13.2 Vagina

Question 1

Females who were exposed in utero to DES are higher risk for what?

-when was DES banned?

Answer 1

• higher risk for vaginal adenosis, which can lead to clear cell adenocarcinoma
• DES banned in 1970s

Question 2

Clear cell adenocarcinoma

• what is it
• risk factors

Answer 2

• malignant proliferation of glands with clear cytoplasm (columnar b/c of vaginal adenosis)
• rare, but feared, complication of DES-assoc vaginal adenosis.

Question 3

Embryonal rhabdomyosarcoma

• what cell type
• clinical presentation (2)
• population

Answer 3

• malignant mesenchymal proliferation of immature skeletal muscle. Rare.
  1. bleeding
  2. grape-like mass protruding from vagina or penis of child (aka sarcoma botryoides)

Child usu

Question 4

Vaginal carcinoma

• usual cause
• precursor lesion
• describe lymph node spread

Answer 4

• high risk HPV (16,18,31,33)
• VAIN–vaginal intraepithelial neoplasia

lymph node spread:

• vagina upper 2/3: iliac nodes
• lower 1/3: inguinal nodes

Question 6

embryonal rhabdomyosarcoma

• what cell type
• appearance histology
• stain with what (2)

Answer 6

• Rhabdomyoblast (immature skeletal m)
• exhibits cytoplasmic cross-striations

Stains with:

1. desmin (part of int. filament of muscle cells)
2. myogenin (gene specific to devo of skeletal muscle)

Question 6

Female pt presents with grape-like mass in vagina

-think what

Answer 6

embryonal rhabdomyosarcoma

Question 7

5 yo female pt presents with vaginal mass.

Biopsy reveals immature cells with cytoplasmic cross striations.

• think what?
• what would this mass stain with?

Answer 7

Embryonal rhabdomyosarcoma (‘grape-like mass’)

-immature skeletal muscle

stains with:

1. desmin (all muscles, int filament)
2. myogenin (specific to skeletal m)

Question 8

Vaginal adenosis

• what is it
• population
• complication

Answer 8

• focal persistance of columnar epithelium in upper vagina (upper 1/3)
• (during devo, squamous epithelium from lower 2/3 of vagina replaces columnar of upper 1/3)
• rare but feared complication: clear cell adenocarcinoma!
• increased incidence in females exposed in utero to DES (DES was believed to reduce pregnancy complications until removed in 1970s)

Question 9

Vagina embryology:

• what is the precursor tissue, what cell types?
• upper 1/3
• lower 2/3
• How is lymph node drainage divided in vagina?

Answer 9

• upper 1/3: comes from Mullerian duct.
• columnar, then becomes squamous by birth (non keratinized)

lower 2/3: comes from UG sinus

-squamous, non keratinized

Upper 2/3: iliac nodes

Lower 1/3: inguinal nodes