Female 1 Flashcards
Mesonephric-like vulvar cyst:
A. Lining.
B. Wall.
C. Contents.
A. Cuboidal or columnar
B. Smooth muscle.
C. Clear fluid.
Ciliated vulvar cyst:
A. Lining.
B. Wall.
A. Ciliated and secretory columnar; may be pseudostratified.
B. No smooth muscle.
Periurethral cyst: Lining.
Transitional epithelium.
Hidradenoma papilliferum:
A. Synonym.
B. Age group.
A. Papillary hidradenoma.
B. Middle age.
Hidradenoma papilliferum: Origins (2).
Apocrine sweat glands.
Ectopic breast tissue.
Hidradenoma papilliferum: Lining.
Luminal layer of columnar or cuboidal cells.
Basal layer of myoepithelial cells.
Herpes viral infection: Histology (4).
“Multinucleation, margination, and molding.”
Ground-glass intranuclear inclusions.
Ballooning degeneration of keratinocytes.
Epidermal necrosis and vesiculation.
Molluscum contagiosum: Cause.
A DNA virus.
Vulvar condyloma: Types of HPV.
6, 11.
Vulvar condyloma: Grading.
Mitotic figures and cytologic atypia:
− Confined to the lower third: VIN 1.
− Present in the middle third: VIN 2.
Vulvar condyloma acuminatum: Behavior (2).
Most lesions regress spontaneously.
Some have progressed to high-grade dysplasia or to carcinoma.
Lichen sclerosus: Relation to squamous-cell carcinoma.
LS is not considered a precancerous condition.
SCC arises in up to 5% of cases of LS in postmenopausal women.
Lichen sclerosus: Treatment.
Topical corticosteroids.
Lichen simplex chronicus vs. squamous-cell hyperplasia.
Squamous-cell hyperplasia is like LSC but without the dermal changes.
Lichen simplex chronicus: Relation to squamous-cell carcinoma.
None known.
The vulvo-gingival syndrome.
Lichen planus involving vulva, vagina, and oral mucosa.
Lichen planus: Histology of advanced disease (2).
Epidermal atrophy.
Postinflammatory hypopigmentation.
Cyst of Bartholin’s duct: Cause.
Obstruction of the duct.
Cyst of Bartholin’s duct:
A. Lining.
B. Contents.
A. Squamous, transitional, or cuboidal.
B. Secretions but no laminated keratin.
Lower Anogenital Squamous Terminology (LAST) terms for ___.
A. Condyloma acuminatum.
B. Bowenoid papulosis.
A. LSIL.
B. HSIL.
Vulvar erythroplasia of Queyrat: Grade.
VIN 3.
Squamous-cell carcinoma of the vulva: Epidemiology.
Young women who smoke and have HPV-associated lesion.
Postmenopausal women without evidence of HPV.
Superficially invasive SCC of the vulva: Criteria (2).
Depth of invasion of more than 1 mm (measured from the base of the nearest dermal papilla).
Less than 2 cm in diameter.
Invasive SCC of the vulva: Criterion.
Depth of invasion is than 1 mm.
Invasive SCC of the vulva: Grading.
Grade 1: No undifferentiated cells; keratin pearls.
Grade 2: Less than half of cells are undifferentiated.
Grade 3: More than half of cells are undifferentiated.
Verrucous carcinoma of the vulva: Synonym.
Giant condyloma of Buschke and Löwenstein.
Warty carcinoma of the vulva:
A. Synonym.
B. Silhouette.
A. Condylomatous carcinoma.
B. Papillary and exophytic.
Warty carcinoma of the vulva: Histology (3).
Fibrovascular fronds.
Many koilocytes.
Irregularly outlined nests of invasive tumor at the base.
Squamous-cell carcinoma of the vulva: Important histologic prognostic factors (4).
Dimensions of tumor
− Thickness.
− Depth of invasion.
− Diameter.
Invasion of lymphatic spaces.
Squamous-cell carcinoma of the vulva: Relation of depth of invasive to nodal status.
Depth of invasion greater than 1 mm imparts a significantly greater risk of involvement of inguinal lymph nodes.
Squamous-cell carcinoma of the vulva: Treatment (2).
Superficially invasive: Wide local excision.
Invasive: Partial or total vulvectomy with inguinal lymph-node dissection.
Malignant melanoma of the vulva: Most common location.
Labia.
Malignant melanoma of the vulva: Clinical appearance.
Up to 35% are amelanotic.
Malignant melanoma of the vulva:
A. Behavior (2).
B. Prognosis.
A. Usually already deeply invasive at diagnosis; frequently recurs locally.
B. About half of patients are dead within 5 years.
Carcinoma of Bartholin’s gland:
A. Age group.
B. Clinical appearance.
A. Older women.
B. May mimic cyst or abscess.
Carcinoma of Bartholin’s gland: Histologic types (5).
Squamous-cell carcinoma.
Adenocarcinoma.
Adenoid-cystic carcinoma.
Transitional-cell carcinoma.
Adenosquamous carcinoma.
