Due to HPV 6 and 11= genital wart
*gross=warty growth, hyperplasia of epithelium in s. spinosum, acanthosis and hyperkeratosis
*micro=Koilocytes - nuclear angulation surrounded by perinuclear vacuolisation (produced by cytopathic effect)
Fibrovasuclar core and cellular hyperplasia
Herpes Simplex morph?
*Gross: Herpes Simplex Type II of vulva. Note erythematous vesicles filled with clear fluid - found on the lower genitalia, extragenital sites and anorectal area (homosexuals)
*Micro: Intraepithelial vesicles accompanied by necrotic cellular debris, neutrophils and cells harbouring virus. Infected cells have a characteristic intranuclear viral inclusion - cowdry type A inclusion.
Inclusions stain with antibodies to HSV.
Infected cells may form multinucleated syncytia - seen on
What kind of stain can you use to visualize herpes simplex virus?
Tzanck test- take a scraping of the base of the ulcer. Look for multinucleated giant cells with eosinophilic intranuclear Cowdry type A inclusions and individual epithelial cells with a ground glass appearance
Patient presents with erythematous, pruritic ulcerated vulva skin? disease and morph?
**Gross: Pruritic, red, crusted sharply demarcated map-like areas
**Micro: Single anaplastic large tumour cells with halos are seen infiltrating the epidermis; stain positively with PAS/mucicarmine
extramammary paget's disease differs from paget's disease of the nipple how?
In breast 100% of the cases are associated with underlying ductal carcinoma of the breast while vulvar lesions are normally confined to the skin (usually no underlying carcinoma)
Cyst found on anterolateral wall of vagina?
Gartner's cyst - derived from Wolffian (mesonephric) duct remnants and are located in the anterolateral wall of the vagina
mesonephric cysts are similar but found on the lateral aspect of vulva
Bartholin's cyst - obstruction of the Bartholin's gland (lateral wall of vestibule) forming a cysts lined by transitional epithelium. Due to bartholinitis (infection Strep, stpah, gonococci, E. coli inflammation blockage of the duct cystic dilatation of the gland). Can lead to abscess formation. *Unilateral lesiona djacent to the vaginal canal in the lower vestibule
Nabothian cysts - Obstruction of mucous gland ducts within the endocervix e.g. by chronic cervicitis
keratinous sebaceous cyst?
Keratinous (epithelial inclusion)/ sebaceous cysts - found within skin of the vulva and contain a white cheesy material
Vulvar squamous cell carcinoma?
SQUAMOUS CELL CARCINOMA
Most common histologic type of vulvar cancer
Exophytic, polypoidal fungating mass OR ulcer with raised edges; precursor is VAIN (vaginal intraepithelial neoplasia) and risk factor is high risk HPV
Spread to pelvic or inguinal nodes based on location (upper 1/3 iliac nodes, lower 2/3 inguinal nodes); Poor prognosis (early
Vaginal adenosis morph?
Morphology of vaginal adenosis
Gross: Red, moist granules superimposed on pink/white vaginal mucosa
Micro: Gland formation by cells with clear cytoplasm resembling cells of the endocervix; PERSISTENT COLUMNAR EPITHELIUM
VAGINAL ADENOSIS AND CLEAR CELL ADENOCARCINOMA?
*Vaginal adenosis is the precursor lesion seen prior to the development of adenocarcioma (clear cell CA of the vagina 10-35 years later)
*Aetiology: Exposure to Diethyl stilbesterol (DES) - used in pregnancy to prevent abortion
*Pathogenesis may be associated with the inhibition of transformation of Mullerian epithelium into squamous epithelium; focal persistence of columnar epithelium in the upper 1/3 of the vagina (should have changed to squamous
-A form of Embryonal rhabdomyosarcoma
-Occurs in girls less than 5 years of age; Highly malignant
-Micro: Small blue cell tumour (rhabdomyoblasts) with spindle shaped tumour cells that are desmin positive/myoglobin + because of skeletal muscle differentiation; cytoplasmic cross-striations
-Gross: Looks like a bunch of grapes hanging in the
Vulvar IN (VIN)?
Histologically similar to cervical intraepithelial carcinoma (See cervix section)
VIN grade I, II, and III
HPV related and often associated with CIN or cervical carcinoma; progression to invasion in 4-7% after treatment
Gross: Flat, erythomatous grey-white papule
LICHEN SCLEROSUS/ KRAUROSIS VULVAE?
Occurs in Postmenopausal women
Gross: Pruritic white plaque on vulva - i.e. leukoplakia (atrophic lesion)
Micro: Atrophy of the epidermis (PARCHMENT LIKE THINNING) and underlying dermal fibrosis
LOW MALIGNANT POTENTIAL (may be precursor for non-HPV related vulvar squamous cell CA
LICHEN SIMPLEX CHRONICUS/HYPERPLASTIC DYSTROPHY?
Occurs in postmenopausal women
Gross: Leukoplakia, thick, leathery vulvar skin
Micro: Localised Hyperplastic dermis
No malignant potential
LEUKOPLAKIA - BOWEN'S DISEASE?
Carcinoma in situ - potential for progression into squamous cell carcinoma
Gross: Leukoplakia/ reddish brown plaque
CARCINOMA VULVA: (rare) >60y/o. Fungating polyploid mass, anterior 2/3 labia majora - squamous cell CA (presents as leukoplakia d/d lichen sclerosis/lichen simplex chronicus. Arises from HPV-related VIN or non-HPV related (lichen sclerosis