Fig. 4: Differential diagnosis of HPV-independent, p53-wild-type verruciform acanthotic Vulvar Intraepithelial Neoplasia.

HPVi(p53mutant) differentiated VIN can present with prominent exophytic growth (A) and verruciform acanthosis (B, C). Attention to the basal cell layers is imperative in this differential, as HPVi(p53mutant) dVIN is characterized by loss of basal organization, nuclear enlargement, and prominent nucleoli (D, E).