Pathology of Vulva and Vagina

Question 1

a congenital condition where there is a complete duplication of the uterus, vagina and cervix is called ______ and is due to __________

Answer 1

diadelphys which is due to failure of TOTAL fusion of mullerian ducts (para mesonephric ducts)

incomplete partial fusion of mullerian ducts = bicornate uterus

Question 2

Gartner’s duct cyst is the remnant of _______.

Where can it be found on the vagina?

Answer 2

• remnant of the mesonephric/Wolfian duct

- can fee found on the anterolateral wall of the vagina

Question 3

_________ is a big risk factor for development of adenosis of the vagina

Answer 3

in utero exposure to DES (diethylstilbestrol) which is also associated with clear cell carcinoma of the vagina

Question 4

you find columnar epithelium in the upper vagina. This is a precursor lesion for ______

Answer 4

clear cell carcinoma

Question 5

examination shows multiple polypoid masses resembling a “bunch of grapes” projecting out of the vagina.
this is due to ________

Answer 5

Diagnosis: sarcoma botryoides which is a malignant mesenchymal proliferation of immature skeletal muscle

Question 6

how old are patients with sarcoma botryoides and what stain would you use to confirm your diagnosis?

Answer 6

< 5 years old;

use desmin/ myogenin stain

Question 7

lichen sclerosis is a benign lesion characterized by _____ of the epidermis and _____ of the dermis

Answer 7

thinning of the epidermis and fibrosis of the dermis and thus giving it a parchment like skin w/ leukoplakia (white patches)

Question 8

a postmenopausal patient with parchment paper like vulva comes to you and asks whether her condition has an increased risk for cancer. what do you say?

Answer 8

diagnosis? lichen sclerosis; it has a small increased chance of squamous cell carcinoma of the vulva;

lichen simplex chronicus has a leathery appearance due to thinking of epithelial layer but has NO increased chance of cancer

Question 9

what is the difference between extramammary Paget’s disease and Paget’s disease of the breast?

Answer 9

unlike Paget’s disease of the nipple, there is no underlying carcinoma in extramammary Paget’s disease.

Paget’s disease of the nipple arises from DCIS while extramammary doesn’t

Question 10

because Paget’s disease of the vulva presents with skin changes, it can be confused with melanoma.
what are some cytological findings that would help you distinguish between the two

Answer 10

PAS: + for Paget’s; - for melanoma
keratin: + for Paget’s; - for melanoma
S-100: - for Paget’s ; + for melanoma

Question 11

what are the two different types of VIN (vulvar intraepithelial neoplasm)

Answer 11

1. classic type → related to HPV infection and leads to basaxoid squamous carcinoma
2. differentiated/simplex type → NOT related to HPV infection, rather has p53 mutation which then leads to keratinizing squamous cell carcinoma

Question 12

what is a precursor lesion of keratinizing squamous carcinoma of the vulva? Is this related to HPV infection?

Answer 12

differentiated type of VIN and is NOT related to HPV infection

Question 13

carcinoma of the vulva most commonly occurs in ______

Answer 13

anterior 2/3 of the labia majora