Vulva/Vagina Pathology

Question 1

Answer 1

Lichen Sclerosus of the Vulva

Premenarchal or postmenopausal

Painful, pruritic

Thin epidermis

1-5% develop squamous cell carcinoma

Question 2

Answer 2

Lichen Simplex Chronicus

Secondary to chronic irritation underlying inflammatory dermatosis

Also can appear as leukoplakia, epthelial thickening, hyperkeratosis, dermal chronic inflammation

No known predilection for malignancy

Question 3

Answer 3

Condyloma Accuminata

VIN-1 (warty lesion)

Papillary, raised or flat

On anogenital surfaces

Single or multiple, small or very large

Koilocytosis (perinuclear cytoplasm vacuuolization and wrinkled nuclear contours)

Assoc with HPV 6 and 11

Question 4

Answer 4

Vulvar dysplasia

VIN-2 & VIN-3 – high grade

Associated with HPV 16 & 18

Full thickness dysplasia: nuclear atypia, high nuclear:cytoplasmic ratio, abundant mitosis

Progression to invasive squamous cell carcinoma

Question 5

Answer 5

Carcinoma of Vulva

Mostly > 60 yo

90% squamous cell carcinoma

Two forms:

1. high risk HPV associated – preceded by VIN, multifocal, poorly differentiated, higher incidence in smokers, immunodeficiency
2. in older age group – preceded by reactive changes, mainly Lichen sclerosis, well differentiated, keratinizing

Question 6

Answer 6

Extramammary Paget’s Disease

Red, scaly plaques

Intraepidermal proliferation of malignant cells

Most commonly de novo from epidermal progenitor cells

Large pale cells in the epidermis (glandular)

Differential diagnosis: malignant melanoma, squamous cell carcinoma

Question 7

Answer 7

CK7 positive Paget cells

Question 8

What is clear cell adenocarcinoma of the vagina associated with?

Answer 8

Women who had exposure to DES in utero

Question 9

Answer 9

Embryonal (botryoid) Rhabdomyosarcoma

Rare primary vaginal malignancy

Infance and children <5 years