Pathology of Cervix, Vagina, and Vulva 4

Question 1

What is the pathway of squamous carcinogenesis in the vulvula related to HPV?

Answer 1

• Induced by low risk HPV infections
• Called condylomas - exophytic proliferations of squamous cells
• More likely in immunocompromised people
• Lesions not considered premalignant due to low risk HPV as the causative agents
• More common in younger women

Question 2

What are pathologic hallmarks of a condyloma?

Answer 2

• Papillae
  
  • finger-like projections of epithelium with fibrovascular cores
• Eptiehalial thickening - acanthosis
• Koilocytic change

Question 3

What is the pathway of squamous carcinogenesis in the vulva related to lichen sclerosus?

Answer 3

• Etiology is not entirely understood
• Thought to be related to lack of estrogen and autoimmunity
• Progressive condition - precursor to some cases of vulvar squamous cell carcinoma
• “Differentiated” VIN pathway
  
  • associated with p53 mutations
  • lichen sclerosis in 70%
  • older women