Obgyn Path Vulva, Vagina, & Cervix

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Bartholin Gland Cyst

Hint 1

Obstruction and possible secondary infection of the Bartholin Gland (posterior 1/3 of labia majora)
Tx: surgical incision & drainage

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Lichen Sclerosis

Hint 2

inflammatory disorder of the vulva
post-menopausal women
association w/ autoimmune disorder
whitish atrophic plaques, hyperkeratosis, acellular homogenous zone
symptoms: itching, dyspareunia
increased risk (15%) for squamous cell carcinoma

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vulvular intraepithelial neoplasia
*note mitotic activity outside basal layer

Hint 3

Preneoplastic Epithelial dysplasia
-undifferentiated (basaloid) (HPV16)
-differentiated - older women
30-40% HPV associated
squamous carcinoma precursor

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Squamous Cell Carcinoma Vulva

Hint 4

Most common vulvar malignancy (3% of gyn cancers)
exophytic or ulcerative, invading contiguous structures, lymph spread
histo: keratin pearl formation
verrucous carcinoma (HPV6/11) - condyloma-like mass, better prognosis

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squamous cell carcinoma vulva

Hint 5

Most common vulvar malignancy (3% of gyn cancers)
exophytic or ulcerative, invading contiguous structures, lymph spread
histo: keratin pearl formation
verrucous carcinoma (HPV6/11) - condyloma-like mass, better prognosis

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extramammary paget disease

Hint 6

red demarcated pruritic lesion
histo: large atypical cells w/ pale cytoplasm in epidermis
rarely associated w/ malignancy

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atrophic vaginitis

Hint 7

post-menopausal women s/p estrogen withdrawal
atrophy of squamous epithelium
symptoms: bleeding, dyspareunia

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DES exposure

Hint 8

Used for high risk pregnancies, daughters affected
Vaginal adenosis (persistence of glandular epithelium)
-grossly: red granular mucosa
-histo: mucin producing/ciliated w/ squamous glandular epithelia
Rarely transforms to clear cell carcinoma

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Squamous Cell Carcinoma (Vagina)

Hint 9

Elderly women, 90% of vaginal malignancies, arises from pre-existing dysplasia (sometimes HPV), poorly differentiated, no keratin pearls

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Embryonal Rhabdomyosarcoma

Hint 10

girls < 4 y/o, polypoid appearance
mesenchymal derived, composed of primitive spindle cells (possibly w/ cross striations (striated muscle derived)), myxomatous stroma
presents w/ vaginal bleeding
highly aggressive

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Embryonal Rhabdomyosarcoma

Hint 11

girls < 4 y/o, polypoid appearance
mesenchymal derived, composed of primitive spindle cells (possibly w/ cross striations (striated muscle derived)), myxomatous stroma
presents w/ vaginal bleeding
highly aggressive

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Cervicitis

Hint 12

Typically bacterial, cervix appears red & edematous w/ purulent exudate
chronic - lymphocytes, plasma cells, may lead to squamous metaplasia

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cervicitis

Hint 13

Typically bacterial, cervix appears red & edematous w/ purulent exudate
chronic - lymphocytes, plasma cells, may lead to squamous metaplasia

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Endocervical Polyp

Hint 14

Benign polyp, lined by mucinous columnar epithelium w/ squamous metaplasia
may present w/ vaginal bleeding/discharge
tx: excision or curretage

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Microglandular Hyperplasia

Hint 15

Progestin stimulation (preg, post-partum, contraceptives)
not be to confused w/ well-differentiated adenocarcinoma
histo: uniform closely packed glands w/out intervening stroma w/ PMN infiltrate

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Mosaicism of arteries in Cervical Intraepithelial Neoplasia

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Cervical Intraepithelial Neoplasia

Hint 17

Arises at squamocolumnar junction
from mild atypia to full thickness dysplasia/carcinoma in situ
Can spontaneously regress, low grade lesions have better prognosis
Low grade - koilocytes (squamous cells w/ clearing of cytoplasm)
High grade - full thickness changes w/ prominent atypia
CIN --> Carcinoma in situ ~10 yr

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HPV infection

Hint 18

Episomal form (HPV6/11) - active replication and accumulation of virus (low grade)
Integrative form (HPV16/18) - virus incorporated into genome

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HPV

Hint 19

Episomal form (HPV6/11) - active replication and accumulation of virus (low grade)
Integrative form (HPV16/18) - virus incorporated into genome

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Squamous cell carcinoma (cervix)

Hint 20

40-60 y/o
HPV, multiple partners, early age of first coitus, cigarette smoking
pap smear for early detection
Microinvasion of basement membrane (limited metastatic potential)
Direct invasion or lymphatic spread
Prognosis dependent on clinical stage at dx
Tx: radical hysterectomy w/ or w/out radiation

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Squamous Cell Carcinoma

Hint 21

40-60 y/o
HPV, multiple partners, early age of first coitus, cigarette smoking
pap smear for early detection
Microinvasion of basement membrane (limited metastatic potential)
Direct invasion or lymphatic spread
Prognosis dependent on clinical stage at dx
Tx: radical hysterectomy w/ or w/out radiation

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Squamous Cell Carcinoma

Hint 22

40-60 y/o
HPV, multiple partners, early age of first coitus, cigarette smoking
pap smear for early detection
Microinvasion of basement membrane (limited metastatic potential)
Direct invasion or lymphatic spread
Prognosis dependent on clinical stage at dx
Tx: radical hysterectomy w/ or w/out radiation

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Adenocarcinoma (cervix)

Hint 23

50-60 y/o
HPV, multiple partners, early age of first coitus, cigarette smoking
precursor lesion (cervical glandular intraepithelial neoplasia) originate near squamocolumnar junction
CIN coexists in 40%
similar spread as squamous carcinoma w/ poorer prognosis