[08.30] Pathology of Vulva & Vagina V2.pdf

Inflammatory process

What is the cause of an obstruction in the Bartholin duct leading to a cyst?

Transitional or squamous epithelium

What types of epithelium line a Bartholin cyst?

Pain and local discomfort

What are the typical clinical presentations of a Bartholin cyst?

Lower 1/3 of the duct

In what part of the duct does the Bartholin cyst typically cause distention?

Unilocular cystic cavity filled with serous fluid

Describe the gross appearance of an excised Bartholin cyst.

Smooth inner lining and glistening inner wall

What does the inner wall of a Bartholin cyst look like upon gross examination?

All ages

In what age group do Bartholin cysts occur?

Opaque white plaque-like epithelial thickening

What is the descriptive clinical definition of leukoplakia?

Descriptive clinical term

What kind of term is leukoplakia considered in clinical practice?

Pruritus and scaling

What are the two common clinical symptoms associated with non-neoplastic epithelial disorders?

Psoriasis and chronic dermatitis

Name two inflammatory dermatoses that can present as vulvar leukoplakia.

Lichen sclerosus and squamous cell hyperplasia

What are the two categories of non-neoplastic epithelial disorders of unknown etiology?

Multiple

Are the lesions in lichen sclerosus and squamous cell hyperplasia usually solitary or multiple?

Postmenopausal women

In which group of women is lichen sclerosus most commonly seen?

Activated T cells

The presence of which cells in the subepithelium suggests an autoimmune reaction in lichen sclerosus?

Smooth white plaques or macules

What is the gross morphology of lichen sclerosus?

Atrophic and stiffened

How do the labia appear clinically in advanced lichen sclerosus?

Narrowed introitus and constricted vaginal orifice

What happens to the vaginal opening in lichen sclerosus?

Atrophy or thinning

What happens to the thickness of the epidermis in lichen sclerosus?

Hydropic degeneration

What is the term for cellular swelling seen in the basal layer of lichen sclerosus?

Hyperkeratosis

What is the term for an increase in keratinization at the surface of the epithelium?

Dermal fibrosis

What do the bands of pink acellular collagen in the dermis represent in lichen sclerosus?

Scant perivascular mononuclear cell infiltrate

Describe the type of inflammatory infiltrate seen in the dermis of lichen sclerosus.

Lichen simplex chronicus or hyperplastic dystrophy

What are the two former names for squamous cell hyperplasia?

Rubbing or scratching the skin

What is the direct cause of squamous cell hyperplasia?

Candidiasis or C. albicans

Which fungal infection can contribute to the itching that leads to squamous cell hyperplasia?

Epithelial thickening or acanthosis

What is the primary histological difference in the epidermis between squamous cell hyperplasia and lichen sclerosus?

Expansion of stratum granulosum

Which specific layer of the epidermis expands in squamous cell hyperplasia?

Lymphocytic infiltration

What type of infiltration is found in the dermis of squamous cell hyperplasia?

No atypia

Is there cellular atypia present in squamous cell hyperplasia?

Polypoid fungating lesions

What is the meaning of the term exophytic?

Sexually transmitted infections and reactive conditions of unknown etiology

What are the two major etiologic categories for benign exophytic lesions?

Human Papillomavirus or HPV

What is the causative agent of condyloma acuminatum?

Secondary syphilis or Treponema pallidum

What is the causative agent of condyloma latum?

HPV types 6 and 11

Which specific low oncogenic risk HPV types cause condyloma acuminatum?

Not considered precancerous

Are condyloma acuminatum lesions considered precancerous?

Verrucous or wart-like

Describe the gross morphology of condyloma acuminatum.

Solitary or multifocal

Can condyloma acuminatum be multiple or must it be a solitary lesion?

Branching tree-like cores of stroma

Describe the histological core structure of condyloma acuminatum.

Stratified squamous epithelium

What type of epithelium covers the stroma of a vulvar wart?

Koilocytotic atypia

What are the viral cytopathic changes seen in HPV-infected cells?

Nuclear enlargement and hyperchromasia

What are two nuclear changes seen in koilocytotic atypia?

Clear cytoplasmic perinuclear halo

What is the characteristic cytoplasmic feature of a koilocyte?

Raisinoid nuclei or kulubot

How are the irregular nuclear borders of koilocytes described in the source?

Fibroepithelial polyps and squamous papillomas

Which two reactive exophytic conditions are often used interchangeably?

Skin tags

What is the common name for fibroepithelial polyps?

Mushroom-like and pedunculated

Describe the curious gross appearance of a fibroepithelial polyp.

Loose fibrovascular stroma

What is the central core of a fibroepithelial polyp composed of?

Fibroblasts and thick-walled blood vessels

What specific histological elements are found within the stroma of a polyp?

