Vulva and vagina - Revision history

Michael: make to disambig

2010-11-19T16:07:01Z

make to disambig

← Older revision		Revision as of 16:07, 19 November 2010
Line 1:		Line 1:
	This ~~article addresses~~ the ~~basics of everything '''vulva''' and '''vagina''', from a pathologic perspective~~.		This is now dealt with in the articles:
			*[[Vagina]].
			*[[Vulva]].

	Low grade pre-cancerous lesions (VAIN, VIN) are typically HPV positive, while high grade pre-cancerous lesions and cancer are less often HPV positive.<ref name=pmid19115209>{{cite journal \|author=De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S \|title=Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis \|journal=Int. J. Cancer \|volume=124 \|issue=7 \|pages=1626–36 \|year=2009 \|month=April \|pmid=19115209 \|doi=10.1002/ijc.24116 \|url=}}</ref>

	~~Most common malignancy of vulva:~~
	*Invasive squamous cell carcinoma.

	~~Precursor lesion:~~
	*vulvar intraepithelial neoplasia (VIN).

	~~VIN can be divided into:~~
	*''Classic VIN'', and
	*''Differentiated VIN''.
	**''Differentiated VIN'' is mostly irrelevant as it is basically never seen alone, i.e. it usually accompanies cancer.

	~~==Classic VIN==~~
	~~===Epidemiology===~~
	*Classic VIN, like CIN, is associated with [[HPV]] and seen in younger women.

	~~===General===~~
	*Classic VIN is graded like cervical pre-cancerous lesions:
	**VIN I.
	***Not common.
	**VIN II.
	***Not common.
	**VIN III.
	***Commonly seen.

	~~DDx:~~
	*Condyloma (genital wart).
	**Most caused by HPV.

	~~===Micro. of classic VIN===~~
	*Increased NC ratio.
	*Multinucleation.
	*Lack of maturation to surface (not very useful -- unlike in the cervix).<ref>LAE. February 2009.</ref>
	*Apical mitoses.

	~~==Differentiated VIN==~~
	~~===Epidemiology===~~
	*Assoc. with [[lichen sclerosis]].
	*NOT associated with HPV and seen in older women.

	~~===Histology===~~
	*NOT graded like classic VIN.
	*Acanthosis (thickening of stratum spinosum) + elongation of rete ridges.

	~~==IHC for VIN==~~
	*Classic VIN: p16+, p53-.
	*Differentiated VIN: p16-, p53+.

	~~ASIDE: [[p16]] can be thought of as a poor man's HPV test.~~

	~~==Lichen sclerosus==~~
	~~===General===~~
	*Pruritis -> leads to scratching.

	~~===Microscopic===~~
	~~Features:<ref>[http://www.pathologyoutlines.com/vulva.html#lichensclerosis http://www.pathologyoutlines.com/vulva.html#lichensclerosis]</ref>~~
	*Loss of rete ridges - '''key feature'''.
	*Severe hyperkeratosis.
	*Fibrosis of dermis with loss of adnexal structures<ref>NEED REF.</ref>
	*Inflammation - often with eosinophils.

	~~==Bartholin cyst==~~
	~~===General===~~
	*Common.

	~~===Micro===~~
	*Cyst with squamous or urothelial epithelium.<ref>[http://pathologyoutlines.com/vulva.html#bartholincyst http://pathologyoutlines.com/vulva.html#bartholincyst]</ref>

	~~==Vagina==~~
	~~===Normal===~~
	*Squamous epithelium, non-keratinized.

	~~===Prolapse===~~
	*Pieces of vagina are often submitted in the context of uterine prolapse.

	~~====Microscopic====~~
	*Squamous epithelium - may be keratinized.

	~~===Vaginal cancer===~~
	*Most common cancer of the vagina is [[squamous cell carcinoma]].
	*Precursor lesions are similar to the [[cervix]]<ref name=pmid18714572>{{cite journal \|author=Indraccolo U, Chiocci L, Baldoni A \|title=Does vaginal intraepithelial neoplasia have the same evolution as cervical intraepithelial neoplasia? \|journal=Eur. J. Gynaecol. Oncol. \|volume=29 \|issue=4 \|pages=371–3 \|year=2008 \|pmid=18714572 \|doi= \|url=}}</ref> and are often HPV associated - see ''vaginal intraepithelial neoplasia'' (VAIN).
	*Development of VAIN can be associated with [[cervical intraepithelial neoplasia]] and arises in up to 7.4% of patients that underwent a (total) hysterectomy for CIN2 or worse.<ref name=pmid18456229>{{cite journal \|author=Schockaert S, Poppe W, Arbyn M, Verguts T, Verguts J \|title=Incidence of vaginal intraepithelial neoplasia after hysterectomy for cervical intraepithelial neoplasia: a retrospective study \|journal=Am. J. Obstet. Gynecol. \|volume=199 \|issue=2 \|pages=113.e1–5 \|year=2008 \|month=August \|pmid=18456229 \|doi=10.1016/j.ajog.2008.02.026 \|url=}}</ref>

	~~===Vaginal intraepithelial neoplasia (VAIN)===~~
	~~VAIN is graded like cervical lesions:~~
	*Mild vaginal intraepithelial neoplasia (VAIN I).
	*Moderate vaginal intraepithelial neoplasia (VAIN II).
	*Severe vaginal intraepithelial neoplasia (VAIN III).

