Difference between revisions of "Vulva"

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


==Neoplasms of the vulva==
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>
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>


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


VIN can be divided into:  
VIN can be divided into:  
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**Most caused by HPV.
**Most caused by HPV.


===Micro. of classic VIN===
===Microscopic of classic VIN===
*Increased NC ratio.
*Increased NC ratio.
*Multinucleation.
*Multinucleation.
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==Differentiated VIN==
==Differentiated VIN==
===Epidemiology===
===Epidemiology===
*Assoc. with [[lichen sclerosis]].
*Associated with [[lichen sclerosis]].
*NOT associated with HPV and seen in older women.
*NOT associated with HPV and seen in older women.


===Histology===
===Microscopic===
Features:
*NOT graded like classic VIN.
*NOT graded like classic VIN.
*Acanthosis (thickening of stratum spinosum) + elongation of rete ridges.
*Acanthosis (thickening of stratum spinosum) + elongation of rete ridges.
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*Loss of rete ridges - '''key feature'''.
*Loss of rete ridges - '''key feature'''.
*Severe hyperkeratosis.
*Severe hyperkeratosis.
*Fibrosis of dermis with loss of adnexal structures<ref>NEED REF.</ref>
*Fibrosis of dermis with loss of adnexal structures.
*Inflammation - often with eosinophils.
*Inflammation - often with eosinophils.


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===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>
==Hidradenoma papilliferum==
===General===
*Dermal thingy.
===Microscopic===
Features:
*Cystic spaces.
*Epithelium with apocrine differentiation (as demonstrated by apocrine snouts).
*Well-circumscribed.
Images:
*[http://farm4.static.flickr.com/3019/2646470314_12fb77d3ec_z.jpg Hidradenoma papilliferum (flickr.com)].
Notes:
*No attachment to epidermis.
*No nuclear changes suggestive of malignancy.


==See also==
==See also==

Revision as of 16:17, 19 November 2010

This article addresses the basics of vulva, from a pathologic perspective.

Neoplasms of the vulva

Low grade pre-cancerous lesions (VIN) are typically HPV positive, while high grade pre-cancerous lesions and cancer are less often HPV positive.[1]

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.

Microscopic of classic VIN

  • Increased NC ratio.
  • Multinucleation.
  • Lack of maturation to surface (not very useful -- unlike in the cervix).[2]
  • Apical mitoses.

Differentiated VIN

Epidemiology

  • Associated with lichen sclerosis.
  • NOT associated with HPV and seen in older women.

Microscopic

Features:

  • 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:[3]

  • Loss of rete ridges - key feature.
  • Severe hyperkeratosis.
  • Fibrosis of dermis with loss of adnexal structures.
  • Inflammation - often with eosinophils.

Bartholin cyst

General

  • Common.

Micro

  • Cyst with squamous or urothelial epithelium.[4]

Hidradenoma papilliferum

General

  • Dermal thingy.

Microscopic

Features:

  • Cystic spaces.
  • Epithelium with apocrine differentiation (as demonstrated by apocrine snouts).
  • Well-circumscribed.

Images:

Notes:

  • No attachment to epidermis.
  • No nuclear changes suggestive of malignancy.

See also

References

  1. ↑ De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S (April 2009). "Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis". Int. J. Cancer 124 (7): 1626–36. doi:10.1002/ijc.24116. PMID 19115209.
  2. ↑ LAE. February 2009.
  3. ↑ http://www.pathologyoutlines.com/vulva.html#lichensclerosis
  4. ↑ http://pathologyoutlines.com/vulva.html#bartholincyst
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