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S3B3 Pathology > Vulva and Vagina > Flashcards

Vulva and Vagina Flashcards

1
Q

The provided slide is a normal histological sample of what gross structure?

A

Labia majora

  • black curved arrow: collagen in subepithelial collagen
  • blue open arrow: adipose
  • black open arrow: adnexal structure
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2
Q

How could you differentiate a histological slide of the labia majora & labia minora?

A

adnexal structures & adipose tissue are largely absent in the labia minora

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3
Q

What type of virus is HSV & which subtype is most commonly associated with genital infections?

A

DNA

HSV2

(cases of HSV1 are increasing)

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4
Q

What are the 4 types of genital herpes infections?

A
  • Primary
    • symptomatic or non-symptomatic (3-7 days post inoculation)
    • fever, malaise, tender inguinal lymph nodes painful ulcers
    • ulcers heal 1-3 weeks
  • Non-primary
    • acquisition of HSV-1 if already infected with HSV-2 (or vice versa)
  • Latent
    • virus established in the regional lumbosacral nerve ganglia
  • Reactivation
    • reactivation due to any decrease in immune function
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5
Q

Are primary or non-primary HSV infections more likely to be symptomatic?

A

primary

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6
Q

What demographic is most at risk to HSV infections?

A

neonates

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7
Q

Why is it recommended that a pregnant woman with active HSV infection at time of labor have a C-section?

A

neonatal infections can be severe / fatal

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8
Q

The provided image is a gross example of what condition?

A

HSV2 infection

  • small, grouped papules or vesicles on mucosa → extending to skin
  • vesicles rupture, leavign erosions (ulcers)
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9
Q

What condition is depicted in the provided histological slide?

A

HSV2 infection

  • Cowdry Type A body (large, eosinophilic nuclear inclusions & clear halo)
  • ulcerated epidermis
  • intracellular ballooning & degradation keratinocytes
  • keratinocytes that have lost intercellular connection, multinucleation, nuclear molding, ground glass appearance
  • prominent acute inflammatory infiltrate
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10
Q

The provided image is a gross example of what condition? Where can these lesions be located?

A

molluscum contagionsum

genitals, lower abdomen, buttocks, inner thighs

  • well-circumscribed, dome-like structure with central umbilication
  • usually multiple & separate
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11
Q

What is the cause of molluscum contagiosum & how is it transmitted? Treatment?

A

pox virus

direct contact or shared articles (ie towels)

most regress within 6 months

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12
Q

The provided histological slides show what condition?

A

molluscum contagiosum

  • dome-shaped papule with cup-shaped center with brightly eosinophilic cytoplasmic inclusions (“molluscum bodies”)
  • downward proliferation of squamous epithelium into dermis
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13
Q

Genital warts is usually caused by what HPV strains?

How is it transmitted?

A

6 & 11

sexual contact

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14
Q

What condition is shown in the provided gross image?

Precancerous?

A

condyloma acuminatum (genital warts)

not usually precancerous

  • exophytic, papillary lesions
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15
Q

The provided histological slides are samples of what condition? The image on the left is an example of what cell type characteristic of this condition?

A

condyloma acuminatum (genital warts)

  • epidermal hyperplasia, hyperkeratosis, prominent granular layer
  • usually little to no dysplasia
  • Left: koilocytes -→
    • enlarged cells with perinuclear halos
    • enlarged / condensed nuclei
    • multinucleate often sen
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16
Q

What is the most common genital warts seen in children?

A

verruca vulgaris

HPV2

(HPV6 / 11 is abuse until proven othrwise)

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17
Q

What condition is shown in the provided image?

A

Bartholin Duct Cyst

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18
Q

What is the most common vulvar cysts?

Cause?

A

Bartholin Duct Cysts

obstruction of the duct by inflammation

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19
Q

What would be the typical presentation of a patient with a Bartholin Duct Cyst?

A
  • female in 20s
  • most commonly unilateral in labia minora
  • painless swelling
    • enlargement of cyst may cause pain
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20
Q

Bartholin duct cysts have what type of epithelium?