Carcinoma of Bartholin’s gland: Immunohistochemistry (2).
Positive:
− CEA in adenocarcinoma.
− S-100 in adenoid-cystic carcinoma.
Carcinoma of Bartholin’s gland: Prognosis (2).
Overall, lymph nodes are involved in up to 40% of cases.
Best prognosis: Adenoid-cystic carcinoma.
Worst prognosis: Adenocarcinoma.
Extramammary Paget’s disease:
A. Presentation.
B. Clinical tool.
A. Often with pruritus.
B. Fluorescein highlights the lesion for excision.
Extramammary Paget’s disease: Origin (2).
Probably represents carcinoma in situ of the sweat ducts.
Not necessarily associated with invasive carcinoma of the vulva.
Extramammary Paget’s disease:
A. Behavior (2).
B. Treatment.
A. Slow progression; often recurs because true extent is difficult to estimate clinically.
B. Wide local excision.
Extramammary Paget’s disease: Clinical appearance.
Red scaly patches with white areas of hyperkeratosis.
Extramammary Paget’s disease: Frequency of underlying adenocarcinoma in the dermis.
10-20%.
Extramammary Paget’s disease: Stains (5).
Positive: CK7, CEA, PAS, mucicarmine, alcian blue.
Granular-cell tumor: Possible confounder.
Pseudoepitheliomatous hyperplasia mimicking SCC.
Angiomyofibroblastoma: Presentation (2).
Painless; clinically resembles cyst of Bartholin’s gland.
Angiomyofibroblastoma: Histology (4).
Hypo- and hypercellular areas.
Thin-walled vessels around which spindle cells congregate.
Edematous or collagenous matrix.
Lymphocytic inflammation.
Angiomyofibroblastoma: Immunohistochemistry (1,1,4).
Positive: Desmin.
Negative: SMA.
Variable: S100, ER, PR, CD34.
Aggressive angiomyxoma vs. angiomyofibroblastoma: Gross pathology.
Aggressive angiomyxoma: Deeper and poorly circumscribed.
Aggressive angiomyxoma: Age group.
Premenopausal women.
Aggressive angiomyxoma: Histology (3).
Benign spindled (myo)fibroblasts in a myxoid stroma.
Medium-sized or large vessels surrounded by collagen and bundles of smooth muscle.
Normal structures may be entrapped.
Aggressive angiomyxoma: Immunohistochemistry (3).
Positive: SMA, ER, PR.
Aggressive angiomyxoma: Behavior.
Locally aggressive; often recurs locally.
Leiomyosarcoma of the vulva: Usual location.
Labium majus.
Leiomyosarcoma of the vulva: Clues to malignancy in a cytologically bland tumor (3).
Infiltrative margins.
Coagulative necrosis.
More than 5 mitotic figures per 10 hpf.
Leiomyosarcoma of the vulva: Behavior (2).
More likely to recur if more than 5 cm in diameter.
May metastasize to lung and liver.
Leiomyosarcoma of the vulva: Treatment.
Wide excision.
Vaginal polyp: Synonyms (2).
Fibroepithelial polyp.
Mesodermal stromal polyp.
Vaginal polyp: Histology.
Resembles ordinary fibroepithelial polyp, but the following could cause confusion with a sarcoma:
− Atypical-appearing myofibroblasts.
− Bizarre multinucleate giant cells.
Vaginal intraepithelial neoplasia:
A. Behavior.
B. Treatment (3).
A. Less than 10% of cases progress to invasive carcinoma.
B. Excision, laser ablation, 5-FU.
Squamous-cell carcinoma of the vagina: Those with low rates of metastasis to lymph nodes (2).
Conventional SCC with less than 3 mm of depth of stromal invasion.
Verrucous carcinoma.
Squamous-cell carcinoma of the vagina: Treatment (2).
Most types: Radiation.
Verrucous carcinoma: Radiation is contraindicated because it can cause transformation to SCC of higher grade.
Vaginal adenosis: Relation to diethylstilbestrol.
Occurs in about 1/3 of women exposed in utero to diethylstilbestrol.
Vaginal adenosis:
A. Presentation.
B. Clinical appearance.
A. Mucoid discharge from the vagina.
B. Red granular spots that iodine does not stain.
Vaginal adenosis: Causes other than diethylstilbestrol (2).
5-FU.
CO₂ laser.
Vaginal adenosis: Most common location.
Upper third of anterior wall of vagina.
Vaginal adenosis: Histology (3).
Usually endocervical-type mucosa, but can be ciliated or endometrial-type.
Mucinous glands in the lamina propria.
Squamous metaplasia in longstanding lesions.
Vaginal adenosis:
A. Behavior.
B. Significance.
A. Usually regresses spontaneously.
B. Rarely associated with clear-cell adenocarcinoma of vagina and cervix.
Clear-cell adenocarcinoma of the vagina: Association (2).
Occurs in very few women who were exposed in utero to DES.
Also occurs in women with no exposure to DES.
Clear-cell adenocarcinoma of the vagina: Typical age of patient.
About 20 years.
Clear-cell adenocarcinoma of the vagina: Patterns of growth (5).
