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RGU 1 > Pathology of Vulva & Vagina > Flashcards

Pathology of Vulva & Vagina Flashcards

1
Q

What is a bartholin cyst?

A
  • cystic dilation of the bartholin gland (produces mucus-like fluid that drains via ducts into the lower vestibule) that arises due to inflammation and obstruction of the gland in women of reproductive age.
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2
Q

How does a batholin cyst present?

A
  • as a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal.
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3
Q

** What is a condyloma?

A
  • a watery neoplasm of vulvar skin that is often large.
  • most commonly due to HPV 6 and 11 (CONDYLOMA ACUMINATA); LOW RISK.
  • less commonly due to secondary syphilis (CONDYLOMA LATUM).
  • both sexually transmitted
  • HPV condyloma characterized by KOILOCYTES (hallmark of HPV cells; nucleus looks crinkled like a raisin with perinuclear HALO).
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4
Q

What does HPV affect?

A
  • the lower female genital tract (vulva, lower vaginal canal, and cervix)
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5
Q

Do condylomas often progress to carcinoma?

A

NO :)

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6
Q

What are the high risk HPV subtypes?

A
  • 16, 18, 31, 33.
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7
Q

** What is lichen sclerosis? (BOARDS LOVE THIS)

A
  • THINNING of the epidermis and fibrosis (sclerosis) of the dermis (replaced by DENSE collagen).
  • presents as a white patch (leukoplakia) with PARCHMENT-LIKE vulvar skin.
  • BENIGN
  • most commonly seen in POSTMENOPAUSAL women (or from sexual assault).
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8
Q

What causes lichen sclerosis?

A

possibly autoimmune

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9
Q

Is lichen sclerosis associated with a slightly increased risk for squamous cell carcinoma?

A

YES

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10
Q

What is lichen simplex chronicus (squamous cell hyperplasia)?

A
  • hyperplasia of the vulvar squamous epithelium.
  • presents as leukoplakia with THICK, leathery vulvar skin.
  • associated with CHRONIC IRRITATION and SCRATCHING.
  • BENIGN
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11
Q

Is there an increased risk for squamous cell carcinoma in lichen simplex chronicus?

A

NO :)

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12
Q

What is vulvar carcinoma?

A
  • carcinoma arising from squamous epithelium lining the vulva.
  • rare
  • presents as leukoplakia; biopsy to distinguish from other leukoplakia causes.
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13
Q

** What is the etiology of vulvar carcinoma?

A
  • can be HPV related (due to high-risk types 16 and 18)= arises from VIN (vulvar intraepithelial neoplasia), a dysplastic precursor lesion characterized by KOILOYTIC change. Occurs around ages 40-50.
  • can be NON-HPV related= usually from long-standing lichen sclerosis around age 70.
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14
Q

What is extramammary Paget disease?

A
  • malignant epithelial cells in the epidermis of the vulva (usually labia majora).
  • presents as erythematous, pruritic, ulcerated vulvar skin.
  • represents CARCINOMA IN SITU, usually with no underlying carcinoma.
  • Paget disease of the nipple can also occur, but is almost ALWAYS with an underlying carcinoma of the breast.
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15
Q

*** From what must you distinguish extramammary Paget disease (i.e. carcinoma)?

A
  • MELANOMA= PAS-, keratin-, and S100 +
  • Paget cells= PAS+ (indicates that cells are making mucus and only epithelial cells make mucus), keratin+ (intermediate filament present in epithelial cells), and S100-. Also have a clear halo.
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16
Q

Where can ectopic mammary tissue occur?

A
  • along primitive milk line. Tissue is subject to physiologic and pathologic changes including swelling and secretion of milk during pregnancy.
17
Q

What does syphilis do?

A
  • produces a chancre (HARD ulcer) with inflammatory infiltrate composed of plasma cells, lymphocytes, and histiocytes. This is covered by a zone of ulceration on the vulva infiltrated by neutrophils and necrotic debris.
  • syphilis also has a predilection for small blood vessels causing ENDARTERITIS (especially vaso vasorum of aorta).
18
Q

What is granuloma inguinale?

A
  • chronic infection caused by Calymmatobacterium granulomatis.
  • begins as a SOFT elevated granulomatous area, which enlarges slowly and has dense stromal infiltrate.
  • characterized by DONOVAN’S bodies.
19
Q

What is lymphogranuloma venereum?

