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Block 2 PATH Exam -- Vagina, Vulva and Cervix Lecture


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NON-keratinizing stratified squamous epithelium
MUCIN-secreting simple columnar epithelium
Low Risk HPV types
6, 8, 11
High Risk HPV types
16, 18, 31, 33
1 -- Dysplasia stays within lower third of SC epithelium
2 -- Dysplasia extends till middle third
3 -- Dysplasia extends all the way through SC epithelium
Squamous cell, often binuclear, having a perinuclear hole
Characteristics of genital warts
Microinvasive SCC
Invades to a depth of LESS THAN 3 mm
NO lymphovascular invasion
EXCELLENT prognosis (potentially curable)
NON-infectios cervicitis
Result of chemical/mechanical irritation
Often asymptomatic
Histology -- non-specific inflammation
Often, there is accompanying squamous metaplasia
Causes of Infectious cervicitis
Chlamydia trachomatis (most common)
Herpes Simplex Virus 2
Chlamydia Trachomatis
Mucopurulent discharge
Histology -- follicular cervicitis
Diagnosis needs to be confirmed (culture, IF, etc)
Complications -- endometritis (40%), salpingitis (11%)
Sequalae -- PID, infertility, neonatal pneumonia
Herpes Simplex Virus 2
Non-painful vesicles, BUT excruciatingly painful ulcerations
Histology goes through stages:
Early -- glassy nuclei (chromatin pushed to periphery)
Intermediate -- prominent nuclear inclusion
Later -- 3Ms (multinucleation, margination, molding)
Small, but real risk of transmitting to fetus during delivery
Most common vulvar cyst
Bartholin's gland cysts
Lichen Sclerosis
White changes of the vulva
Histology -- thin, atrophic epithelium
Small risk of developing into SCC (5%)
Padget Disease
Red, eczematous vulvar lesion with irregular borders
Histology -- INTRepithelial proliferation of malignant gland-like cells
Slowly progressive
15% of pts. have an associated malignancy elsewhere
Vulvar Melanoma
Typically occurs in 60s and 70s
Histology -- nests of cells infiltrating dermis
Survival based on depth of invasion:
Under 1.5 mm, EXCELLENT prognosis
Metastasized, LESS THAN 5% 5 yr. survival
Pategoid Spread
Refers to percolation of single cells up through the dermis
Occurs in Vulvar melanoma
Clear Cell Carcinoma
Looks identical to its ovarian counterpart
Epidemiology is DIFFERENT
Vaginal clear cell in adolescents, ovarian in older women
Strong association with DES use during pregnancy
Histology -- glands composed of clear cells that "hobnail"
Embryonal Rhabdomyosarcoma
Sarcoma of primitive SKELETAL MUSCLE
Occurs in CHILDREN
Can arise anywhere in the body
Histology -- individual cells have a round nucleus and an eosinophilic belly
Grow rapidly, metastasize to regional LNs, require chemo
~50% 5 yr survival
Sarcoma Botryoides
Particular subtype of embryonal rhabdomyosarcoma
Has a propensity for cavities (vagina, bladder)

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