Difference between revisions of "Vulva and vagina"

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Vulva and vagina (view source)

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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
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