Vulvar - Differentiated VIN 2 Biopsy

Sorry for the length, but I didn't want to be incomplete on the chance I’ll find someone who knows about this.  After researching this, I’ve found very little information on Differentiated VIN.  I’m hoping to finally find someone who has some information.  I certainly don’t expect answers to all my questions and appreciate any information/experiences you can share.  Thanks for your help!   My daughter is a sexually active 20 year old college student (she's leaving the initial research on this up to me- probably better with all the possibilities you see on the internet).  For at least the past 5 years she has had almost chronic issues with vulvar itching.  She has been on many creams for Yeast Infections as well as about 10 cases of Bacterial Vaginosis (maybe more since she has to travel home from college to get to our GYN which doesn't always happen).  Last year our OBGYN finally sent her to a GYN Specialist, at the time she finally got in for her appointment he told her she didn't have BV right then and come back when she did.  She had an episode of bloody diarrhea this past winter and after a clear upper GI scan, and colonoscopy in January they found a clear polyp and an adenomas nodule (precancerous) which were removed.  She also has been having urinary issues (urge to go) so our GP sent her to a Urologist and she's currently taking Detrol. After continued itching issues I insisted on another appointment with the GYN Specialist this January and we saw his associate.  He diagnosed her with Vulvar Vestibulitis and gave her Lidocaine to numb the area, incidentally he suggested she start Gardisil shots, which she's now completed.  A few weeks ago she was back to our GYN and she pointed out a few (3-4) "bumps under the skin- haired area, both sides".  They biopsied one bump and didn’t mention any skin changes in the area (none mentioned on the GYN report).  The bio! psy came back with VIN 2, and I've scheduled her to see another Specialist at the same Hospital in mid-August (I'm told this one has some experience with Oncology and knows about VIN).  The GYN told me they would probably laser the bumps off. BTW she had a negative PAP last summer and tells me she's had recent HIV/STD screening, all negative, and she’s always been a non-smoker. I'm a Mom who WANTS to know as much as possible before we go in.  I've got a copy of the Pathology report now and after doing days of research online I still have questions.   FINAL PATHOLOGY: Focal Vulvar Intraepithelial Neoplasia (VIN 2), Differentiated Type.  Epidermal Cyst.  Ki-67: Positive Staining into Parakeratotic Layer. P-16: Positive Patch Cytoplasmic and Nuclear Staining.  The detail says the epidermal cyst-benign, underlying the dysplastic epithelium is negative for p16.  It mentions a rare mitotic figure in the middle third of the epidermis, as well as the P-16 and few koilocytic cells support a high-risk HPV infection.  Findings consistent with a localized high grade squamous intraepithelial lesion or VIN 2.   My/others interpretation of the Pathology is that she has the Differentiated type of VIN not usual/classic warty HPV, but the smooth non-HPV related kind (although Pathology shows she has HPV).  The “bumps” are benign cysts and the VIN was only found in the skin above the the cyst so it sounds like the cysts are unrelated.  So it sounds like they found the VIN by accident while doing the biopsy for the cyst. MY QUESTIONS:1. Is it likely that the precancerous nodule found in her colon and this are related (2 precancerous areas in 6 months)...and should we be seeing an Oncologist to put this all together (I called our GP and they said no, they're probably unrelated)?2. From the report, she has the Differentiated type which everyone says is not caused by HPV, although she obviously has HPV from the Patholog! y report .  Is there a reason to test for which type of HPV she has?  Are these (her HPV and VIN) really unrelated?3. Are there other tests she should have to look for cancer/cysts in other areas- PAP (not due for one until fall), mammogram (she now tells me she's had a few small bumps between her breast/armpit for about 5 years.  I/Mom have many breast cysts-they say benign.), other scans?4.  After hearing about the cysts, I was expecting it to be the HPV genital warts, but I immediately asked our GYN if the Pathology showed genital warts, but she confirmed she spoke to the Pathologist and it was a epidermal cysts and not the warts.  The Pathology report says the cyst is benign.  Does this mean the cysts are really unrelated and the VIN is just in the surface skin above it?  If so, it sounds like she was lucky they found this at all (just an accident?)?!  5. I don't know what the treatment will be, but it doesn't sound like laser is the way to go.  I'm reading since she has the bumps in haired areas that excision or LEEP may be better?  Isn't it always better to be able to get the pathology, which is destroyed with laser/freezing?6. It sounds like there's a large correlation with finding this differentiated VIN adjacent to areas with Vulvar Cancer.  Is just removing the other cysts going to be enough?  If she really doesn't have any skin changes and just the cysts below, how can they find it all?7. Since they also call this Differentiated type "Simplex".  Does this mean it has anything to do with Herpes Simplex?  The only thing I've read is a correlation with the Usual VIN and having Herpes Simplex in some, but no mention with Differentiated.8. The VIN Differentiated sounds like it's VERY unusual (reading 2-10% of all VIN) and EXTREMELY unusual in someone her age (sounds like the mean age is in the 60's for this type, 50's for usual VIN-but found sometimes in women in their 20's). ! In fact I haven't found mention yet of anyone her age diagnosed with it.  Hopefully they won't find any Cancer at this point, but given her age and the precancer in her colon, we're really concerned about her long-term care, screening and prognosis.  Is there any great source for us?9. What else should we be doing/know?