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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
extramammary paget's disease * cause * clinical * morphology - gross & microscopic * dx * sequelae
* 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)
26
extramammary paget disease - gross presentation
**red, moist eczematous plaque** - often pruritic (confused w/ inflammation)
27
extramammary paget's disease - microscopic morphology
**large, pale cells** with abundant cytoplasm (intracytoplasmic mucin)
28
what is the differential dx for for extra-mammary pagets disease? how do we rule it out?
melanoma - is microscopically similar distinguish between the two with **mucarmine** and **melanoma stain** extra-mammary pagets: * mucarmine + * melanoma - melenoma: * mucarmine - * melanoma +
29
vulvovaginal candidiasis * cause * clinical * morphology - gross, microscopic * sequelae
* 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
30
trichomonas vaginalis * cause * clinical * morphology
* 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
31
gardnerella vaginalis * cause * clinical * morphology - gross & microscopic
* 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
vaginal intraepithelial neoplasia (VaIN) * cause * clinical * morphology * sequelae
* 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
vaginal SCC * cause * clinical * morphology
* 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
where in the lower genital tract is is the l_east common_ site of intraepithelial neoplasia?
vagina (VaIN)
35
compare and contrast vulvar and vaginal SCC
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
embryonal rhabdomyosarcoma * cause * clinical * morphology - gross, microscopic * sequelae
= 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
a woman needs lifetime surveillance if she develops (?) of any kind?
VIN (vulvular intraepithelial neoplasia)
38
genital warts in children are typically caused by..?
**HPV-2** If child has genital warts d/t HPV 6, 11 - sexual abuse
39
identify
ulcer on neonate d/t HSV-1
40
identify
neonated with disseminated HSV infection
41
identify
erosions from ruptured vesicles primary HSV infection
42
label
Cowdry Type A bodies: esionophillic _nuclear_ inclusions seen in HSV infection
43
identify and label
44
identify
molluscum contagiosum, gross
45
identify
molluscum contagiosum miscroscopic dome-shaped papule with dimpled center
46
identify
molluscum contagiosum miscroscopic dome-shaped papule with dimpled center
47
identify
**molluscum body** - esiononophillic _cytoplasmic_ viral (pox virus) inclusion mollscum contagiosum
48
identify
**molluscum body** - esiononophillic _nuclear_ viral (pox virus) inclusion mollscum contagiosum
49
identify
**papillary, exophytic growth** condyloma acuminatum
50
identify
**exophytic papillomas** with _broad base_ and _fibrovascular cores_ condyloma acuminatum
51
identify
**koilocytes** (clear perinuclear halos w/ wrinkled, hyperchromatic nuclei) condyloma acuminatum
52
identify
bartholin duct cyst
53
identify
epithelium surrounding _residual mucinous glands_ bartholin duct cyst
54
identify
**lymphocytic band (lichenoid)** beneath atrophic epidermis lichen sclerosis
55
identify
pale pink to white dry, scaly plaques - **“parchment paper”** skin lichen sclerosis
56
identify
full thickness atypia with minimal maturation U-VIN
57
identify
atypia in basal layers, superficial maturation D-VIN
58
identify
white, firm mass, with raised borders +/- central ulceration vulvar squamous cell carcinoma
59
invasive squamous cell carcinoma
keratin pearls, stroma is desmoplastic invasive squamous cell carcinoma
60
identify
well circumscribed **skin colored** nodules papillary hidrademoma
61
identify
anastomosing, branching papillae lined with **two layers:** **outer myoepithelium** and **inner cuboidal-columnar** papillary hidradenoma
62
identify
**red, moist pruritic lesions** that appears likely inflammation extramammary paget disease
63
identify
atypical cells with **abundant pale cytoplasm** (mucous filled cytoplasm) extramammary paget disease
64
identify
atypical cells with **abundant pale cytoplasm** _+ mucarmine stain:_ stains pink d/t intra-cytoplasmic mucin extrammmary paget disease
65
identify
* atypical melanocytes * resembles extrammary pagets disease * **mucicarmine stain -** vulvular melanoma
66
identify
**white curd-like deposits** on vaginal wall vulvovaginal candidiasis
67
identify
**psuedohyphae** and _rare budding yeast_ (curved arrow) vulvovaginal candidiasis
68
identify
psuedohyphae piercing epithelial cells vulvovaginal candidiasis
69
identify label
black arrow: hyphae and pseudohyphae (GMS stain) oriented vertically vulvovaginal candidia
70
identify
**trophozoites:** unicellular, flagellated, protazoan parasite trichomoniasis vaginalis
71
identify
trophozoites + neutrophils trichomoniasis vaginalis
72
identify
**clue cells:** coccobacilli covering squamous cells garderella vaginalis
73
label identify
1. **actetowhite lesion with sharp borders** 2. normal squamous vaginal epithelium 3. region of HPV infection
74
identify
koilocytic changes VaIN
75
identify
**polypoid mass** embryoyal rhabdoomyosarcoma
76
identify
**botryoides ("grape-like")** polyploid, rounded bulky masses embryonal rhabdomyosarcoma
77
identify
**“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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