Vulva/vagina

Question 1

benign mimics of malignancy

Answer 1

infection: granuloma inguinale (Donovanosis/Klebsiella), LGV, HSV

granular cell tumour

seb K (vs VIN)

fibroepithelial polyp with atypical stromal cells (vs sarcoma)

genital type rhabdomyoma (vs RMS)

mesonephric remnants

prolapse

endometriosis +/- decidualisation

Question 2

granuloma inguinale - features

Answer 2

SCC-like ulcerations

pseudoepitheliomatous hyperplasia

neutrophils, plasma cells, foamy histiocytes

Donovan bodies

Warthin-Starry +

Question 3

LGV - features

Answer 3

pseudoepitheliomatous hyperplasia

necrosis

giant cells and chronic inflammation

Warthin-Starry +

Question 4

vasculitis - think of…

Answer 4

Behcet syndrome

Question 5

granulomas - think of…

Answer 5

Crohns

Question 6

mesenchymal lesions

Answer 6

aggressive angiomyxoma: infiltrative, paucicellular, thick walled vessels, myoid bundles, RBC extrav

angiomyofibroblastoma: well circ, alternating cellularity, small vessels, oedematous matrix

cellular angiofibroma: spindle cells fascicles (CD34+), wispy collagen, thick walled vessels

FE stromal polyp: may have atypical stromal cells

superficial angiofibroma: circumscribed, thin walled vessels, desmin- (cf desmin+ in AAM)

Question 7

myxoid lesions

Answer 7

superficial angiomyxoma

aggressive angiomyxoma

myxoid neurofibroma

myxoid leiomyoma/LMS

myxoid liposarcoma

Question 8

Pagets vs melanoma vs scc in situ vs visceral malignancy

Answer 8

primary Paget’s: LMWCK+ CK7+ CK20-

secondary Paget’s: LMWCK+ CK7/20 depends on underlying ca (TCC +/+, cervical +/-, anorectal -/+)

melanoma melanA+

SCC HMWCK+

Question 9

basaloid SCC vs BCC vs Merkel

Answer 9

SCC: CK5/6+

BCC: BerEP4+

Merkel: dot CK20+, NE markers+