Pathology of Vulva/Vagina/Cervix 1 Flashcards
What cell type is present in the vulva?
What lymph nodes drain this area?
Vulva is keratinizing squamous
Vulva drains to inguinal lymph nodes
What cell type is present in the vagina?
What lymph nodes drain this area?
Vagina is non-keratinizing squamous epithelium
Drained by inguinal (distallly) or internal iliac (proximally)
Define endophytic, exophytic, and pagetoid growth
Endophytic = growing down into tissue (growth is flush with the surface though)
Exophytic = growing out from surface
Pagetoid = single cells or clusters that percolate through epithelium
What is the presenting symptom of a vulvar HSV-2 infection?
What do the infected cells look like?
- Very painful blisters/ulcers
- Infected cells have eosinophilic, intranuclear inclusions
What is condyloma acuminatum and what causes it?
What cellular feature is present?
Condyloma acuminatum = verrucous growth (genital wart) due to low-risk HPV (6, 11)
Koilocytes (halo of clearing around the cells)
What are the two types of vulvar squamous cell carcinoma?
Compare the cause and age of women for each.
- HPV-associated
- HPV 16/18/31
- Reproductive age women
- Inflammatory-associated
- Due to long-standing lichen sclerosis
- Older (70+) women
What demographic gets non-HPV associated vulvar carcinoma?
What mutation causes this?
- Older women with long-standing lichen sclerosus
- Due to p53
A vulva biopsy shows thin epidermis and fibrosis of the dermis, which looks like “parchment paper”. What is this called?
How does this impact cancer risks?
Lichen sclerosis
- Thin epidermis, fibrosis of dermis
- “Parchment paper”
- Slightly increased risk for vulvar squamous cell carcinoma
What type of cancer is extramammary paget disease?
Why is it called “paget” disease?
- Adenocarcinoma within the epithelium of the vulva (in-situ)
- Exhibits pagetoid spread (individual cells percolating)
What vulvar neoplasm presents with crusting, ulcers, and pruritis?
Extramammary Paget disease?
Name 3 vaginal pathologies associated with in utero DES exposure.
- Embryonal rhabdomyosarcoma
- Adenosis (glandular tissue in the vagina)
- Clear cell carcinoma
DES is An Excellent Carcinogen
Name 4 descriptors for embryonal rhabdomyosarcoma.
- Grape-like polypoid mass
- Spindle shaped cells
- Desmin +
- Cambium layer (skeletal muscle cells beneath epithelial surface)
What pathology is associated with a “kissing lesion”?
Clear cell carcinoma of the vulva (related to DES)
What is cell feature is pathagnomonic for HPV infection?
Koilocytes
Which HPV strains cause condyloma acuminatum and which cause dysplasia/carcinoma?
HPV 6/11 = condyloma
HPV 16/18/31 = cercival dysplasia/carcinoma
Where does cervical dysplasia most commonly occur?
Squamocolumnar junction (transformation zone)
What cell type is present in the ectocervix?
Endocervix?
Uterus?
- Ectocervix = nonkeratinizing squamous (same as vagina)
- Endocervix = columnar epithelium
- Uterus = columnar epithelium with glands
What is a common feature of squamous cell carcinomas?
Keratin pearls
What demographic most commonly gets lichen sclerosus?
Post-menopausal women
A woman presents with leathery, thick vulvar skin. What is this called?
What is the cellular pathology?
Lichen simplex chronicus.
Hyperplasia of vulvar squamous epithelium. (benign)
What causes invasive endocervical adenocarcinoma?
HPV (usually strain 18)
What is the typical outcome of cervical dysplasia?
Name 4 risk factors
Cervical dysplasia typically regresses but can progress into cancer
Risk factors = multiple sexual partners, early intercourse, smoking, immunocompromise
