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Pathology III > Vulva & Vagina > Flashcards

Vulva & Vagina Flashcards

1
Q

genital herpes

  • cause
  • demographics
  • morphology - gross and microscopic
  • sequelae
A
  • cause = HSV-1, HSV-2
  • morphology
    • gross - small grouped vesicles that rupture → leaving ulcers/erosions
    • microscopic
      • keratinocytic changes
        • multinucleated acantholytic keratinocytes - have lost intracellular connection
        • ballooning
        • necrosis
      • nuclear molding
      • chromatin margination
      • Cowdry Type A bodies: large nuclear eiosinophillic inclusions in nucleus
    • sequelae
      • biggest risk is transmission to neonates from HSV+ mothers → disseminated infection
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2
Q

HSV infection - gross appearance

A

small grouped vesicles that rupture → leaving ulcers/erosions

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3
Q

HSV simplex infection - microscopic

A
  • keratinocytic changes
    • multinucleated acantholytic keratinocytes - have lost intracellular connection
    • ballooning
    • necrosis
  • nuclear molding
  • chromatin margination
  • Cowdry Type A bodies: large nuclear eiosinophillic inclusions in nucleus
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4
Q

molluscum contagiosum

  • cause
  • morphology - gross and microscopic
  • sequelae
A
  • cause
    • pox virus infection
    • spread to others by
      • direct contact (fomites) or,
      • sexual contact
  • morphology
    • gross - small umbilicated papule with dimpled center (caseous plug) on lower body - lower abdomen / inner thighs / buttocks / genitals
    • microscopic
      • dome-shaped papule with dimpled center
      • contains molluscum bodies:
        • eisoniophillic cytoplasmic inclusions
  • sequelae
    • non-significant (resolves spontaneously_
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5
Q

molluscum - gross presentation

A

small umbilicated papule with dimpled center (caseous plug)

on lower body: lower abdomen / inner thighs / buttocks / genitals

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6
Q

mollscum - microscopic presentation

A
  • dome-shaped papule with dimpled center
  • + molluscum bodies:
    • eisoniophillic cytoplasmic inclusions
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7
Q

condyloma acuminatum

  • cause
  • morphology
  • sequelae
A
  • cause:
    • HPV-6,11
    • spread by sexual contact
  • morphology
    • gross- exophytic papillary lesions
    • microscopic
      • exophytic papillomatous growth with
        • broad tumor base
        • fibrovascular cores
      • contain koilocytes:
  • sequelae
    • most regress
    • but can progress to VIN which can progress to SSC
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8
Q

condyloma acuminatum - gross morphology

A

papillary, exophytic lesions

on vulva / perineum / perianal skin

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9
Q

condyloma acuminatum - microscopic morphology

A
  • exophytic papillomatous growth with
    • broad tumor base
    • fibrovascular cores
  • contain koilocytes: enlarged cells with perinuclear halos
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10
Q

bartholin cyst

  • cause
  • morphology - gross, microscopic
  • sequelae
A
  • cause: obstruction of bartholin duct leading to fluid accumulating
  • morphology
    • gross - cyst enlargement in labia minor (unilateral)
    • microscopic - transitional epithelium lining residual mucous glands
  • sequlae
    • n/a, no neoplastic potential
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11
Q

lichen sclerosis

  • cause
  • clinical
  • morphology - gross and microscopic
  • sequelae
A
  • cause - unknown
  • clinical
    • sx - pruritic (itchy)
    • demographics - post-menopausal women
  • gross
    • pale pink - white dry, rough scaly plaques in anogenital skin
      • “parchment-like” skin
    • microscopic
      • band-like lymphocytic infiltrate in deep dermis
        • deep to thinning (atrophic) epidermis
        • above hypocellular basal layer
      • absence of skin adenexa (sweat glands, pilosebaceous units)
  • sequelae
    • can progress to D-VIN (HPV-unlrelated VIN)
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12
Q

lichen sclerosis - gross morphology

A

pale pink - white dry, rough scaly plaques in anogenital skin - “parchment-like” skin

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13
Q

lichen sclerosis - microscopic morphology

A
  • band-like lymphocytic infiltrate in deep dermis
    • deep to thinning (atrophic) epidermis
    • above hypocellular basal layer
  • absence of skin adenexa (sweat glands, pilosebaceous units)
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14
Q

vulvar intraepithelial neoplasia (VIN)