A

lined by cuboidal, transitional or mucinous epithelium (may be obliterated by inflammation)

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21
Q

When looking at a histological slide, how could you differentiate condyloma acuminatum from molluscum contagiosum?

A

NO koilocytes in molluscum contagiosum

YES koilocyttes in condyloma acuminatum

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22
Q

What is the clinical presentation of a patient with lichen sclerosus?

A
  • postmenopausal woman
  • +/ - itchy
  • white, parchment-like appearance of skin
  • “tissue paper” appearance
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23
Q

What condition is depicted in the provided image?

A

Lichen sclerosus

  • initially smooth, pale plaques that enlarge & coalesce to form rough, scaly patches
  • severe cases, labia may become atrophic w/ constricted vaginal orifice
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24
Q

The provided histological slide is a sample of what condition?

A

Lichen Sclerosus

  • band-like lymphocytic infiltrate in deeper dermis
  • thinning of epidermis with degeneration of basal cells & hyperkeratosis
  • sweat glands & pilosebaceous units are absent
  • low cellularity of dermis
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25
Q

Usual Vulvar Intraepithelial Neoplasia

(U-VIN)

HPV-related?

Age most commonly affected?

Progression?

A
  • HPV-related, usually type 16
  • 30s & 40s
  • progression is unlikely & may regress spontaneously
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26
Q

Differentiated Vulvar Intraepithelial Neoplasia

(D-VIN)

HPV-related?

Age most commonly affected?

Progression?

A

Not HPV-related

60-70s

Progression is likely

80-90% progress to SCC over 23 months

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27
Q

Which of the provided images is an example of U-VIN & which is an example of D-VIN?

A
  • Left: U-VIN
    • atypical parakeratosis -/+ koilocytosis
    • peripheral palisading and hypercellularity
    • mitotic figures are common
  • Right: D-VIN
    • epithelial thickening with parakeratosis & elongated, anastamosing rete ridges
    • enlarged, hypereosinophilic keritinocytes
    • abundant keratin & keratin pearls
    • atypia is concentrated at basal layer
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28
Q

Describe the typical gross presentation of U-VIN.

A
  • usually multiple lesions
  • flat or exophytic
  • varying pigmentations
  • most commonly affects
    • labia majora/minora
    • posterior fourchette
    • clitoris
    • mons pubis
    • perineal
    • perianal skin
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29
Q

Is the provided histological slide more likely a sample from U-VIN or D-VIN?

A

U-VIN

30
Q

Describe the typical gross presentation of D-VIN.

A
  • usually a solitary lesion
  • flat or exophytic
  • usually hypopigmented
  • most commonly affects
    • labia majora/minora
    • posterior fourchette
    • clitoris
    • mons pubis
    • perineal
    • perianal skin
31
Q

Answer the following questions with regards to HPV-dependent Vulvar Squamous Cell Carcinoma (VSCC):

  • Makes up what percent of all VSCC?
  • Most common in women of what age?
  • Association with what other conditions?
  • Positive / negative for p16?
  • Positive / negative for p53 mutations?
A
  • 30%
  • 35-65 yrs
  • associated with U-VIN & HPV
  • Positive p16
  • Negative for p53 mutations
32
Q

Answer the following questions with regards to HPV-independent Vulvar Squamous Cell Carcinoma (VSCC):

  • Makes up what percent of all VSCC?
  • Most common in women of what age?
  • Association with what other conditions?
  • Positive / negative for p16?
  • Positive / negative for p53 mutations?
A
  • 70%
  • 55-85 (older)
  • Associated with lichen sclerosus & D-VIN
  • Negative for p16
  • Positive for p53 mutations
33
Q

What condition is shown in the provided image?

A

Vulvar Squamous Cell Carcinoma

  • white, firm mass with raised borders
  • endophytic or exophytic
  • flat or ulcerated
  • may be multiple tumors
  • few mm to cm
34
Q

Squamous cell carcinoma constitutes what percent of all vulvar cancers? What percent of all female genital cancers?

