Difference between revisions of "Vagina"
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*Pieces of vagina are often submitted in the context of [[uterine prolapse]]. | *Pieces of vagina are often submitted in the context of [[uterine prolapse]]. | ||
**In this context the squamous epithelium may be keratinized (due to irritation). | **In this context the squamous epithelium may be keratinized (due to irritation). | ||
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====Not quite normal==== | |||
<pre> | |||
VAGINA, BIOPSY: | |||
- SUPERFICIAL VAGINAL MUCOSA WITH PARAKERATOSIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
</pre> | |||
=Vaginal cysts= | =Vaginal cysts= | ||
Revision as of 19:35, 4 February 2014
This article addresses the basics of vagina, from a pathologic perspective.
Low grade pre-cancerous lesions of the vagina (VAIN) are typically HPV positive, while high grade pre-cancerous lesions and cancer are less often HPV positive.[1]
Normal vagina
Microscopic
- Non-keratinized squamous epithelium.
Note:
- Pieces of vagina are often submitted in the context of uterine prolapse.
- In this context the squamous epithelium may be keratinized (due to irritation).
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Not quite normal
VAGINA, BIOPSY: - SUPERFICIAL VAGINAL MUCOSA WITH PARAKERATOSIS. - NEGATIVE FOR DYSPLASIA.
Vaginal cysts
- Vaginal inclusion cyst (epidermal inclusion cyst) - squamous epithelium.
- Gartner's duct cyst - cuboidal epithelium.
- Bartholin's cyst - squamous or columnar cells, usu. inflamed.
- Endometriosis.
- Muellerian cysts - endocervical epithelium.
Vaginal inclusion cyst
General
- Most common vaginal cyst.[2]
- Usually due to trauma (surgical or birth).
Microscopic
Features:[3]
- Cyst lined by non-keratinized squamous epithelium.
- +/-Inflammation.
DDx:
- Bartholin's cyst[4] - clinical information essential.
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CYST WALL, VAGINA, EXCISION: - CONSISTENT WITH BENIGN VAGINAL INCLUSION CYST. - SQUAMOUS MUCOSA WITH FOCAL KERATINIZATION. - NEGATIVE FOR MALIGNANCY.
Viral infections
General
- Cannot differentiate HSV1, HSV2, VZV using H&E.[5]
Microscopic
Features:[5]
- Keratinocytes enlargement + acanthosis.
- Intraepidermal vesicles & bullae.
- Nuclear changes - 3 Ms:
- Moulding of nuclei.
- Margination of chromatin.
- Multinucleation.
- Nuclei have "steel gray" colour.
Images:
Vaginal cancer
- Squamous cell carcinoma - most common cancer of the vagina.
- 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]
- Precursor lesions are similar to the cervix[6] and are often HPV associated - see vaginal intraepithelial neoplasia (VAIN).
- Malignant melanoma - rare.
- Adenocarcinoma of the vagina.
- Primary adenocarcinoma is very rare.
Notes:
- Tumours of uncertain origin that involve the:
Images:
Vaginal intraepithelial neoplasia
- Abbreviated VAIN.
General
VAIN is graded like cervical lesions used to be:
- Mild vaginal intraepithelial neoplasia (VAIN I).
- Moderate vaginal intraepithelial neoplasia (VAIN II).
- Severe vaginal intraepithelial neoplasia (VAIN III).
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VAGINAL VAULT, BIOPSY: - SEVERE VAGINAL INTRAEPITHELIAL NEOPLASIA (VAIN 3), SEE COMMENT. COMMENT: The biopsy shows some maturation; however, focally, large cells, dyskeratotic cells and keratinization are present. The lamina propria/epithelial interface sampled is well-demarcated.
VAGINAL VAULT, BIOPSY: - SEVERE VAGINAL INTRAEPITHELIAL NEOPLASIA (VAIN 3).
VAGINA, BIOPSY: - MODERATE VAGINAL INTRAEPITHELIAL NEOPLASIA (VAIN 2).
VAGINA, BIOPSY: - MILD VAGINAL INTRAEPITHELIAL NEOPLASIA (VAIN 1).
Micro
VAIN 3
The sections shows squamous epithelium with large atypical cells in the upper third of the epithelium. Mitotic activity is seen in the upper third of the epithelium. Dyskeratotic cells are present. Compact keratin and parakeratosis are present.
The lamina propria/epithelial interface sampled is well-demarcated.
VAIN 2
A. The sections shows squamous epithelium with large atypical cells in the lower two-thirds of the epithelium. Mitotic activity is seen in the lower half of the epithelium. Dyskeratotic cells are present. Compact keratin and parakeratosis are present. Some maturation to the surface is present.
The lamina propria/epithelial interface sampled is well-demarcated.
See also
- Gynecologic pathology.
- Uterus.
- Cervix - cervical intraepithelial neoplasia.
- Anus - anal intraepithelial neoplasia.
- Vulva.
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.
- ↑ 2.0 2.1 URL: http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm. Accessed on: 6 July 2010.
- ↑ 3.0 3.1 3.2 Kondi-Pafiti, A.; Grapsa, D.; Papakonstantinou, K.; Kairi-Vassilatou, E.; Xasiakos, D. (2008). "Vaginal cysts: a common pathologic entity revisited.". Clin Exp Obstet Gynecol 35 (1): 41-4. PMID 18390079.
- ↑ Apostolis, CA.; Von Bargen, EC.; DiSciullo, AJ.. "Atypical presentation of a vaginal epithelial inclusion cyst.". J Minim Invasive Gynecol 19 (5): 654-7. doi:10.1016/j.jmig.2012.03.027. PMID 22935309.
- ↑ 5.0 5.1 URL: http://missinglink.ucsf.edu/lm/DermatologyGlossary/herpes_simplex.html. Accessed on: 30 August 2011.
- ↑ 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.
- ↑ 8.0 8.1 URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Vagina_11protocol.pdf. Accessed on: 4 April 2012.