Vulva/Vagina Pathology Flashcards
Lichen Sclerosus of the Vulva
Premenarchal or postmenopausal
Painful, pruritic
Thin epidermis
1-5% develop squamous cell carcinoma
Lichen Simplex Chronicus
Secondary to chronic irritation underlying inflammatory dermatosis
Also can appear as leukoplakia, epthelial thickening, hyperkeratosis, dermal chronic inflammation
No known predilection for malignancy
Condyloma Accuminata
VIN-1 (warty lesion)
Papillary, raised or flat
On anogenital surfaces
Single or multiple, small or very large
Koilocytosis (perinuclear cytoplasm vacuuolization and wrinkled nuclear contours)
Assoc with HPV 6 and 11
Vulvar dysplasia
VIN-2 & VIN-3 – high grade
Associated with HPV 16 & 18
Full thickness dysplasia: nuclear atypia, high nuclear:cytoplasmic ratio, abundant mitosis
Progression to invasive squamous cell carcinoma
Carcinoma of Vulva
Mostly > 60 yo
90% squamous cell carcinoma
Two forms:
- high risk HPV associated – preceded by VIN, multifocal, poorly differentiated, higher incidence in smokers, immunodeficiency
- in older age group – preceded by reactive changes, mainly Lichen sclerosis, well differentiated, keratinizing
Extramammary Paget’s Disease
Red, scaly plaques
Intraepidermal proliferation of malignant cells
Most commonly de novo from epidermal progenitor cells
Large pale cells in the epidermis (glandular)
Differential diagnosis: malignant melanoma, squamous cell carcinoma
CK7 positive Paget cells
What is clear cell adenocarcinoma of the vagina associated with?
Women who had exposure to DES in utero
Embryonal (botryoid) Rhabdomyosarcoma
Rare primary vaginal malignancy
Infance and children <5 years