13. Female Genital System and Gestational Pathology

Question 1

warty neoplasm of vulvar skin, may be due to what?

Answer 1

HPV types 6 and 11.

May also be due to secondary syphilis.

Question 2

HPV associated condylomas are associated with what cells?

cam they progress to carcinoma?

Answer 2

Koilocytes

rarely progress to carcinomas (HPV 6 and 11 are low-risk types)

Question 3

what are the high-risk HPV types?

Answer 3

16, 18, 31, 33

High rate of development of carcinoma or CIN

Question 4

Lichen sclerosis v lichen simplex chronicus?

Answer 4

Sclerosis -> thinned skin. parchment-like, may be seen in post-menopausal women.

Simplex chronicus -> thickened skin, hyperplasia, leukoplakia.

Question 5

vulvar leukoplakia: what could it be? test to dx?

Answer 5

could be Lichen Simplex Chronicus or Vulvar Carcinoma (from HPV 16, 18). (Vulvar carcinoma could be from HPV or from chronic Lichen Simplex Chronicus.)

Biopsy to diagnose.

Question 6

Age ranges for Vulvar Carcinoma due to HPV vs due to Lichen Simplex Chronicus?

Answer 6

due to HPV: 40s-50s

Due to LSC: 70s +

Question 7

Extramammary Paget Disease

where is original cancer?

Where/how does it present?

Answer 7

Original cancer is in nipple

Presents in vulva as erythematous, pruritic, ulcerated vulvar skin.

Question 8

How do we distinguish Extramammary Paget’s Disease from vulvar melanoma?

Answer 8

Paget: cells are PAS+, keratin+, S100- (remember keratin is the intermediate filament in epithelial cells - if something is epithelial and malignant it is a carcinoma!)

Melanoma: cells are PAS-, keratin-, S100+