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Glossary of Pathology - S2B1 - Female GU 1

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Produces small vesicles and shallow ulcers that can involve the vulva, cervix, vagina, etc

MNGC's with eosinophilic intranuclear inclusions
Herpes -> HSV-2

What causes this?
Herpes Simplex Virus 2

Seen in males as ulcers

What is this?

Describe what you see
Herpes

MNGC's with viral inclusions in the nucleus
HPV:
-Sexually transmitted __1__ virus
-virus is located in the __2__ of affected cells
-affected cells are called __3__
1. DNA
2. nucleus
3. Koilocytes
What is HPV associated with an increased risk of?
Dysplasia

Carcinoma
What 2 ways does HPV stimulate the proliferation of Squamous epithelium?
Exphytic = condyloma

Flat

What is this called?

What is the cause?
Condylomata acuminata

HPV

What is this showing?
Condyloma caused by HPV

What are these cells called?

What causes them?
Koilocytes

HPV
Pruritic vaginitis with a white discharge and a fiery red mucosa
Candida

What is this?
Candidiasis
What are 4 risk factors for Candidiasis?
1. Diabetes
2. Broad-spectrum Antibiotics
3. Oral Contraceptives
4. Pregnancy

What is this?
Wet mount of Candida

What is the cause of this?

How would your suspicion be confirmed?
Tuberculosis

Non-caseating granulomas in histology
Describe the pathophysiology of Bartholin's Gland Cyst

Duct obstruction that leads to cyst formation -> edema and swelling
What is the most common cause of Bartholin's Gland cyst?
N. gonorrhoeae

What is shown at the right?
Bartholins Gland cyst
-Abnormal growth of the Vulvar skin with white plaques and skin atrophy
-Histologically there is Hyperkeratosis, loss of Rete Ridges, an Acellular Zone, and Chronic inflammation
Lichen Sclerosus

What is this called?

How can it present clinically?
Lichen Sclerosus

Itching or Painful sex

What is this?

How do you know?
Lichen Sclerosus

-Hyperkeratosis
-Loss of Rete ridges = undulation between dermis and epidermis
-Acellular zone
-Chronic Inflammation

What is this and how do you know?
Squamous Hyperplasia
- thickened epithelium
- hyperkeratosis
- epidermal dipping
Is a spectrum of neoplastic changes in the vulva, ranging from koilocytic changes to mild/moderate/severe dysplasia to Carcinoma in situ
Vulvar Intraepithelial Neoplasia
What is Vulvar Intraepithelial Neoplasia associated with?

What is it a precursor of?
HPV 16, 6, 11

Squamous Cell Carcinoma
What is the most common cancer of the Vulva?
Squamous Cell Carcinoma
What are the 3 gross appearances Squamous Cell Carcinoma of the Vulva can be?
1. Exophytic (2/3)
2. Ulcerative
3. Endophytic

What is the pic showing?
Squamous Cell Carcinoma of the Vulva that has ulcerated through

What is this picture showing?
Squamous Cell Carcinoma of the Vulva that is invading the Stroma

What is this picture showing?
Anaplasia in Vulvar Squamous Cell Carcinoma

What is this picture showing?
Blood vessel filled with tumor = radical surgery is not enough -> need chemo or radiation as well
How can Squamous Cell Carcinoma of the Vulva present clinically?
1. Pruritis
2. Bleeding
3. Infection
4. Ulcer
5. Mass
Where do Squamous Cell Carcinomas of the Vulva metastasize to?

What is the survival rate for this cancer?
Inguinal and Femoral Lymph Nodes

90%

What is this called?

What is the cause?

What is it a variant of?

What is the prognosis?
Verrucous Carcinoma = Giant Condyloma

HPV 6

Squamous Cell Carcinoma

Good -> invades locally

1. What is this?
2. What is most commonly associated with causing this?
1. Verrucous Carcinoma
-finger-like projections at bottom
2. HPV 6
Red, moist lesion on the labia majora

Often crusts over
Extramammary Paget's Disease

What is this?
Extramammary Paget's Disease

What is this?

What type of cells are they?
Extramammary Paget's Disease

Adenocarcinoma cells

What is this?
Melanoma

What is this?
Melanoma
Replacement of the Squamous epithelium in the Vagina with Glandular Epithelium
Vaginal Adenosis
What is Vaginal Adenosis most commonly the result of?
Prenatal DES exposure
Describe the pathophysiology of Vaginal Adenosis (Vulvar Vaginosis)
DES inhibits Mullerian differentiation -> see remnants of Mullerian glands -> Adenocarcinoma

From a vaginal biopsy:

What is it?
What is it the result of?
Vaginal Adenosis

DES exposure

What is this?
Vaginal Adenosis (Vulvar Vaginosis)

From a vaginal biopsy:

What is it?
What causes it?
Clear cell adenocarcinoma

DES exposure
What is the most common cancer of the vagina?
Squamous Cell carcinoma

What is this?
Vaginal Squamous Cell Carcinoma
Polypoid mass resembling a "bunch of grapes" on vaginal exam in a 3 year old girl
Embryonal Rhabdomyosarcoma = Sarcoma Botryoides

What is this?

How old of a person would have this?
Embryonal Rhabdomyosarcoma (Sarcoma Botyroides)

Child < 4 years old
Replacement of normal squamous epithelium by a glandular epithelium. History of DES exposure in the early prenatal life
VULVAR VAGINOSIS
A rare vulvar neoplasm in which malignant, large, pale vacuolated cells are found scattered throughout the epidermis. Wide local excision is usually curative
Extramammary Paget's Disease
A variant of well differentiated squamous cell carcinoma that presents as a large fungating mass resembling a giant condyloma. HPV type 6 is commonly identified in this tumor. The tumor invades locally and typically does not metastasize. Local surgical e
Verrucous carcinoma

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