Difference between revisions of "Vagina"

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Vagina (view source)

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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.<ref name=pmid19115209>{{cite journal |author=De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S |title=Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis |journal=Int. J. Cancer |volume=124 |issue=7 |pages=1626–36 |year=2009 |month=April |pmid=19115209 |doi=10.1002/ijc.24116 |url=}}</ref>
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.<ref name=pmid19115209>{{cite journal |author=De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S |title=Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis |journal=Int. J. Cancer |volume=124 |issue=7 |pages=1626–36 |year=2009 |month=April |pmid=19115209 |doi=10.1002/ijc.24116 |url=}}</ref>


==Normal==
=Normal vagina=
*Squamous epithelium, non-keratinized.
===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).
 
===Sign out===
====Not quite normal====
<pre>
VAGINA, BIOPSY:
- SUPERFICIAL VAGINAL MUCOSA WITH PARAKERATOSIS.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
<pre>
VAGINAL VAULT, BIOPSY:
- SQUAMOUS EPITHELIUM WITH COMPACT KERATIN, PARAKERATOSIS AND HYPERGRANULOSIS.
- NEGATIVE FOR DYSPLASIA.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
=====Micro=====
The sections show squamous epithelium with compact keratin, parakeratosis and
hypergranulosis. The nuclei mature normally to the surface.  No significant nuclear atypia is identified. Mitotic activity is not readily apparent. Minimal intracellular edema is present.  No significant inflammation is identified.  A very small amount of fibrous subepithelial tissue is present.
 
=Vaginal cysts=
DDx:<ref name=medlineplus001509/><ref name=pmid18390079/>
*[[Vaginal inclusion cyst]] (epidermal inclusion cyst) - squamous epithelium.
*[[Gartner's duct cyst]] -  cuboidal epithelium.
*[[Bartholin's cyst]] - squamous or columnar cells, usu. inflamed.
*[[Endometriosis]].
*[[Müllerian cyst of the vagina|Müllerian cyst]] - endocervical epithelium.
 
==Vaginal inclusion cyst==
*[[AKA]] ''[[epidermal inclusion cyst]]''.<ref name=pmid18390079>{{Cite journal  | last1 = Kondi-Pafiti | first1 = A. | last2 = Grapsa | first2 = D. | last3 = Papakonstantinou | first3 = K. | last4 = Kairi-Vassilatou | first4 = E. | last5 = Xasiakos | first5 = D. | title = Vaginal cysts: a common pathologic entity revisited. | journal = Clin Exp Obstet Gynecol | volume = 35 | issue = 1 | pages = 41-4 | month =  | year = 2008 | doi =  | PMID = 18390079 }}</ref>
===General===
*Most common vaginal cyst.<ref name=medlineplus001509>URL: [http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm]. Accessed on: 6 July 2010.</ref>
*Usually due to trauma (surgical or birth).
 
===Microscopic===
Features:<ref name=pmid18390079/>
*Cyst lined by non-keratinized squamous epithelium.
*+/-Inflammation.
 
DDx:
*[[Bartholin's cyst]]<ref name=pmid22935309>{{Cite journal  | last1 = Apostolis | first1 = CA. | last2 = Von Bargen | first2 = EC. | last3 = DiSciullo | first3 = AJ. | title = Atypical presentation of a vaginal epithelial inclusion cyst. | journal = J Minim Invasive Gynecol | volume = 19 | issue = 5 | pages = 654-7 | month =  | year =  | doi = 10.1016/j.jmig.2012.03.027 | PMID = 22935309 }}</ref> - clinical information essential.
 
===Sign out===
<pre>
CYST WALL, VAGINA, EXCISION:
- CONSISTENT WITH BENIGN VAGINAL INCLUSION CYST.
- SQUAMOUS MUCOSA WITH FOCAL KERATINIZATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
=Viral infections=
===General===
*Cannot differentiate HSV1, HSV2, VZV using H&E.<ref name=herpes>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/herpes_simplex.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/herpes_simplex.html]. Accessed on: 30 August 2011.</ref>
 
===Microscopic===
Features:<ref name=herpes/>
*Keratinocytes enlargement + [[acanthosis]].
**Intraepidermal vesicles & bullae.
*Nuclear changes - 3 Ms:
*#Moulding of nuclei.
*#Margination of chromatin.
*#Multinucleation.
*Nuclei have "steel gray" colour.
 
