Vagina

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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

  • Squamous epithelium, non-keratinized.

Prolapse

  • Pieces of vagina are often submitted in the context of uterine prolapse.

Microscopic

  • Squamous epithelium - may be keratinized.

Vaginal cysts

  • Most common is vaginal inclusion cyst.[2]
    • Usually due to trauma.

Vaginal cancer

  • Squamous cell carcinoma - most common cancer of the vagina.
    • Precursor lesions are similar to the cervix[3] 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:
    • Cervix and vagina are usually considered to be cervical primaries.[5]
    • Vulva and vagina are usually considered to be vulvar primaries.[5]

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).

Micro

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.

Viral infections

General

  • Cannot differentiate HSV1, HSV2, VZV using H&E.[6]

Microscopic

Features:[6]

  • Keratinocytes enlargement + acanthosis.
    • Intraepidermal vesicles & bullae.
  • Nuclear changes - 3 Ms:
    1. Moulding of nuclei.
    2. Margination of chromatin.
    3. Multinucleation.
  • Nuclei have "steel gray" colour.

Images:

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. ↑ URL: http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm. Accessed on: 6 July 2010.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 5.0 5.1 URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Vagina_11protocol.pdf. Accessed on: 4 April 2012.
  6. ↑ 6.0 6.1 URL: http://missinglink.ucsf.edu/lm/DermatologyGlossary/herpes_simplex.html. Accessed on: 30 August 2011.
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