Female Repro Tract Pathology (Hillard) Flashcards
Mayer-Rokitansky -Kuster-Hauser Syndrome
mullerian ageneis; missing fallopian tubes, uterus, and upper third of the vagina, presents with amenorrhea; but normal breast, pubic hair and vulvar development
Bartholin Cyst
benign vulvar lesion; results from obstruction of the Bartholin glands; cysts are non tender, unilateral, soft mass (3-5 cm) in the posterior aspect of the vaginal introitus; fluid is white or clear
Infected Bartholin Cyst
benign vulvar lesion; abscess; fluid is green or yellow; lesion is painful, warm, +/- surrounding edema and cellulitis; most common bug is E. coli
Lichen Sclerosus
benign vulvar and anogenital skin lesion; inflammatory disorder with activated T cells; most common in postmenopausal women; pruritis, dyspareunia, dysuria; white plaques; risk for TP53 positive keratinizing squamous cell carcinoma; histo thinning (atrophy), edematous band with lymphocytic infiltrate
Dyspareunia
painful sexual intercourse
Lichen Sclerosus has increased risk for what?
TP53 positive keratinizing squamous cell carcinoma
Histology of Lichen Sclerosus
thinning (atrophy), edematous band with lymphocytic infiltrate
Squamous Cell Hyperplasia (Lichen Simplex Chronicus)
thickening of skin (vulva) due to chronic, uncontrolled rubbing or scratching, appears as thickened reddened surface which can whiten over time. Associated with contact dermatitis, lichen sclerosis, and squamous cell carcinoma
Squamous Cell Hyperplasia (Lichen Simplex Chronicus) can be associated with other disorders?
contact dermatitis, psoriasis, lichen sclerosis, and squamous cell carcinoma
Condyloma Acuminatum
anogenital wart caused by HPV (6,11); sexual intercourse; laten phase can last weeks to months; skin-colored exophytic plaques; cauliflower-like appearance
Fleshy, skin-colored papules and plaques with a cauliflower appearance around the anogenital region should make you consider what?
Condyloma Acuminatum caused by HPV (6,11); low risk for progression to SCC
Histological findings of Condyloma Acuminatum?
hyperplastic papillary projections compromised of squamous cells with parakeratosis (surface keratinocytes with nuclei); some cells are kolicytic atypia (enlarged hyperchromic nuclei with a surrounding cleared-out halo space)
Vulvar carcinoma
SCC is the most common. 2 types:
1. Basaloid/Warty SCC
2. Keratinizing SCC
both arise from Vulvar intraepithelial neoplasia (VIN)
HPV related SCC of the vulva arises from what?
Vulvar intraepithelial neoplasia (VIN)
Basaloid / Warty Squamous Cell Carcinoma
Avg age 60 yrs; “Classic VIN”, associated with HPV (16 and 18)
Keratinizing Squamous Cell Carcinoma
Avg age 76 yrs; “Differentiated VIN”; caused by chronic irritation (lichen sclerosus or squamous cell hyperplasia); freq with TP53 mutations
Keratinizing Squamous Cell Carcinoma has a high frequency with what mutation?
TP53 mutations; causes an abnormal p53 tumor suppressor protein
Classic VIN
high risk HPV driven Basaloid / Warty SCC; full thickness atypia; lots of mitotic figures on histo; can progress to invasive SCC
Differentiated VIN
Non-HPV related vulvar SCC; basal/parabasal atypia; can lead to keratinizing SCC; with KSCC will show invasive nest of squamous cells showing keratinization
Papillary Hidradenoma
benign neoplasm; solitary, well-circumscribed vulvar dermal or subcutaneous nodule; columnar and myoepithelial cells with apocrine (sweat gland) differentiation; arises from the mammary-type glands along the primitive milk-line
What embryonic structure does papillary hidradenoma of the vulvar arise?
arises from the mammary-type glands along the primitive milk-line
What identical lesion of the papillary hidradenoma is seen in the breast?
intraductal papilloma
Extramammary Paget’s Disease (EMPD)
intraepithelial adenocarcinoma; sweat gland and keratinocyte differentiation; pruritic, ill-defined, erythematous +/- white crusted lesion with a “map-like” quality; immunostain CK7 positive
A pruritic, ill-defined, erythematous +/- white crusted lesion with a “map-like” quality in the anogenital region should make you think of what?
Extramammary Paget’s Disease (EMPD)