Nodulocystic, solid (most common).
Papillary.
Tubular.
Trabecular.
Clear-cell adenocarcinoma of the vagina: Cytology (3).
The hobnail cell is characteristic.
Other appearances: flat, cuboidal, oxyphilic, signet rings.
Intracellular hyaline and/or psammoma bodies.
Clear-cell adenocarcinoma of the vagina: Associated histologic finding.
Adenosis.
Clear-cell adenocarcinoma of the vagina:
A. Behavior.
B. Likelihood of nodal metastasis.
A. More aggressive than SCC.
B. High if the depth of invasion exceeds 3 mm.
Clear-cell adenocarcinoma of the vagina: Treatment (2).
Early stage: Vaginectomy and hysterectomy.
Late stage: Radiation.
Rhabdomyoma of the vagina:
A. Typical age of patient.
B. Presentation.
A. Middle-aged.
B. Vaginal bleeding, dyspareunia.
Embryonal rhabdomyosarcoma:
A. Most common location.
B. Gross pathology.
A. Anterior wall of vagina.
B. Botryoid.
Embryonal rhabdomyosarcoma: Layers (3).
Superficial: Attenuated squamous mucosa.
Intermediate: Cambium layer consisting of small round (and spindled) blue cells.
Deep: Sparser infiltrate of small round blue cells in a loose stroma.
Embryonal rhabdomyosarcoma: Cytology (3).
Strap cells are helpful but not necessary for the diagnosis.
Cells appear to condense around blood vessels.
Brisk mitotic activity.
Embryonal rhabdomyosarcoma: Immunohistochemistry (4).
Positive: Vimentin, desmin, myogenin, Myo-D1.
Embryonal rhabdomyosarcoma: Behavior (2).
Rapid local invasion; other pelvic organs may be involved at presentation.
Metastasis to lung or bone occurs late.
Müllerian papilloma:
A. Histology.
B. Significance.
A. Papillary tumor with broad fibrovascular cores covered by cuboidal or mucinous epithelium.
B. Clinically similar presentation to that of embryonal RMS.
Papillary adenofibroma of the cervix: Histology.
Similar to phyllodes tumor.
Microglandular hyperplasia: Associations (3).
Oral contraceptives.
Pregnancy.
Postpartum state.
Microglandular hyperplasia: Gross pathology.
Resembles small endocervical polyp; may be multiple.
Microglandular hyperplasia: Histology (3).
Glands are crowded but bland, with no more than 1 mitotic figures per 10 hpf.
Squamous metaplasia and signet-ring cells can be seen.
Inflammatory cells within glands and stroma.
Microglandular hyperplasia: Immunohistochemistry.
Negative: CEA.
Squamous intraepithelial lesion of the cervix: Type most likely to exhibit binucleate cells.
LSIL.
Microinvasive squamous-cell carcinoma of the cervix: Criteria (3).
Depth of invasion is less than 3 mm.
Diameter of invasion is less than 7 mm.
No invasion of vascular spaces.
Microinvasive squamous-cell carcinoma of the cervix: Point from which depth is measured (2).
Most cases: From the basal layer.
Next to a gland: From the top of the gland.
Verrucous carcinoma of the cervix:
A. Association.
B. Behavior.
A. HPV-6 and its subtypes.
B. Rarely metastasizes.
Papillary carcinoma of the cervix: Histology (3).
Papillae lined by several layers of atypical, mitotically active spindle cells.
May show focal squamous differentiation.
Resembles TCC of the genitourinary tract.
Lymphoepithelioma-like carcinoma of the cervix:
A. Cytology of malignant cells.
B. Association.
A. Abundant pink cytoplasm, vesicular nucleus, large nucleolus.
B. Not associated with EBV.
Squamous-cell carcinoma of the cervix: Immunohistochemistry (3).
Positive: Cytokeratin, p63.
Focal: CEA.
Squamous-cell carcinoma of the cervix: Poor prognostic factor.
Overexpression of p21 in large-cell keratinizing and in non-keratinizing SCCs.
Glassy-cell carcinoma of the cervix: Histology (4).
Discrete cell borders.
Ground-glass cytoplasm.
Large nucleoli.
Many mitotic figures.
Invasive squamous-cell carcinoma of the cervix: Treatment.
Radical hysterectomy with or without adjuvant chemotherapy.
Adenocarcinoma in situ of the cervix: Presentation (2).
Usually asymptomatic and incidentally discovered.
Adenocarcinoma in situ of the cervix: Associations (4).
HPV-18.
Obesity.
Hypertension.
Progesterone-containing OCPs.
Adenocarcinoma in situ of the cervix: Histology (4).
High ratio of nucleus to cytoplasm.
Nuclear atypia.
Cellular stratification.
Mitotic figures, apoptotic bodies.
Adenocarcinoma in situ of the cervix: Most common types (3).
Endocervical.
Intestinal.
Endometrioid.
Immunohistochemistry for CEA in the endocervix.
Absent in normal endocervical glands.
Usually present in mucinous adenocarcinomas.