Difference between revisions of "Vulva"

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


Precursor lesion:  
Precursor lesion:  

Revision as of 02:54, 28 February 2011

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:

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.
  • AKA papillary hidradenoma.[5]
  • Looks like intraductal papilloma of the breast.[6]

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
  5. ↑ Hidradenoma papilliferum. Stedman's Medical Dictionary. 27th Ed.
  6. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1067. ISBN 0-7216-0187-1.
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