A
  • swelling of inguinal lymph nodes with stellate abscesses surrounded by pale epitheliod cells.
  • caused by Chlamydia.
  • may have a small ulcer at the site early.
20
Q

What disease is associated with PERINEAL disease and fistula formation?

A
  • Crohn’s disease (aka GI involvement)
21
Q

What is Behcet’s disease?

A
  • autoimmune vasculitis involving the mucous membranes.

- may have ocular problems, but rare in vulva.

22
Q

What is vulvar vestibulitis?

A
  • chronic inflammatory infiltrate involving the lamina propria and periglandular connective tissue of the vestibule.
  • small glands can be inflamed, producing severe pinpoint pain in vestibule.
23
Q

What is Hidradenoma papilliferum?

A
  • BENIGN tumor that presents as a well circumscribed nodule covered with normal skin.
  • identical to intraductal papillomas of breast.
  • may arise from ectopic breast tissue.
24
Q

What do we have to know about the differentiated variant of VIN?

A
  • associated with squamous cell hyperplasia (lichen simplex chronicus) and lichen sclerosis.
  • p53 overexpression
  • NOT typically associated with HPV
25
Q

What is microinvasive cancer?

A
  • vulvar cancer with depth of penetration less than 5 mm.

- often have low incidence of lymph node metastasis.

26
Q

What is verrucous carcinoma?

A
  • type of squamous carcinoma that may be large, exophytic (grows out of vulva) and infiltrates locally.
  • mets nonexistent :)
  • can mimic condyloma
27
Q

What is aggressive angiomyxoma?

A
  • mimics bartholin gland cyst usually in women in their 20s-30s.
  • grossly edematous with hypocellular stroma (not many cells there, but large blood vessels).
  • recurrence is common
28
Q

What type of epithelium lines the vagina?

A
  • NON-keratinized stratified squamous epithelium
29
Q

What is Adenosis?

A
  • focal persistence of columnar epithelium in the upper vagina (due to lack of stratified squamous epithelium replacement during development).
30
Q

What females are at risk for adenosis?

A
  • those who were exposed to DES (diethylstilbestrol) in utero; estrogen compound used for pregnancy related complications, but crosses the placenta.
31
Q

** What is the problem with adenosis? (BOARDS LOVE THIS)

A
  • can lead to CLEAR CELL ADENOCARCINOMA= malignant proliferation of glands with clear cytoplasm. Rare. Can also cause infertility in daughters of DES moms.
32
Q

For what does DES increase a mother’s risk?

A

breast cancer

33
Q

** What is embryonal rhabdomyosarcoma (sarcoma botryoides)?

A
  • malignant mesenchymal proliferation of immature skeletal muscle; rare.
  • presents as bleeding and a GRAPE-LIKE mass protruding from the vagina or penis of a child (less than 5 y/o).
34
Q

What key cell forms the rhabdomyosarcoma?

A

rhabdomyoblast= exhibits cytoplasmic cross-striations and + immunohistochemical staining for DESMIN (intermediate filament present in muscle cells) and MYOGENIN (nuclear transcription factor present in immature muscle).

35
Q

What is vaginal carcinoma?

A
  • carcinoma arising from squamous epithelium lining the vaginal mucosa.
  • usually related to high-risk HPV (16 & 18)
  • precursor lesion is VAGINAL intraepithelial neoplasia (VAIN; not VIN).
36
Q

** What is important to remember about vaginal carcinoma spread to the lymph nodes?

A

bc the vagina is derived from 2 different embryological sources the lower 1/3 (derived from the urogenital sinus) will spread to INGUINAL nodes, and the upper 2/3 (derived from the mullerian duct) will spread to regional ILIAC nodes.

37
Q

What will benign mixed tumors of the vagina have?

A
  • made of stromal-type spindle glands mixed with mature squamous cells
38
Q

What are fibroepithelial polyps of the vagina?

A
  • mesenchymal tumor that has a fibrovascular core lined by squamous eptihelium.
39
Q

What is the most common BENIGN MESENCHYMAL tumor of the vagina?

A

leiomyoma

RGU 1 (17 decks)

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