Path - Vulva and Vagina

Question 1

where is a latent HSV 2 infection located? what can cause reactivation?

Answer 1

lumbosacral nerve ganglia

change in immunity, stress, trauma

Question 2

microscopic appearance of HSV 2

Answer 2

multinucleated cells with nuclear inclusions

Question 3

who gets non-genital molluscum contagiosum and how is it transmitted? what is its characteristic appearance?

Answer 3

children 2-12 - shared towels

pearly dome shaped papule with central depression

Question 4

characteristic appearance of trichomonas vaginalis

Answer 4

caused by flagellated protozoan

red vaginal and cervical mucosa with dilated vessels - STRAWBERRY CERVIX

Question 5

clinical features of bacterial vaginosis

Answer 5

thin green grey odorous discharge - fishy smelling

Question 6

4 stages of syphilis infection

Answer 6

1. primary - chancre
2. secondary - moist papules, condyloma lata, scaly rash
3. latency
4. tertiary - gumma (systemic disease) - typically seen on scalp as multiple disseminated lesions

Question 7

common causes of PID and some long term complications of chronic PID

Answer 7

gonorrhea, chlamydia

infertility, tubal obstruction, ectopic pregnancy

Question 8

clinical presentation of Bartholin cyst

Answer 8

reproductive age women

UNILATERAL pain

Question 9

what is Lichen sclerosis and how does it present?

Answer 9

thinning of epithelium and fibrosis of dermis (flattening) of vulva
white patch with PARCHMENT like vulvar skin

Question 10

what is lichen simplex chronicus and how does it present?

Answer 10

Thickened epidermis of vulva (squamous hyperplasia)

thick leathery vulvar skin associated with rubbing or scratching

Question 11

condyloma accuminatum presentation and common cause

Answer 11

warty neoplasm of vulvar skin, can be multiple lesions, often large
HPV types 6 or 11 (rarely progresses to carcinoma)

Question 12

histology of condyloma

Answer 12

Koilocytes - raisin appearing (hallmark of HPV infected cells)
papillary tree like branching stromal cores covered by thickened epithelium

Question 13

presentation and causes of HPV related vulvar carcinoma

Answer 13

SCC
presents as leukoplakia - need biopsy to distinguish
women of reproductive age (40-50)
HPV types 16 and 18

Question 14

basaloid and warty SCC of vulva vs keratinizing SCC

Answer 14

B&W: related to HPV, younger age (6th decade), arises from classic VIN
K: UNrelated to HPV, older women (8th decade), due to chronic irritation

Question 15

what vulvar neoplasia has a high mortality rate?

Answer 15

melanoma - 60% if > 1 mm thick

Question 16

what is the presentation of extra-mammary Paget disease and how does it differ from that of the nipple?

Answer 16

pruritic, red crusted map like areaa usually on labia minor

usually NO underlying carcinoma and confined to squamous mucosa/skin epidermis - nipple has underlying carcinoma

Question 17

how to distinguish extra mammory paget disease from melanoma

Answer 17

paget cells are PAS+, kertain+, S-100-

melanoma is PAS-, keratin-, S-100+

Question 18

what is vaginal adenosis? exposure to what increases incidence?

Answer 18

persistence of columnar epithelium in the upper vagina (should become squamous everywhere)
diethylstilbestrol (DES) in utero

Question 19

what is almost every primary SCC of vagina associated with? where does cancer of the lower 1/3 vs upper 2/3 of vagina spread to?

Answer 19

HPV 16 and 18 (high risk)

lower: inguinal nodes
upper: iliac nodes

Question 20

presentation of embryonal rhabdomyosarcoma (sarcoma botryoides) and microscopic appearance

Answer 20

infants and children under 5
maligant mesenchymal proliferation of immature skeletal muscle - polypoid grape like masses protruding from vagina
cells have cytoplasmic cross striations and stain for desmin and myogenin (look like muscle)

Question 21

who gets vulvar basal cell carcinoma and what is the microscopic appearance?

Answer 21

post menopausal white women

classic “rodent” ulceration, solid and adenoid patterns