Difference between revisions of "Vulva and vagina"
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Revision as of 17:45, 12 May 2010
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.[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
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.
- VIN I,
DDx:
- Condyloma (genital wart),
- Most caused by HPV.[2]
Micro. of classic VIN
- Increased NC ratio.
- Multinucleation.
- Lack of maturation to surface (not very useful -- unlike in the cervix).[3]
- 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[4]
- inflammation - often with eosinophils
Ref.:[5]
Bartholin cyst
Micro
- cyst with squamous or urothelial epithelium[6]
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[7] 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.[8]
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
- ↑ 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.
- ↑ NEED REF
- ↑ LAE Feb 2009
- ↑ NEED REF.
- ↑ http://www.pathologyoutlines.com/vulva.html#lichensclerosis
- ↑ http://pathologyoutlines.com/vulva.html#bartholincyst
- ↑ Indraccolo U, Chiocci L, Baldoni A (2008). "Does vaginal intraepithelial neoplasia have the same evolution as cervical intraepithelial neoplasia?". Eur. J. Gynaecol. Oncol. 29 (4): 371–3. PMID 18714572.
- ↑ Schockaert S, Poppe W, Arbyn M, Verguts T, Verguts J (August 2008). "Incidence of vaginal intraepithelial neoplasia after hysterectomy for cervical intraepithelial neoplasia: a retrospective study". Am. J. Obstet. Gynecol. 199 (2): 113.e1–5. doi:10.1016/j.ajog.2008.02.026. PMID 18456229.