Vulva

Question 1

A 65 year old woman came in due to white and red papules in her vulva. Biopsy shows Sclerosis/hyalinization with edema of the papillary dermis with or without erythrocytes extravasation. There is a band like lymphocytic infiltrate beneath the homogenized collagen. The overlying epidermis has atrophy with rete effacement.
Dx
Pathogenesis
Prognosis

Answer 1

Lichen sclerosus (lichen sclerosus et atrophicus)
All ages but MC in postmenopausal
Autoimmune disease (activated T cells)
Increases risk for differentiated VIN

Question 2

A 65 year old woman came in due vulvar itchiness. Grossly, vulva looks thickened, leathery and scaled (lichenification). Biopsy done showed marked hyperkeratosis and parakeratosis. There is hypergranulosis, irregular psoriasiform-epidermal hyperplasia
Dx
Cause
Prognosis

Answer 2

Squamous cell hyerplasia (Lichen simplex chronicus)
Chronic rubbing/scratching, infection (candida), contact dermatitis
May become differentiated VIN if long-standing

Question 3

A 35 year old woman came in due to vulvar mass m. A cyst was seen at the posterior vestibule. Cyst was excised. Microsections show unilocular cyst with a smooth inner lining of non-keratinizing squamous (transitional, or mucinous) epithelium.
Dx?
Pathogenesis
Ddx

Answer 3

Bartholin’s duct cyst
BD outlet obstruction
Ddx: gartner duct cyst - mesonephric origin at anterolateral vaginal wall (11 or 1 o’clock) lined by cuboidal to low columnar epithelium

Question 4

Biopsy of a small vulvar mass shows a dermal based lesion with mazelike. Papillary proliferation with tubular glands line by cells with apocrine differentiation with apical snouts. 2 cell layers were seen on IHC.
Dx?
Behavior?

Answer 4

Hidrarenoma papilliferum
Benign

Question 5

It is a polyp, most commonly seen in pregnancy and can regress post partum. It is composed of uniform, bland, spindle cells in a fibrous Stroma there are small to medium sized blood vessels with the hyalinized walls
+ER/PR
+/- CD34

Answer 5

Cellular angiofibroma

Question 6

It is composed of small, bland, spindle cells with scant cytoplasm. There are numerous blood vessels of varying sizes, including thin walled, capillary, like and thick walled arteries with the radiating perivascular, smooth muscle, invading fat and muscle.
+ ER, PR, desmin
Dx?
Behavior
Molecular

Answer 6

Aggressive angiomyxoma
Infiltrative
HMGA2

Question 7

Molluscum contagiosum
Virus?
Transmission?

Answer 7

Poxvirus
Molluscum contagiosum viruses 1-4 (MCV1-4)
MCV-1 - most prevalent
MCV-2 - most sexually transmitted

Question 8

Results of gonococcal infection

Answer 8

Acute suppurative salpingitis
Tubo-ovarian abscess
Pyosalpinx
Note: SPARES THE ENDOMETRIUM

Question 9

These are small patches of residual glandular epithelium that persists in adult life in the vagina in this line by columnar mucinous epithelium indistinguishable from endocervix
Dx
Other cause

Answer 9

Vaginal adenosis
DES exposure in utero —> risk of clear cell carcinoma

Question 10

A septate or double vagina and double uterus, or uterus, didelphys may be caused by exposure to what in utero

Answer 10

Diethylstilbestrol (DES)

Question 11

True or false: the most common malignant tumor to involve the vagina is carcinoma, spreading from the cervix followed by primary squamous cell carcinoma of the vagina

Answer 11

True

Question 12

MC affected sites of HPV due to presence of immature basal cells

Answer 12

SCJ of cervix and anus
Tonsillar crypts

Question 13

What are the effects of the E7 protein?

Answer 13

Binds the hyper phosphorylated form of RB
IT ALSO BINDS AND INHIBITS P21 and P27 (CDKi)

Question 14

What are the effects of a E6 protein?

Answer 14

It binds P 53 and up-regulates the expression of telomerase

Question 15

What consists and causes the cytoplasmic halos in koilocytes

Answer 15

These are perinuclear vacuoles cost by E5

Question 16

True or false 20% of cases of HSIL develop de novo and not from LSIL

Answer 16

True