Nonkeratinized squamous epithelium

What type of epithelium covers a squamous papilloma?

1/8 as frequent

How does the frequency of vulvar cancer compare to cervical cancer?

3 percent

What percentage of all female genital cancers does vulvar carcinoma represent?

Older than 60 years

In what age group do 2/3 of vulvar carcinomas occur?

Squamous cell carcinoma or SCCA

What is the most common histologic type of vulvar carcinoma?

High oncogenic risk HPVs

The basaloid and warty carcinoma group is related to infection with what?

Classic VIN or Bowen disease

What is the precursor lesion for basaloid and warty carcinomas?

30 percent

What percentage of vulvar SCCA cases belong to the basaloid and warty group?

Younger women or average 60 years old

Which age group is typically affected by the basaloid and warty group?

Keratinizing SCCA

Which group of vulvar SCCA is not associated with HPV?

Differentiated VIN

What is the precursor lesion for keratinizing SCCA?

70 percent

What percentage of vulvar SCCA cases are keratinizing SCCA?

Older women or at least 75 years old

What age group is most commonly affected by keratinizing SCCA?

Lichen sclerosus and squamous cell hyperplasia

Which long-standing non-neoplastic conditions predispose patients to keratinizing SCCA?

Duration/extent of disease and immune status

The risk of cancer development in VIN depends on which two factors?

Insidious fashion

In what fashion do invasive carcinomas associated with lichen sclerosus develop?

Size and depth of invasion

Name two factors linked to the risk of metastatic spread once invasive cancer develops.

Involvement of lymphatic vessels

Besides size and depth, what is the third factor linked to metastatic spread risk?

All layers or full thickness

What part of the epithelium does dysplasia involve in classic VIN?

Reproductive age women

In which age group does classic VIN mainly occur?

Bowen disease

What is the synonymous term for classic VIN as an in situ carcinoma?

Young age at first intercourse and multiple sexual partners

Name two HPV-related risk factors for VIN.

Hyperkeratotic white or raised and pigmented

Describe the gross appearance of VIN lesions.

Epidermal thickening and nuclear atypia

Name two histological features of VIN analogous to cervical SIL.

Increased mitoses and lack of cellular maturation

Name two more histological features of VIN analogous to cervical SIL.

Spontaneous regression

What can happen to classic VIN in some younger women?

Older than 45 years and immunosuppressed

In which women is the risk of classic VIN progressing to invasive cancer higher?

Middle layer

In which layer of the epithelium is the retention of hyperchromatic nuclei and crowding seen in classic VIN?

Exophytic or indurated with central ulceration

What are the two possible gross appearances of invasive basaloid or warty carcinoma?

Nests and cords of small tightly packed malignant squamous cells

Describe the cellular arrangement in basaloid carcinoma.

Immature cells from the basal layer

The cells in basaloid carcinoma resemble which normal epithelial cells?

Foci of central necrosis

What specific histological feature is found within the nests of basaloid carcinoma?

Papillary architecture

Describe the architectural pattern of warty carcinoma.

Prominent koilocytic atypia

What viral cytopathic change is prominent in warty carcinoma?

Basal layer

In differentiated VIN, where is the atypia and dysplasia confined?

Superficial layers

Which layers show normal appearing differentiation in differentiated VIN?

Nests and tongues of malignant squamous epithelium

What is the growth pattern of invasive keratinizing SCCA?

Keratin pearls

What prominent histological feature is seen centrally in the nests of well-differentiated SCCA?

Distinct cytologic borders and intercellular bridges

Name two cellular features seen in well-differentiated keratinizing SCCA.

Chronic epithelial irritation

What is postulated to contribute to the gradual evolution of lichen sclerosus to malignancy?

Acquisition of driver mutations in oncogenes

Presumably, how does chronic irritation lead to malignant phenotypes?

Sharply circumscribed nodule

Describe the gross appearance of a papillary hidradenoma.

Labia majora or interlabial folds

Where is a papillary hidradenoma typically located?

Tendency to ulcerate

Why might a papillary hidradenoma be confused with a carcinoma?

Intraductal papilloma of the breast

What breast lesion is papillary hidradenoma identical to in appearance?

Columnar secretory cells and flattened myoepithelial cells

What are the two layers of cells covering the papillary projections in hidradenoma?

Upper layer

Which layer contains the columnar secretory cells in a hidradenoma?

Deeper layer or base

Which layer contains the flattened myoepithelial cells in a hidradenoma?

Complex papillary pattern

Describe the histological pattern of the dermal sweat gland tumor.

Pruritic red crusted map-like area

Describe the clinical presentation of extramammary Paget disease.

Vulvar epidermis only

Where are the malignant cells confined in vulvar Paget disease?