	~~===Vaginal cysts===~~
	*Most common is ''vaginal inclusion cyst''.<ref>URL: [http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm]. Accessed on: 6 July 2010.</ref>
	**Usually due to trauma.
	~~==See also==~~
	*[[Gynecologic pathology]].
	*[[Uterus]].
	*[[Cervix]] - cervical intraepithelial neoplasia.
	*[[Anus]] - anal intraepithelial neoplasia.

	~~==References==~~
	~~{{reflist\|2}}~~

	[[Category:Gynecologic pathology]]		[[Category:Gynecologic pathology]]

Michael: inclusion cysts

2010-07-06T21:56:42Z

inclusion cysts

← Older revision		Revision as of 21:56, 6 July 2010
Line 91:		Line 91:
	*Severe vaginal intraepithelial neoplasia (VAIN III).		*Severe vaginal intraepithelial neoplasia (VAIN III).

			===Vaginal cysts===
			*Most common is ''vaginal inclusion cyst''.<ref>URL: [http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm]. Accessed on: 6 July 2010.</ref>
			**Usually due to trauma.
	==See also==		==See also==
	*[[Gynecologic pathology]].		*[[Gynecologic pathology]].

Michael: /* Lichen sclerosus */

2010-07-06T21:54:25Z

Lichen sclerosus

← Older revision		Revision as of 21:54, 6 July 2010
Line 53:		Line 53:

	==Lichen sclerosus==		==Lichen sclerosus==
	===~~Micro~~===		===General===
	*~~loss of rete ridges~~ - ~~key feature~~		*Pruritis -> leads to scratching.
	*severe hyperkeratosis
	*fibrosis of dermis with loss of adnexal structures<ref>~~NEED REF~~.~~</ref>~~		===Microscopic===
	*inflammation - often with eosinophils		Features:<ref>[http://www.pathologyoutlines.com/vulva.html#lichensclerosis http://www.pathologyoutlines.com/vulva.html#lichensclerosis]</ref>
	~~Ref.~~:<ref>[http://www.pathologyoutlines.com/vulva.html#lichensclerosis http://www.pathologyoutlines.com/vulva.html#lichensclerosis]</ref>		*Loss of rete ridges - '''key feature'''.
			*Severe hyperkeratosis.
			*Fibrosis of dermis with loss of adnexal structures<ref>NEED REF.</ref>
			*Inflammation - often with eosinophils.

	==Bartholin cyst==		==Bartholin cyst==

Michael: /* Bartholin cyst */ general

2010-07-06T21:51:41Z

Bartholin cyst: general

← Older revision		Revision as of 21:51, 6 July 2010
Line 61:		Line 61:

	==Bartholin cyst==		==Bartholin cyst==
			===General===
			*Common.

	===Micro===		===Micro===
	*~~cyst~~ with squamous or urothelial epithelium<ref>[http://pathologyoutlines.com/vulva.html#bartholincyst http://pathologyoutlines.com/vulva.html#bartholincyst]</ref>		*Cyst with squamous or urothelial epithelium.<ref>[http://pathologyoutlines.com/vulva.html#bartholincyst http://pathologyoutlines.com/vulva.html#bartholincyst]</ref>

	==Vagina==		==Vagina==

Michael: /* Classic VIN */ format

2010-07-06T21:51:05Z

Classic VIN: format

← Older revision		Revision as of 21:51, 6 July 2010
Line 15:		Line 15:

	==Classic VIN==		==Classic VIN==
	===~~Epi.~~===		===Epidemiology===
	*Classic VIN, like CIN, is associated with [[HPV]] and seen in younger women.		*Classic VIN, like CIN, is associated with [[HPV]] and seen in younger women.

	===General===		===General===
	*~~classic~~ VIN is graded like cervical pre-cancerous lesions:		*Classic VIN is graded like cervical pre-cancerous lesions:
	**VIN I,		**VIN I.
	***~~not~~ common.		***Not common.
	**VIN II,		**VIN II.
	***~~not~~ common.		***Not common.
	**VIN III,		**VIN III.
	***~~commonly~~ seen.		***Commonly seen.

	DDx:		DDx:
	*Condyloma (genital wart),		*Condyloma (genital wart).
	**Most caused by HPV.~~<ref>NEED REF</ref>~~		**Most caused by HPV.

	===Micro. of classic VIN===		===Micro. of classic VIN===
	*Increased NC ratio.		*Increased NC ratio.
	*Multinucleation.		*Multinucleation.
	*Lack of maturation to surface (not very useful -- unlike in the cervix).<ref>LAE ~~Feb~~ 2009</ref>		*Lack of maturation to surface (not very useful -- unlike in the cervix).<ref>LAE. February 2009.</ref>
	*Apical mitoses.		*Apical mitoses.

