oncogene's role. It has been reported that the keratinocyte cells may become immortalization after the transfection of the high-risk HPV E6 and E7 genes. While immortalization is considered to be a step in the development of a malignant. VIN whose symptoms are frequent itching, skin elasticity decreased, pigment depletion or other symptoms subside, has got the long history of research and treatments. For VAIN, whose symptoms are not obvious, the incidence rate is about 25% of the intraepithelial neoplasia in low reproductive tract. There is still a lack of experience in clinical data and treatment measures.5-FU has effect on the S-phase cells. Its anti-tumor activities are low but long-lasting. The drug not only inhibited the proliferation of viral infectious cells but also blocked the viral DNA replication and the synthesis of the protein shells. Its role is both directly and indirectly on virus. On the basis of the anti-metabolism of both virus and cells multiplication, we retrospectively analyzed the application of 5-FU on 25 VIN patients (include 7 CIN coexisted patients ) to evaluate the long-term effects of the method. We also use this method to treat four cases with this disease to observe the recent effect. With these experience, we focus on the two cases of VAIN3 the clinicalmanifestations and pathological performances and discuss the results of the treatment by using topical injection of 5-FU.Local injection method of 5-FU is to use the injection 50mg-75mg (2-3ml) with small needles (the 5th) to inject subcutaneous for 3-4 points, depth about 2-3mm.The lesions of vaginal mucosa or vulval skin were disinfected before. Every other day, 10 times a course, each course interval is 7-10 days. Before the next course of treatment, with the naked eyes or colposcope, we chose the most serious appearance point or the near areas of last biopsy to get new biopsies and confirm the efficacy. This study shows that the efficiency is 100% and the cure rate is 84% while using this method to treat VIN. And the recurrence rate is also low up to three years. We also satisfied with the outcome of the recent cases treated. Symptoms improved significantly after the treatment. Pathological examination showed thinning prickle cell thickness. Shallow or middle dermal inflammatory response was reduced significantly or disappear. The caryocinesia of VIN decreased and in the lower position within the epithelium. Differentiation of cells are maturation. Before the treatment heterotypic epithelial cells accounted for around one-third, while no obvious heterotypic epithelial cells after treatment. Two cases of VAIN3 after hysterectomy because of uterine cervix cancer Ia, their cytologic tests before and after treatment were all negative. The acetic acid test and iodine test results indicated the extent of lesions. In this study, two cases of the disease had typical performances under colposcopy. Before treatment, white epithelial regions are lamellar and these distributions mainly in the up-third of the vagina, atypical spot vessels can be seen and negative stained areas with iodine test, mainly distributed in the anterior ends. Colposcopy diagnosed that it was to be suspicious of cancer. Wegot several biopsies above and around the iodine test negative regions. During the treatment, abnormal regions gradually narrowed and finally distributed like small points. The atypical vascular disappeared. Pathological examination showed heterotypic epithelial cells reduced and near the basal body. The caryocinesia reduced. Differentiation of cells are maturation. The following conclusions can be drawn from the above: 1.Local injection of 5-FU to treat VIN is effective. Its side effects are few. The course is short. The recurrence rate is low. And the method is convenient. It is worth to continue to apply. 2. The diagnosis of VAIN depends on the histopathologic examination. Colposcopy can improve the accuracy of biopsies. It has no specific symptoms and signs, and the cytology-positive rate is low. 3. VAIN3 patients received 5-FU injection, their histological abnormalities can be reversed, with no pain and no side effects. It is a new method to choose of conservative treatment for the disease. 4.Once one kind of reproductive tract intraepithelial neoplasia or cancer was found, we should pay attention to other kinds of reproductive tract cancer or precancerous lesions.
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