Images:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/herpes_high_power.jpg Herpes (ucsf.edu)].
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/herpes_low_power.jpg Herpes - skin (ucsf.edu)].
 
=Other=
==Vaginal mucosa with irritation==
:''Rectocele'', ''cystocele'', ''vaginal mucosa'' and ''vaginal repair'' redirect here.
===General===
*Seen in the context of vaginal repairs for ''rectocele'' or ''cystocele''.


==Prolapse==
*Pieces of vagina are often submitted in the context of uterine prolapse.
===Microscopic===
===Microscopic===
*Squamous epithelium - may be keratinized.
Features:
*Squamous mucosa with hyperkeratosis.
*Negative for atypia.
*Negative for inflammation.


==Vaginal cysts==
===Sign out===
*Most common is ''vaginal inclusion cyst''.<ref>URL: [http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm http://www.nlm.nih.gov/medlineplus/ency/article/001509.htm]. Accessed on: 6 July 2010.</ref>
<pre>
**Usually due to trauma.
Vaginal Mucosa, Excision During Vaginal Repair:
- Squamous mucosa with compact keratin layer.
- NEGATIVE for significant inflammation.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>


==Vaginal cancer==
=Vaginal cancer=
*[[Squamous cell carcinoma]] - most common cancer of the vagina.
*[[Squamous cell carcinoma]] - most common cancer of the vagina.
**Precursor lesions are similar to the [[cervix]]<ref name=pmid18714572>{{cite journal |author=Indraccolo U, Chiocci L, Baldoni A |title=Does vaginal intraepithelial neoplasia have the same evolution as cervical intraepithelial neoplasia? |journal=Eur. J. Gynaecol. Oncol. |volume=29 |issue=4 |pages=371–3 |year=2008 |pmid=18714572 |doi= |url=}}</ref> and are often HPV associated - see ''vaginal intraepithelial neoplasia'' (VAIN).
**Precursor lesions are similar to the [[cervix]]<ref name=pmid18714572>{{cite journal |author=Indraccolo U, Chiocci L, Baldoni A |title=Does vaginal intraepithelial neoplasia have the same evolution as cervical intraepithelial neoplasia? |journal=Eur. J. Gynaecol. Oncol. |volume=29 |issue=4 |pages=371–3 |year=2008 |pmid=18714572 |doi= |url=}}</ref> and are often HPV associated - see ''vaginal intraepithelial neoplasia'' (VAIN).
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VAGINA, BIOPSY:
VAGINA, BIOPSY:
- MODERATE VAGINAL INTRAEPITHELIAL NEOPLASIA (VAIN 2).
- MODERATE VAGINAL INTRAEPITHELIAL NEOPLASIA (VAIN 2).
</pre>
<pre>
VAGINA, BIOPSY:
- MILD VAGINAL INTRAEPITHELIAL NEOPLASIA (VAIN 1).
</pre>
</pre>


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The lamina propria/epithelial interface sampled is well-demarcated.
The lamina propria/epithelial interface sampled is well-demarcated.


==Viral infections==
=====VAIN 2=====
===General===
A. The sections shows squamous epithelium with large atypical cells in the lower two-thirds
*Cannot differentiate HSV1, HSV2, VZV using H&E.<ref name=herpes>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/herpes_simplex.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/herpes_simplex.html]. Accessed on: 30 August 2011.</ref>
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.


===Microscopic===
The lamina propria/epithelial interface sampled is well-demarcated.
Features:<ref name=herpes/>
*Keratinocytes enlargement + acanthosis.
**Intraepidermal vesicles & bullae.
*Nuclear changes - 3 Ms:
*#Moulding of nuclei.
*#Margination of chromatin.
*#Multinucleation.
*Nuclei have "steel gray" colour.
 
Images:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/herpes_high_power.jpg Herpes (ucsf.edu)].
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/herpes_low_power.jpg Herpes - skin (ucsf.edu)].


==See also==
=See also=
*[[Gynecologic pathology]].
*[[Gynecologic pathology]].
*[[Uterus]].
*[[Uterus]].
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*[[Vulva]].
*[[Vulva]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]
Michael
48,466

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