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Difference between revisions of "Vulva"
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This article addresses the basics of '''vulva''', from a pathologic perspective. | This article addresses the basics of '''vulva''', from a pathologic perspective. | ||
==Neoplasms of the vulva== | |||
Low grade pre-cancerous lesions (VIN) 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 (VIN) 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> | ||
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Precursor lesion: | Precursor lesion: | ||
* | *Vulvar intraepithelial neoplasia (VIN). | ||
VIN can be divided into: | VIN can be divided into: | ||
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**Most caused by HPV. | **Most caused by HPV. | ||
=== | ===Microscopic of classic VIN=== | ||
*Increased NC ratio. | *Increased NC ratio. | ||
*Multinucleation. | *Multinucleation. | ||
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==Differentiated VIN== | ==Differentiated VIN== | ||
===Epidemiology=== | ===Epidemiology=== | ||
* | *Associated with [[lichen sclerosis]]. | ||
*NOT associated with HPV and seen in older women. | *NOT associated with HPV and seen in older women. | ||
=== | ===Microscopic=== | ||
Features: | |||
*NOT graded like classic VIN. | *NOT graded like classic VIN. | ||
*Acanthosis (thickening of stratum spinosum) + elongation of rete ridges. | *Acanthosis (thickening of stratum spinosum) + elongation of rete ridges. | ||
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*Loss of rete ridges - '''key feature'''. | *Loss of rete ridges - '''key feature'''. | ||
*Severe hyperkeratosis. | *Severe hyperkeratosis. | ||
*Fibrosis of dermis with loss of adnexal structures | *Fibrosis of dermis with loss of adnexal structures. | ||
*Inflammation - often with eosinophils. | *Inflammation - often with eosinophils. | ||
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===Micro=== | ===Micro=== | ||
*Cyst with squamous or urothelial epithelium.<ref>[http://pathologyoutlines.com/vulva.html#bartholincyst http://pathologyoutlines.com/vulva.html#bartholincyst]</ref> | *Cyst with squamous or urothelial epithelium.<ref>[http://pathologyoutlines.com/vulva.html#bartholincyst http://pathologyoutlines.com/vulva.html#bartholincyst]</ref> | ||
==Hidradenoma papilliferum== | |||
===General=== | |||
*Dermal thingy. | |||
===Microscopic=== | |||
Features: | |||
*Cystic spaces. | |||
*Epithelium with apocrine differentiation (as demonstrated by apocrine snouts). | |||
*Well-circumscribed. | |||
Images: | |||
*[http://farm4.static.flickr.com/3019/2646470314_12fb77d3ec_z.jpg Hidradenoma papilliferum (flickr.com)]. | |||
Notes: | |||
*No attachment to epidermis. | |||
*No nuclear changes suggestive of malignancy. | |||
==See also== | ==See also== | ||