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51 Cards in this Set

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Herpes -> HSV-2
Produces small vesicles and shallow ulcers that can involve the vulva, cervix, vagina, etc

MNGC's with eosinophilic intranuclear inclusions
Herpes Simplex Virus 2

Seen in males as ulcers
What causes this?
Herpes

MNGC's with viral inclusions in the nucleus
What is this?

Describe what you see
HPV:
-Sexually transmitted __1__ virus
-virus is located in the __2__ of affected cells
-affected cells are called __3__
1. DNA
2. nucleus
3. Koilocytes
What is HPV associated with an increased risk of?
Dysplasia

Carcinoma
What 2 ways does HPV stimulate the proliferation of Squamous epithelium?
Exphytic = condyloma

Flat
Condylomata acuminata

HPV
What is this called?

What is the cause?
Condyloma caused by HPV
What is this showing?
Koilocytes

HPV
What are these cells called?

What causes them?
Pruritic vaginitis with a white discharge and a fiery red mucosa
Candida
Candidiasis
What is this?
What are 4 risk factors for Candidiasis?
1. Diabetes
2. Broad-spectrum Antibiotics
3. Oral Contraceptives
4. Pregnancy
Wet mount of Candida
What is this?
Tuberculosis

Non-caseating granulomas in histology
What is the cause of this?

How would your suspicion be confirmed?
Describe the pathophysiology of Bartholin's Gland Cyst
Duct obstruction that leads to cyst formation -> edema and swelling
What is the most common cause of Bartholin's Gland cyst?
N. gonorrhoeae
Bartholins Gland cyst
What is shown at the right?
-Abnormal growth of the Vulvar skin with white plaques and skin atrophy
-Histologically there is Hyperkeratosis, loss of Rete Ridges, an Acellular Zone, and Chronic inflammation
Lichen Sclerosus
Lichen Sclerosus

Itching or Painful sex
What is this called?

How can it present clinically?
Lichen Sclerosus

-Hyperkeratosis
-Loss of Rete ridges = undulation between dermis and epidermis
-Acellular zone
-Chronic Inflammation
What is this?

How do you know?
Squamous Hyperplasia
- thickened epithelium
- hyperkeratosis
- epidermal dipping
What is this and how do you know?
Is a spectrum of neoplastic changes in the vulva, ranging from koilocytic changes to mild/moderate/severe dysplasia to Carcinoma in situ
Vulvar Intraepithelial Neoplasia
What is Vulvar Intraepithelial Neoplasia associated with?

What is it a precursor of?
HPV 16, 6, 11

Squamous Cell Carcinoma
What is the most common cancer of the Vulva?
Squamous Cell Carcinoma
What are the 3 gross appearances Squamous Cell Carcinoma of the Vulva can be?
1. Exophytic (2/3)
2. Ulcerative
3. Endophytic
Squamous Cell Carcinoma of the Vulva that has ulcerated through
What is the pic showing?
Squamous Cell Carcinoma of the Vulva that is invading the Stroma
What is this picture showing?
Anaplasia in Vulvar Squamous Cell Carcinoma
What is this picture showing?
Blood vessel filled with tumor = radical surgery is not enough -> need chemo or radiation as well
What is this picture showing?
How can Squamous Cell Carcinoma of the Vulva present clinically?
1. Pruritis
2. Bleeding
3. Infection
4. Ulcer
5. Mass
Where do Squamous Cell Carcinomas of the Vulva metastasize to?

What is the survival rate for this cancer?
Inguinal and Femoral Lymph Nodes

90%
Verrucous Carcinoma = Giant Condyloma

HPV 6

Squamous Cell Carcinoma

Good -> invades locally
What is this called?

What is the cause?

What is it a variant of?

What is the prognosis?
1. Verrucous Carcinoma
-finger-like projections at bottom
2. HPV 6
1. What is this?
2. What is most commonly associated with causing this?
Red, moist lesion on the labia majora

Often crusts over
Extramammary Paget's Disease
Extramammary Paget's Disease
What is this?
Extramammary Paget's Disease

Adenocarcinoma cells
What is this?

What type of cells are they?
Melanoma
What is this?
Melanoma
What is this?
Replacement of the Squamous epithelium in the Vagina with Glandular Epithelium
Vaginal Adenosis
What is Vaginal Adenosis most commonly the result of?
Prenatal DES exposure
Describe the pathophysiology of Vaginal Adenosis (Vulvar Vaginosis)
DES inhibits Mullerian differentiation -> see remnants of Mullerian glands -> Adenocarcinoma
Vaginal Adenosis

DES exposure
From a vaginal biopsy:

What is it?
What is it the result of?
Vaginal Adenosis (Vulvar Vaginosis)
What is this?
Clear cell adenocarcinoma

DES exposure
From a vaginal biopsy:

What is it?
What causes it?
What is the most common cancer of the vagina?
Squamous Cell carcinoma
Vaginal Squamous Cell Carcinoma
What is this?
Polypoid mass resembling a "bunch of grapes" on vaginal exam in a 3 year old girl
Embryonal Rhabdomyosarcoma = Sarcoma Botryoides
Embryonal Rhabdomyosarcoma (Sarcoma Botyroides)

Child < 4 years old
What is this?

How old of a person would have this?
Replacement of normal squamous epithelium by a glandular epithelium. History of DES exposure in the early prenatal life
VULVAR VAGINOSIS
A rare vulvar neoplasm in which malignant, large, pale vacuolated cells are found scattered throughout the epidermis. Wide local excision is usually curative
Extramammary Paget's Disease
A variant of well differentiated squamous cell carcinoma that presents as a large fungating mass resembling a giant condyloma. HPV type 6 is commonly identified in this tumor. The tumor invades locally and typically does not metastasize. Local surgical excision is the treatment of choice
Verrucous carcinoma