  • cause
  • demographics
  • sequelae
  • morphology - gross, microscopic
A

cause, demographics, sequelae

  • usual VIN (U-VIN)
    • HPV related (HPV-16)
    • younger women - 4th/5th decade (30s, 40s)
    • progression unlikely.
      • if progresses:
        • to SCC, takes 40+ months
  • differentiated type VIN (D-VIN)
    • Not HPV related
      • spontaneous or d/t lichen sclerosis
    • older women - 7th/8th decade (60s, 70s)
    • progression very likely (80-90%)
      • to SCC, 2x as fast at U-VIN (23-mos)

morphology:

  • microscopic
    • (both): hyperkeratosis & hyperchromatic nuclei
      • U-VIN: full-thickness atypia
      • D-VIN: atypia often confined to lower epithelial layers, superficial layers mature
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15
Q

U-VIN

  • cause
  • demographic
  • sequelae
A

more prevalent VIN (>90%)

  • HPV related (HPV-16)
  • younger women - 4th/5th decade (30s, 40s)
  • progression unlikely.
    • if progresses:
      • to SCC, takes 40+ months
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16
Q

D-VIN

  • cause
  • demographic
  • sequelae
A

less prevalent VIN

  • Not HPV related
    • spontaneous, or
    • d/t lichen sclerosis
  • older women - 7th/8th decade (60s, 70s)
  • progression very likely (80-90%)
    • to SCC, 2x as fast at U-VIN (23-mos)
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17
Q

vulva intraepithelial neoplasm (VIN) - morphology

A
  • in both:
    • hyperkeratosis
    • hyperchromatic nuclei
  • U-VIN vs D-VIN:
    • U-VIN: full-thickness atypia
    • D-VIN: atypia often confined to lower layers, superficial layers mature
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18
Q

vulvar squamous cell carcinoma (SCC)

  • cause
  • demographics
  • diagnosis
  • morphology
A

cause / demographics / sequelae / dx

  • two variations
    • HPV-dependent (30%)
      • associated with HPV-16 - typically from U-VIN
      • demographics - younger women
        • m/c in smokers/immunocompromised
      • dx
          • for p16
          • for p53 mutations
    • HPV-independent (70%)
      • not associated with HPV - typically from D-VIN / lichen sclerosis
      • demographics - older women
      • dx
          • for p16
          • for p53 mutation

morphology

  • gross: white, firm central mass with raised borders
    • +/- central ulceration
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19
Q

HPV-associated vulvar SSC

  • cause
  • demographics
  • sequelae
  • diagnosis
A

< 30% of vulvar SCC

  • associated with HPV-16 / U-VIN
  • demographics - younger women (35-65)
    • m/c in smokers / immunocompromised
  • dx
    • positive for p16
    • negative for p53 mutations
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20
Q

HPV-independent vulvar SSC

  • cause
  • demographics
  • sequelae
  • diagnosis
A
  • not associated with HPV
    • typically from D-VIN / lichen sclerosis
  • demographics - older women (55-85)
  • dx
    • negative for p16
    • positive for p53 mutation
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21
Q

invasive vulvar SCC

microscopic presentation

A
  • infiltrating nests of eosinophillic cytoplasm
  • formation of keratin pearls
  • desmoplastic stroma
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22
Q

papillary hidradenoma

  • cause
  • demographics
  • morphology
  • sequelae
A
  • cause - gland forming tumor with aprocrine differentiation
  • demographics - white women 35-50
  • morphology
    • gross: well-circumscribed skin-colored nodules
    • microscopic:
      • branching/anastomosing papillary projections lined with two layers:
        • outer - myoepithelial
        • inner - cudoidal-columnar
  • sequelae
    • n/a - is benign
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23
Q

papillary hidradenoma

gross morphology

A

well-circumscribed skin-colored nodules

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24
Q

papillary hydradenoma - microscopic presentation

A
  • branching/anastomosing papillary projections that are
    • lined with two layers:
      • outer - myoepithelial
      • inner - cudoidal-columnar
    • have apocrine secretion
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25
Q

extramammary paget’s disease

  • cause
  • clinical
  • morphology - gross & microscopic
  • dx
  • sequelae
A
  • cause - intraepidermal adnenocarcinoma
  • clinical
    • middle aged older women
    • highly pruritic - mistaken for dermatitis/allergic rxn
  • morphology
    • gross - scaly, red raised plaque
    • microscopic - nests/single large pale cells w/ abundant cytoplasm (intracytoplasmic mucin)
  • dx
      • for mucarmine stain
      • for melenoma cells
  • sequelae
    • usually not invasive - good prognosis in this case (worse is invasive)
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26
Q

extramammary paget disease - gross presentation

A

red, moist eczematous plaque - often pruritic (confused w/ inflammation)

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27
Q

extramammary paget’s disease - microscopic morphology

A

large, pale cells with abundant cytoplasm (intracytoplasmic mucin)

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28
Q

what is the differential dx for for extra-mammary pagets disease?

how do we rule it out?

