Female Genital System Pathology

Question 1

Extramammary Paget Disease

Answer 1

Malignant ells in the epidermis of the vulva
Presents with erythematous, pruritic, ulcerated vulvar skin (carcinoma in situ)
PAS+, keratin +, S100-

Question 2

Vulva Mucosa

Answer 2

Squamous epithelium

Question 3

Vaginal Mucosa

Answer 3

Non-keratinizing squamous epithelium

Question 4

Adenosis

Answer 4

Focal persistence of columnar epithelium in the upper vagina (derived from mullerian duct)
Increased incidence in women who were exposed to diethylstilbestrol (DES) in utero

Question 5

Clear Cell Adenocarcinoma

Answer 5

Malignant proliferation of glands with clear cytoplasm; Rare but feared complication of DES-associated vaginal adenosis

Question 6

Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)

Answer 6

Malignant mesenchymal proliferation of immature skeletal muscle
Presents with bleeding and grape-like mass protruding from the vagina or penis of a child (usu. <5); Rhabdomyoblast cell exhibits cytoplasmic cross-striations and is + for desmin and myogenin (like skeletal muscle)

Question 7

Vaginal Carcinoma

Answer 7

Arises from squamous epithelium; Usu related to high-risk HPV
Precursor lesion is vaginal intraepithelial neoplasia
Lower 1/3 of vagina –> inguinal nodes
Upper 2/3 of vagina –> regional iliac nodes

Question 8

Cervix Mucosa

Answer 8

Exocervix - non-keratinizing squamous epithelium
Endocervix - single layer of columnar cells
Junction between too is called transformation zone

Question 9

HPV

Answer 9

Infects lower genital tract, esp the transformation zone
Persistent infection leads to increased risk for cervical dysplasia (CIN)
High Risk - 16, 18, 31, 33 (HSIL) - produce E6, which destroys p53 TS gene and E7, which destroys Rb oncogene
Low Risk - 6, 11, 42-44 (LSIL)