Michael: create

2010-05-12T17:45:42Z

create

New page

This article addresses the basics of everything '''vulva''' and '''vagina''', from a pathologic perspective.

Low grade pre-cancerous lesions (VAIN, VIN) are typically HPV positive, while high grade pre-cancerous lesions and cancer are less often HPV positive.<ref name=pmid19115209>{{cite journal |author=De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S |title=Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis |journal=Int. J. Cancer |volume=124 |issue=7 |pages=1626–36 |year=2009 |month=April |pmid=19115209 |doi=10.1002/ijc.24116 |url=}}</ref>

Most common malignancy of vulva:
*Invasive squamous cell carcinoma.

Precursor lesion:
*vulvar intraepithelial neoplasia (VIN).

VIN can be divided into:
*''Classic VIN'', and
*''Differentiated VIN''.
**''Differentiated VIN'' is mostly irrelevant as it is basically never seen alone, i.e. it usually accompanies cancer.

==Classic VIN==
===Epi.===
*Classic VIN, like CIN, is associated with [[HPV]] and seen in younger women.

===General===
*classic VIN is graded like cervical pre-cancerous lesions:
**VIN I,
***not common.
**VIN II,
***not common.
**VIN III,
***commonly seen.

DDx:
*Condyloma (genital wart),
**Most caused by HPV.<ref>NEED REF</ref>

===Micro. of classic VIN===
*Increased NC ratio.
*Multinucleation.
*Lack of maturation to surface (not very useful -- unlike in the cervix).<ref>LAE Feb 2009</ref>
*Apical mitoses.

==Differentiated VIN==
===Epidemiology===
*Assoc. with [[lichen sclerosis]].
*NOT associated with HPV and seen in older women.

===Histology===
*NOT graded like classic VIN.
*Acanthosis (thickening of stratum spinosum) + elongation of rete ridges.

==IHC for VIN==
*Classic VIN: p16+, p53-.
*Differentiated VIN: p16-, p53+.

ASIDE: [[p16]] can be thought of as a poor man's HPV test.

==Lichen sclerosus==
===Micro===
*loss of rete ridges - key feature
*severe hyperkeratosis
*fibrosis of dermis with loss of adnexal structures<ref>NEED REF.</ref>
*inflammation - often with eosinophils
Ref.:<ref>[http://www.pathologyoutlines.com/vulva.html#lichensclerosis http://www.pathologyoutlines.com/vulva.html#lichensclerosis]</ref>

==Bartholin cyst==
===Micro===
*cyst with squamous or urothelial epithelium<ref>[http://pathologyoutlines.com/vulva.html#bartholincyst http://pathologyoutlines.com/vulva.html#bartholincyst]</ref>

==Vagina==
===Normal===
*Squamous epithelium, non-keratinized.

===Prolapse===
*Pieces of vagina are often submitted in the context of uterine prolapse.

====Microscopic====
*Squamous epithelium - may be keratinized.

===Vaginal cancer===
*Most common cancer of the vagina is [[squamous cell carcinoma]].
*Precursor lesions are similar to the [[cervix]]<ref name=pmid18714572>{{cite journal |author=Indraccolo U, Chiocci L, Baldoni A |title=Does vaginal intraepithelial neoplasia have the same evolution as cervical intraepithelial neoplasia? |journal=Eur. J. Gynaecol. Oncol. |volume=29 |issue=4 |pages=371–3 |year=2008 |pmid=18714572 |doi= |url=}}</ref> and are often HPV associated - see ''vaginal intraepithelial neoplasia'' (VAIN).
*Development of VAIN can be associated with [[cervical intraepithelial neoplasia]] and arises in up to 7.4% of patients that underwent a (total) hysterectomy for CIN2 or worse.<ref name=pmid18456229>{{cite journal |author=Schockaert S, Poppe W, Arbyn M, Verguts T, Verguts J |title=Incidence of vaginal intraepithelial neoplasia after hysterectomy for cervical intraepithelial neoplasia: a retrospective study |journal=Am. J. Obstet. Gynecol. |volume=199 |issue=2 |pages=113.e1–5 |year=2008 |month=August |pmid=18456229 |doi=10.1016/j.ajog.2008.02.026 |url=}}</ref>

===Vaginal intraepithelial neoplasia (VAIN)===
VAIN is graded like cervical lesions:
*Mild vaginal intraepithelial neoplasia (VAIN I).
*Moderate vaginal intraepithelial neoplasia (VAIN II).
*Severe vaginal intraepithelial neoplasia (VAIN III).

==See also==
*[[Gynecologic pathology]].
*[[Uterus]].
*[[Cervix]] - cervical intraepithelial neoplasia.
*[[Anus]] - anal intraepithelial neoplasia.

==References==
{{reflist|2}}

[[Category:Gynecologic pathology]]