A

95% vulvar cancers

5% female genital cancers

35
Q

What risk factors are associated with vulvar squamous cell carcinoma?

A

increased # sexual partners

cigarette smoking

immunodeficiency

genital granulomatous disease

36
Q

What is the clinical presentation of a patient with vulvar squamous cell carcinoma?

A
  • slow-growing papule, nodule or plaque
    • commonly ulcerates
  • pain, pruritus, +/- bleeding
37
Q

What features of the provided image help you identify the condition? What is the condition?

A

Invasive Squamous Cell Carcinoma

  • irregularly shaped & sized sheets, cords, nests and trabeculae
  • Keratin pearls
  • Desmoplastic stroma
38
Q

What pathology is depicted by the provided gross image?

A

Papillary hidradenoma

  • well-circumscribed, skin-colored nodules
  • solid or cystic
  • may be ulcerate (trauma)
39
Q

What is a Papillary hidradenoma?

A

benign gland-forming tumor with apocrine differentiation

40
Q

Papillary hidradenoma are most commonly found in what demographic? Treatment?

A

30-50

White

excision is curative

41
Q

The provided histological slide is from a sample of what condition?

A

Papillary hidradenoma

  • intradermal, well-circumscribed, nonencapsulated mass
  • complex growth of branching, interconnected, anastomosing tubules
    • +/- papillary structure
  • double cell layer “snouts” (right)
42
Q

What condition is shown in the provided gross sample?

A

Extramammary Paget Disease

  • ill-defined, scaly raised red plaque/rash
  • millimeters to centimeters
43
Q

What is Extramammary Paget Disease?

A

intraepidermal carcinoma

can be primary (90%) or secondary (associated with extracutaneous malignancy)

44
Q

What is the most common vulvar adnexal malignancy?

A

Extramammary Paget Disease

45
Q

What is the clinical presentation of Extramammary Paget Disease?

A
  • middle-aged
  • white
  • moist, red, eczematous-appearing plaque/ulcer on labia majora, labia minora, or perianal skin
46
Q

Extramammary Paget Disease is commonly misdiagnosed as what condition?

A

inflammatory process (dermatitis)

47
Q

How can you differentiate a histological sample of melanoma & Extramammary Paget Disease?

A

Extramammary Paget Disease will stain bright pink with mucicarmine stain due to the intracytoplasmic mucin inside the tumor.

48
Q

What pathology is depicted by the provided histological slides? The image to the right is an a mucicarmine stain.

A

Extramammary Paget Disease

  • Left
    • nests / single cells of large pale cells within the epidermis
    • may extend into adnexa (hair follicles & eccrine glands)
  • Right
    • positive for mucicarmine stain
    • (-) for melanoma stain
49
Q

What pathology is shown in the provided histological slide?

A

Melanoma

  • atypical melanocytes spread throughout full thickness of epidermis
  • positive for melanoma marker
  • negative mucicarmine stain
50
Q

The provided images are normal histology of what aspect of the female reproductive organs?

A

vagina

  • 4 epithelial layers
    • basal layer (black solid arrow)
    • parabasal layer (blue open arrow)
    • intermediate cells (white open arrow)
    • superficial cells (blue curved arrow)
51
Q

What are predisposing factors to a vaginal Candida infection?

A

diabetes mellitus

antibiotic use

pregnancy

immunocompromised

52
Q

What is the clinical presentation of vulvovaginal Candidiasis?

A

vulvovaginal pruritus, erythema, swelling

curd-like, white, vaginal discharge

53
Q

What pathology is confirmed from the provided slides that came from vaginal discharge?

A

Vulvovaginal Candidiasis

  • Left (KOH prep)
    • budding yeast (curved arrow)
    • hyphae & pseudohyphae (open arrow)
  • Right (Thin Prep Papanicolaou stain)
    • pseudohyphae (blue arrow) piercing epithelial cells
54
Q

What pathology is shown in the provided image?

A

Vulvovaginal Candidiasis

  • worm-like things present in teh epidermis
  • often have vertical orientation
  • organisms reside on/within the epidermis & do not invade the mucosa
55
Q

Which infectious organism is shown on the provided slide?

