Difference between revisions of "Vulva"

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Vulva (view source)

Revision as of 15:43, 8 March 2016

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→‎Condyloma acuminatum: split out
 
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=====Micro=====
=====Micro=====
The sections show squamous mucosa with a mild chronic inflammatory infiltrate that consists predominantly of lymphocytes. There is mild nuclear enlargement and intracellular edema. The nuclear membranes are regular. No nuclear hyperchromasia is apparent. No mitotic activity is readily apparent.
The sections show squamous mucosa with a mild chronic inflammatory infiltrate that consists predominantly of lymphocytes. There is mild nuclear enlargement and intracellular edema. The nuclear membranes are regular. No nuclear hyperchromasia is apparent. No mitotic activity is readily apparent.
====Hyperkeratotic====
<pre>
VULVA, BIOPSY:
- SQUAMOUS MUCOSA WITH MILD HYPERGRANULOSIS AND A THIN COMPACT LAYER OF KERATIN.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR DYSPLASIA.
</pre>
=====Micro=====
The sections show a small piece of squamous mucosa with mild hypergranulosis and a compact keratin layer. The epithelial component is not significantly thickened but contains rare intraepithelial lymphocytes and has minimal edema. The subepithelial tissue has rare scattered lymphocytes and a mild prominence of small blood vessels. No subepithelial fibrosis is appreciated. The epithelium has no atypia. No mitotic figures are readily apparent.


=Benign disease=
=Benign disease=
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==Condyloma acuminatum==
==Condyloma acuminatum==
*[[AKA]] ''genital [[wart]]''.
*[[AKA]] ''genital [[wart]]''.
===General===
{{Main|Condyloma acuminatum}}
*Due to [[human papillomavirus]] (HPV).
**Transmission: sexual, non-sexual, horizontal (mother to child).<ref name=Ref_APBR280>{{Ref APBR|280 Q29}}</ref>
***Should raise the suspicion of child abuse.
 
Note:
*Related to [[verruca vulgaris]] (common wart).
*The Bethesda system includes this in [[LSIL]].<ref>{{Ref GP|143}}</ref>
 
Clinical DDx:
*[[Molluscum contagiosum]].<ref>URL: [http://emedicine.medscape.com/article/781735-differential http://emedicine.medscape.com/article/781735-differential]. Accessed on: 5 July 2013.</ref>
 
===Microscopic===
Features:
*Koilocytes.<ref name=pmid11860848>{{Cite journal  | last1 = Huang | first1 = Z. | last2 = Yang | first2 = S. | last3 = Li | first3 = Q. | last4 = Yan | first4 = P. | last5 = Li | first5 = L. | title = [Evaluation the pathological diagnostic values of koilocyte in condyloma acuminatum]. | journal = Zhonghua Liu Xing Bing Xue Za Zhi | volume = 22 | issue = 1 | pages = 58-60 | month = Feb | year = 2001 | doi =  | PMID = 11860848 }}</ref>
**Cells with an enlarged nucleus and perinuclear clearing.
*Papillomatosis.<ref>{{Ref WMSP|204}}</ref>
**Papillomatosis = surface elevation due to dermal papillae enlargement.<ref>{{Ref PBoD|1230}}</ref>
*+/-Parakeratosis.
 
DDx:
*[[Classic vulvar intraepithelial neoplasia]] - architecture different.
 
====Images====
<gallery>
Image:Condyloma_acuminatum_-_low_mag.jpg | Condyloma acuminatum - low mag. (WC)
Image:Condyloma_acuminatum_-_very_high_mag.jpg | Condyloma acuminatum - very high mag. (WC)
Image:Anal_condyloma_%282%29.jpg | Condyloma acuminatum - 2. (WC)
Image:Anal_condyloma_%284%29.jpg | Condyloma acuminatum - 3. (WC)
</gallery>
 
===Sign out===
<pre>
SKIN LESION ("VULVAR WART"), VULVA, EXCISION:
- CONDYLOMA ACUMINATUM (GENITAL WART).
</pre>
 
<pre>
LABIA MINORA, BIOPSY:
- CONDYLOMA/LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL).
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
</pre>
====Seborrheic keratosis-like====
<pre>
SKIN LESION, PERINEUM, BIOPSY:
- SEBORRHEIC KERATOSIS-LIKE CONDYLOMA ACUMINATUM (GENITAL WART).
</pre>
 
====Without viral cytopathic changes====
<pre>
VULVAR LESIONS (x3), EXCISION:
- SQUAMOUS HYPERPLASIA WITH HYPERORTHOKERATOSIS WITHOUT VIRAL CYTOPATHIC EFFECT,
  COMPATIBLE WITH CONDYLOMA (x3).
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Micro====
The sections show a polypoid fragment of skin with epithelium on three sides, acanthosis, hyperkeratosis and parakeratosis. Koilocytic changes (mild nuclear enlargement, perinuclear clearing) are seen focally. There is mild basilar nuclear enlargement and hyperchromasia.  The epithelium matures to the surface and a granular layer is present.
 
=====Seborrheic keratosis-like=====
The sections show skin with acanthosis with papillomatous features (round bulbous rete ridges, acanthosis with penetrating fibrovascular cores) pseudohorn cysts, parakeratosis and hyperkeratosis.  There is no significant basal nuclear atypia. There are no mitoses and no melanocytic nests. There is mild dermal inflammation. There is no solar elastosis. Pigment incontinence is present focally.


==Lichen sclerosus==
==Lichen sclerosus==
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===Sign out===
===Sign out===
====Compatible with Bartholin cyst====
====Compatible with Bartholin cyst====
<pre>
Submitted as "Bartholin's cyst wall - left", Excision:
- Connective tissue with overlying urothelium that is focally
  denuded and associated with a lymphohistiocytic response,
  compatible with Bartholin's cyst.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
=====Block letters=====
<pre>
<pre>
VAGINA, CYST WALL, BIOPSY:
VAGINA, CYST WALL, BIOPSY:
Michael
48,466

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