Gynecological Pathology I

Condition	Cause	Pathology/Histology	Surface Features	Other Features
Vulvar Malgnancies
Vulvar Intraepithelial Neoplasia	HPV	Varying degrees of loss of maturation of squamous cells	Single or multiple plaques or papules	Co-exists with cervical dysplasia
Invasive squamous cell carcinoma		Keratinizing squamous cell histology	Ulcerated exophytic lesions	Most common vulvar malignancy
Verrucous carcinoma		Well differentiated, locally invasive	Giant condyloma	Unlikely to metastasize, subset of invasive squamous cell carcinoma
Extramammary Paget’s Disease		Intraepithelial adenocarcinoma in the vulva	Red, moist plaque
Malignant Melanoma		Same as skin melanoma		Second most common malignant tumor in vulva
Benign Disorders of Vulva
Lichen Sclerosis		Atrophic epidermis, hyalinized epidermis	White plaques
Squamous hyperplasia		Thickened epidermis	White plaques
Hidradenoma	Benign tumor	Sweat gland origin – apocrine
Syringoma	Benign tumor	Sweat gland origin – eccrine
Hemangioma	Benign tumor	Mesenchymal
Vagina
Failure of squamous cell maturation	Absence of estrogen
Adenosis	DES exposure, sporadic	Abnormal retention of embryologic glandular epithelium
Benign disorder
Squamous cell carcinoma	Vaginala intraepithelial neoplasia			Most common vaginal neoplasm, assoc w cervical and vulvar SSC, 80% spread from cervix
Clear Cell Adenocarcinoma	Prior DES exposure			Peak age 17-22, very uncommon
Embryonal Rhabdomyosarcoma		Sarcoma of primitive skeletal muscle	Sarcoma botryoides – grape like	Seen in young children
Cervix
Cervical Intraepithelial Neoplasia	HPV esp types 16,18, 31, 33, 35 à Inactivation of suppressor gene products p53 and Rb	Occurs in transition zone Degree of loss of maturation in squamous cells
Invasive Carcinoma of Cervix		Microinvasion, non-keratinizing squamous cel,l Advancing disease can obstruct ureters, invade locally		Adenocarcinoma – less common, more aggressive 2nd most common cause of death WW