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un-redirect, split-out vagina from vulva and vagina
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# | This article addresses the basics of '''vulva''', from a pathologic perspective. | ||
Low grade pre-cancerous lesions (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> | |||
==See also== | |||
*[[Gynecologic pathology]]. | |||
*[[Uterus]]. | |||
*[[Cervix]] - cervical intraepithelial neoplasia. | |||
*[[Vulva]]. | |||
*[[Anus]] - anal intraepithelial neoplasia. | |||
==References== | |||
{{reflist|2}} | |||
[[Category:Gynecologic pathology]] | |||