MIN(Multicentric intraepithelial neoplasia)

Intraepithelial neoplastic changes seen at more than one site in lower
genital tract.
The sites involve are the cervix, vagina, vulva, perineum, and anal canal.
The aetiology of MIN is the combination of HPV Infection and host immune
suppression of varying degrees.
MIN may be detected in a woman who has repeated abnormal smear despite
treatment for CIN, in a woman being examined for VIN, or an HIV positive
woman.
There are no guidelines for treating this disease. MIN must be treated in
large centres to concentrate experience and expertise.
Cases are complex and chronic. Some women have already undergone repeated
surgery over years.
Investigations must be individualized and may include multiple colposcopic
directed biopsies, HPV typing, HIV testing and test of T cell function.
Management aims to exclude invasive cancer, to control symptoms, and to
preserve anatomy and functional integrity where possible.
New immunomodulating therapies currently under investigations such as
therapeutic vaccination and imiquimod.