A

Trichimonas vaginalis

  • unicellular, flagellate, protazoan parasite
  • motile organism with flagella
56
Q

What is the clinical presentation of a patient with Trichimonas vaginalis?

A
  • Asymptomatic - acute/chronic vaginitis
  • pruritus, painful urination, painful intercourse
  • yellow, frothy vaginal discharge
  • marked dilation of cervical mucosa w/ fiery red appearance (strawberry cervix).
57
Q

Which infectious organism is shown in the provided image?

A

Gardenerella vaginalis

“clue cells”

  • squamous cells covered with coccobacilli with extensions to the cell edges
  • velvety coat or shaggy appearance
  • coccobacilli form faint granular blue background on traditional pap smears
58
Q

What are risk factors for developing a Gardnerella vaginalis bacterial infection?

A

new sexual partner

antibiotic use

IUD

douching

59
Q

What is the clinical presentation of a patient with a Gardnerella vaginalis infection?

A

thin, green/gray, malodorous discharge

more noticeable after intercourse

60
Q

What is the clinical presentation of a patient with Vaginal Intraepithelial Neoplasia (VaIN)? Treatment?

A

usually asymptomatic – may present with condyloma-like lesion

Usually regresses – excellent prognosis

61
Q

What pathology is shown in the provided image?

A

Vaginal Intraepithelial Neoplasia (VaIN)

variable white discoloration with sharp borders (acetowhite) upon application of acetic acid to cervix

62
Q

What are features of the provided images indicative of VaIN?

A
  • Left (low-grade)
    • koilocytotic changes in superficial squamous epithelium
    • expanded basal layer with increased mitoses
  • Right (high-grade)
    • high cellularity, loss of maturation & atypia in all layers
    • cells with high nuclear:cytoplasm ratio
    • p16 positive
63
Q

What pathology is shown in the image of the provided gross sample?

A

Squamous Cell Carcinoma

  • endophytic & exophytic growth with hemorrhagic, friable appearance
  • most often affect posterior wall of upper ½ of vagina
64
Q

What are risk factors for developing squamous cell carcinoma?

A

Greatest: previous carcinoma of cervix or vulva

high-risk HPV

non-HPV venereal infection

smoking

immunosuppression

numerous sexual partners

65
Q

Squamous cell carcinoma of the cervix or vulva usually arise from what condition & most commonly affect which demographic of women?

A

usually arises from VaIN

postmenopausal women

66
Q

What is the clinical presentation of a patient with vulvar/cervical squamous cell carcinoma?

A

vaginal bleeding

pain/discomfort (esp during sex)

abnormal cells on papsmear

67
Q

Tumors in the lower ⅔ of the vagina metastasize to which lymph nodes? What about tumors in the uppermost ⅓ of the vagina?

A
  • lower ⅔: inguinal lymph nodes
  • upper ⅓: iliac lymph nodes
68
Q

The provided image is a histological slide of what condition?

A

Squamous Cell Carcinoma

  • Left
    • non-keratinizing, basaloid & warty SCC
    • most commonly associated with HPV
  • Right
    • keratinizing
    • more often seen non-HPV related cancers
69
Q

What condition is shown in the provided image?

A

Embryonal rhabdomyosarcoma

(sarcoma botryoides)

  • polyploid, rounded, bulky masses with appearance of flusters of grapes
70
Q

Embryonal rhabdomyosarcoma most commonly affects what demographic? Treatment?

A

infants & girls under 5 yrs

surgery & chemotherapy - tend to invade locally

71
Q

The provided slides are histological samples of what condition?

A

Embryonal Rhabdomyosarcoma

  • tumor cells are small with oval nuclei & small protrusions on one end that make them look like “tennis rackets”
  • Tumor cells are crowded just beneath vaginal epithelium in “cambium layer”
  • In deeper regions, cells are less numerous & lie within a edematous, fibromyxoid stroma with inflammatory cells

S3B3 Pathology (6 decks)

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