Path - Vulva and Vagina Flashcards
where is a latent HSV 2 infection located? what can cause reactivation?
lumbosacral nerve ganglia
change in immunity, stress, trauma
microscopic appearance of HSV 2
multinucleated cells with nuclear inclusions
who gets non-genital molluscum contagiosum and how is it transmitted? what is its characteristic appearance?
children 2-12 - shared towels
pearly dome shaped papule with central depression
characteristic appearance of trichomonas vaginalis
caused by flagellated protozoan
red vaginal and cervical mucosa with dilated vessels - STRAWBERRY CERVIX
clinical features of bacterial vaginosis
thin green grey odorous discharge - fishy smelling
4 stages of syphilis infection
- primary - chancre
- secondary - moist papules, condyloma lata, scaly rash
- latency
- tertiary - gumma (systemic disease) - typically seen on scalp as multiple disseminated lesions
common causes of PID and some long term complications of chronic PID
gonorrhea, chlamydia
infertility, tubal obstruction, ectopic pregnancy
clinical presentation of Bartholin cyst
reproductive age women
UNILATERAL pain
what is Lichen sclerosis and how does it present?
thinning of epithelium and fibrosis of dermis (flattening) of vulva
white patch with PARCHMENT like vulvar skin
what is lichen simplex chronicus and how does it present?
Thickened epidermis of vulva (squamous hyperplasia)
thick leathery vulvar skin associated with rubbing or scratching
condyloma accuminatum presentation and common cause
warty neoplasm of vulvar skin, can be multiple lesions, often large
HPV types 6 or 11 (rarely progresses to carcinoma)
histology of condyloma
Koilocytes - raisin appearing (hallmark of HPV infected cells)
papillary tree like branching stromal cores covered by thickened epithelium
presentation and causes of HPV related vulvar carcinoma
SCC
presents as leukoplakia - need biopsy to distinguish
women of reproductive age (40-50)
HPV types 16 and 18
basaloid and warty SCC of vulva vs keratinizing SCC
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
what vulvar neoplasia has a high mortality rate?
melanoma - 60% if > 1 mm thick
what is the presentation of extra-mammary Paget disease and how does it differ from that of the nipple?
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
how to distinguish extra mammory paget disease from melanoma
paget cells are PAS+, kertain+, S-100-
melanoma is PAS-, keratin-, S-100+
what is vaginal adenosis? exposure to what increases incidence?
persistence of columnar epithelium in the upper vagina (should become squamous everywhere)
diethylstilbestrol (DES) in utero
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?
HPV 16 and 18 (high risk)
lower: inguinal nodes
upper: iliac nodes
presentation of embryonal rhabdomyosarcoma (sarcoma botryoides) and microscopic appearance
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)
who gets vulvar basal cell carcinoma and what is the microscopic appearance?
post menopausal white women
classic “rodent” ulceration, solid and adenoid patterns