A

melanoma - is microscopically similar

distinguish between the two with mucarmine and melanoma stain

extra-mammary pagets:

  • mucarmine +
  • melanoma -

melenoma:

  • mucarmine -
  • melanoma +
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29
Q

vulvovaginal candidiasis

  • cause
  • clinical
  • morphology - gross, microscopic
  • sequelae
A
  • cause:
    • candida albicans infection
    • often in the context of
      • antibiotics
      • immunocompromised / DM
      • pregnancy
  • clinical - highly pruritic (itchy)
  • morphology
    • gross - white, curd like deposits on vaginal wall
    • microscopic - filamentous psuedohyphae perpendicular to squamous epithelium
        • occasional budding yeast
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30
Q

trichomonas vaginalis

  • cause
  • clinical
  • morphology
A
  • cause - infection with unicellular, flagellate protozoan parasite
    • spread by sexual contact
  • clinical
    • yellow, frothy vaginal discharge
    • pruritis + dysuria +dyspareunia (painful intercourse)
  • morphology
    • gross - vaginal/cervical mucosa has fiery red appearance (“strawberry cervix) & dilated blood vessels
    • microscopic - isolation of protazoans +/- neutrophils
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31
Q

gardnerella vaginalis

  • cause
  • clinical
  • morphology - gross & microscopic
A
  • cause - shift in normal bacterial flora → overgrowth of coccobacilli (i.e. g. vaginalis)
    • often d/t IUD/douching, new sexual partner, Ab use
  • clinical
    • thin, green-gray malodorous discharge that’s more noticeable after intercourse
  • morphology
    • microscopic - presence of clue cells: squamous cells with a shaggy covering of coccobacilli
32
Q

vaginal intraepithelial neoplasia (VaIN)

  • cause
  • clinical
  • morphology
  • sequelae
A
  • cause - often associated with prior neoplasia of vulva - VIN/vulvar SCC
  • clinical - asymptomatic
  • morphology
    • gross - variable white discoloration with sharp borders (“acetowhite”)
    • microscopic - koilocytic changes in squamous epithelium
  • dx
    • stain with acetowhite
    • stains + for p16
  • sequelae - usually regresses. < 10% turn to SCC
33
Q

vaginal SCC

  • cause
  • clinical
  • morphology
A
  • cause - almost always in the context of high risk HPV
    • typically following VIN/VaIN- most commonly VaIN
  • clinical
    • post-menopausal women
    • often presents with vaginal bleeding
      • +/- other sx of mass lesion (dyspareunia)
    • metastasis
      • in upper ⅓ of vagina → iliac lymph nodes
      • in lower ⅔ vagina → inguinal lymph nodes
  • gross
    • gross - exo/endo-phytic, necrotizing, friable
    • microscopic - keratinizing or non-keratinizing
  • sequelae
34
Q

where in the lower genital tract is is the l_east common_ site of intraepithelial neoplasia?

A

vagina (VaIN)

35
Q

compare and contrast vulvar and vaginal SCC

A

for both:

  • gross appearance = endophytic or exophytic

vulvar SCC:

  • typically (>70%) HPV-independent
    • d/t D-VIN/lichen sclerosis
  • if invasive - well differentiated tumor, desmoplastic stroma

vaginal SCC:

  • almost alway in the context of high risk HPV
    • d/t VaIN
  • if invasive - necrotizing, friable grossly
36
Q

embryonal rhabdomyosarcoma

  • cause
  • clinical
  • morphology - gross, microscopic
  • sequelae
A

= sarcoma botryoides

  • cause - unknown
  • clinical - typically seen in girls < 5 yrs
  • morphology
    • gross - polypoid, rounded bulky masses
      • “cluster of grapes”
    • microscopic - tumor cells with oval nuclei & small cytroplasmic protrusions from one end
      • “tennis racquet” appearance”
  • sequelae - tend to invade locally - need tx w/ surgery or chemo
37
Q

a woman needs lifetime surveillance if she develops (?) of any kind?

