Difference between revisions of "Vulva and vagina"
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==Classic VIN== | ==Classic VIN== | ||
=== | ===Epidemiology=== | ||
*Classic VIN, like CIN, is associated with [[HPV]] and seen in younger women. | *Classic VIN, like CIN, is associated with [[HPV]] and seen in younger women. | ||
===General=== | ===General=== | ||
* | *Classic VIN is graded like cervical pre-cancerous lesions: | ||
**VIN I | **VIN I. | ||
*** | ***Not common. | ||
**VIN II | **VIN II. | ||
*** | ***Not common. | ||
**VIN III | **VIN III. | ||
*** | ***Commonly seen. | ||
DDx: | DDx: | ||
*Condyloma (genital wart) | *Condyloma (genital wart). | ||
**Most caused by HPV. | **Most caused by HPV. | ||
===Micro. of classic VIN=== | ===Micro. of classic VIN=== | ||
*Increased NC ratio. | *Increased NC ratio. | ||
*Multinucleation. | *Multinucleation. | ||
*Lack of maturation to surface (not very useful -- unlike in the cervix).<ref>LAE | *Lack of maturation to surface (not very useful -- unlike in the cervix).<ref>LAE. February 2009.</ref> | ||
*Apical mitoses. | *Apical mitoses. | ||
Revision as of 21:51, 6 July 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
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.
- VIN I.
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).[2]
- 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[3]
- inflammation - often with eosinophils
Ref.:[4]
Bartholin cyst
Micro
- cyst with squamous or urothelial epithelium[5]
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[6] 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.[7]
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.
- ↑ LAE. February 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.