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.

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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