A

VIN (vulvular intraepithelial neoplasia)

38
Q

genital warts in children are typically caused by..?

A

HPV-2

If child has genital warts d/t HPV 6, 11 - sexual abuse

39
Q

identify

A

ulcer on neonate d/t HSV-1

40
Q

identify

A

neonated with disseminated HSV infection

41
Q

identify

A

erosions from ruptured vesicles

primary HSV infection

42
Q

label

A

Cowdry Type A bodies: esionophillic nuclear inclusions

seen in HSV infection

43
Q

identify and label

A
44
Q

identify

A

molluscum contagiosum, gross

45
Q

identify

A

molluscum contagiosum miscroscopic

dome-shaped papule with dimpled center

46
Q

identify

A

molluscum contagiosum miscroscopic

dome-shaped papule with dimpled center

47
Q

identify

A

molluscum body - esiononophillic cytoplasmic viral (pox virus) inclusion

mollscum contagiosum

48
Q

identify

A

molluscum body - esiononophillic nuclear viral (pox virus) inclusion

mollscum contagiosum

49
Q

identify

A

papillary, exophytic growth

condyloma acuminatum

50
Q

identify

A

exophytic papillomas with broad base and fibrovascular cores

condyloma acuminatum

51
Q

identify

A

koilocytes (clear perinuclear halos w/ wrinkled, hyperchromatic nuclei)

condyloma acuminatum

52
Q

identify

A

bartholin duct cyst

53
Q

identify

A

epithelium surrounding residual mucinous glands

bartholin duct cyst

54
Q

identify

A

lymphocytic band (lichenoid) beneath atrophic epidermis

lichen sclerosis

55
Q

identify

A

pale pink to white dry, scaly plaques - “parchment paper” skin

lichen sclerosis

56
Q

identify

A

full thickness atypia with minimal maturation

U-VIN

57
Q

identify

A

atypia in basal layers, superficial maturation

D-VIN

58
Q

identify

A

white, firm mass, with raised borders +/- central ulceration

vulvar squamous cell carcinoma

59
Q

invasive squamous cell carcinoma

A

keratin pearls, stroma is desmoplastic

invasive squamous cell carcinoma

60
Q

identify

A

well circumscribed skin colored nodules

papillary hidrademoma

61
Q

identify

A

anastomosing, branching papillae lined with two layers: outer myoepithelium and inner cuboidal-columnar

papillary hidradenoma

62
Q

identify

A

red, moist pruritic lesions that appears likely inflammation

extramammary paget disease

63
Q

identify

A

atypical cells with abundant pale cytoplasm (mucous filled cytoplasm)

extramammary paget disease

64
Q

identify

A

atypical cells with abundant pale cytoplasm

+ mucarmine stain: stains pink d/t intra-cytoplasmic mucin

extrammmary paget disease

65
Q

identify

A
  • atypical melanocytes
  • resembles extrammary pagets disease
  • mucicarmine stain -

vulvular melanoma

66
Q

identify

A

white curd-like deposits on vaginal wall

vulvovaginal candidiasis

67
Q

identify

A

psuedohyphae and rare budding yeast (curved arrow)

vulvovaginal candidiasis

68
Q

identify

A

psuedohyphae piercing epithelial cells

vulvovaginal candidiasis

69
Q

identify

label

A

black arrow: hyphae and pseudohyphae (GMS stain) oriented vertically

vulvovaginal candidia

70
Q

identify

A

trophozoites: unicellular, flagellated, protazoan parasite

trichomoniasis vaginalis

71
Q

identify

A

trophozoites + neutrophils

trichomoniasis vaginalis

72
Q

identify

A

clue cells: coccobacilli covering squamous cells

garderella vaginalis

73
Q

label

identify

A
  1. actetowhite lesion with sharp borders
  2. normal squamous vaginal epithelium
  3. region of HPV infection
74
Q

identify

A

koilocytic changes

VaIN

75
Q

identify

A

polypoid mass

embryoyal rhabdoomyosarcoma

76
Q

identify

A

botryoides (“grape-like”) polyploid, rounded bulky masses

embryonal rhabdomyosarcoma

77
Q

identify

A

“tennis raquet” tumor cells - oval nuclei with ill defined cytoplasm that sometimes extends in a “whisp”

embryonal rhabdomyosarcoma - microscopic

Pathology III (5 decks)

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