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24 Cards in this Set

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What is Lichen Schlerosis (aka Chronic Atrphic Vulvitis)?
One form of vulvar dystrophy (disorder of epithelial growth that presents with white, patch-like lesion)
What is the visual characteristics of Lichen Schlerosis? (3)
1. skin is gray and parchment-like with labial atrophy (thin and shiny)
2. Micro: thin epidermis with loss all cells
3. Dermis replaced with fibrous tissue and "band-like" lymphocytes.
What is Lichen Simplex Chronicus?
Another non-neoplastic vulvar epithelial disorder with an exaggerated labia minora and majora; has acanthosis and hyperkeritosis along with prescense of lymphocytic infiltrate.
Compare the appearances of Lichen Simplex Chronicus to Lichen Schlerosis:
Lichen Simplex Chronicus: enlarged labia majora and minora

Lichen Schlerosis (opposite): flattened out, atropic appearance.
What are two neoplastic vulvar epithelial disorders?
1. condyloma acuminatum (veneral wart) - caused by HPV 6 and 11

2. Vulvar intraepithelial neoplasia (VIN) - caused by HPV 16 and 18.

VIN is often a predesecor to Squamous cell CA.

Mnemo: my VIN #1618 and if you got a wart dial 611!
How do HPV #'s correlate to the risk of obtaining CA?
The lower the number the lower the risk.
What is VIN (vulvar intraepithelial neoplasia) correlate with in the cervix?
HSIL - high grade squamous _____
Describe the appearance of a vulvar condyloma:
It has a unique look (like hemorrhoids around vuvla); can see koilocyte changes (so you know its caused by an HPV infection). And can see a halo around the koilocytes.
What preceeds squamous cell CA of the vulva?
One of two types of VIN (vulvar intraepithelial neoplasia)
What is the age group for developing squamous cell CA of the vulva?
2/3rd are > 60yo
Describe extramammary Paget's disease:
1. It can occur in the vulva
2. Gross: red, pruritic, maplike, sharply demarchated on labia majora
3. Micro: large, pale Paget cells in small clusters.
4. Cells found at dermal/epidermal junction
What are Gartner duct cysts?
A vaginal congenital abnormalities that is a result of a Wolffian duct.
What does vaginal adenosis look like?
Glandular epithelium present in the vaginal mucosa causes the formation of red areas next to nL pink vaginal mucosa.
VIP
What is the main cause of vaginal adenosis?
the use of Diethylstilbestrol (DES) in mothers for attempted abortion -- daughters get vaginal adenosis.
What CA does DES exposure cause?
Adenocarcinoma (ID by presence of clear glycogen rich cytoplasm) - seen in the upper 1/3 of vaginal wall
VIP

What is a Rhabdomyosarcoma?
It is a rare tumor in infants and girls < 5yo. They are grapelike, fill, and protrude out of the vagina.
VIP

What is the transitional/transformation zone of cervix?

Why is it so important?
The region of endocervical canal that immediately follows the squamo-columnal junction (just before basal cells)

This is where cervical dyplasia arises!!
What causes acute and chronic cervicitis?
Estrogen production from ovaries stimulates squamous cells to take up glycogen and mature.
Mature cells shed and glycogen is released and it produces a drop in pH.
Cervix responds to this drop by squamous metaplasia in transformational zone.
Squamous epi than can cover crypt opennings = cervicitis
VIP

What are two risk factors for Cervical Intraepithelial Neoplasia?
1. multiple sexual partners
2. high-risk HPV types
What HPV types form condylomas over CIN I (Cervical intraepithelial neoplasia)?
Condyloma: HPV 6 and 11

Flat CIN I: HPV 16, 18
VIP

What is the mechanism of HPV?
Viral oncogenes (E6 and E7) of high-risk types can disrupt the cell cycle and enhance DNA synthesis.

E6 = inhibit p53 (tumor suppressor)by binding to it to increase its degradation

E7 = binds to RB gene and upregulates Cyclin E and p16 INK 4.
What is a condyloma (cervix) a precursor to?
Cervical cell dysplasia
VIP!
What do condylomas look like?

What does CIN I look like?
II/III?
Condylomas = plaque on cervix

CIN I = flat lesions with koilocytes with punctations on the cervix. Cells with large "clear zone".

CIN II - cells have variable nuclear size and loss of cell polarity, hyperchromastia and atypical mitoses

CIN III - full thickness atypia and loss of surface differentiation with atypical mitotic figures
-mosaic pattern on cervix
Define staging of cervical cancer:
Stage o - CIN III (carcinoma insitu)

Stage 1 - carcinoma confined to cervix
Stage 2 - extends beyond cervix but not to the pelvis wall. Involves vagina but not lower 1/3
Stage 3 - extends to pelvic wall. No free CA space between tumor and rectal wall and involves lower 1/3 of vagina.
Stage 4 - extends beyond true pelvis or involves bladder/rectal mucosa