Difference between revisions of "Vulva"

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#redirect [[Vulva and vagina]]
This article addresses the basics of '''vulva''', from a pathologic perspective.
 
Low grade pre-cancerous lesions (VIN) are typically HPV positive, while high grade pre-cancerous lesions and cancer are less often HPV positive.<ref name=pmid19115209>{{cite journal |author=De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S |title=Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis |journal=Int. J. Cancer |volume=124 |issue=7 |pages=1626–36 |year=2009 |month=April |pmid=19115209 |doi=10.1002/ijc.24116 |url=}}</ref>
 
Most common malignancy of vulva:
*Invasive squamous cell carcinoma.
 
Precursor lesion:
*vulvar intraepithelial neoplasia (VIN).
 
VIN can be divided into:
*''Classic VIN'', and
*''Differentiated VIN''.
**''Differentiated VIN'' is mostly irrelevant as it is basically never seen alone, i.e. it usually accompanies cancer.
 
==Classic VIN==
===Epidemiology===
*Classic VIN, like CIN, is associated with [[HPV]] and seen in younger women.
 
===General===
*Classic VIN is graded like cervical pre-cancerous lesions:
**VIN I.
***Not common.
**VIN II.
***Not common.
**VIN III.
***Commonly seen.
 
DDx:
*Condyloma (genital wart).
**Most caused by HPV.
 
===Micro. of classic VIN===
*Increased NC ratio.
*Multinucleation.
*Lack of maturation to surface (not very useful -- unlike in the cervix).<ref>LAE. February 2009.</ref>
*Apical mitoses.
 
==Differentiated VIN==
===Epidemiology===
*Assoc. with [[lichen sclerosis]].
*NOT associated with HPV and seen in older women.
 
===Histology===
*NOT graded like classic VIN.
*Acanthosis (thickening of stratum spinosum) + elongation of rete ridges.
 
==IHC for VIN==
*Classic VIN: p16+, p53-.
*Differentiated VIN: p16-, p53+.
 
ASIDE: [[p16]] can be thought of as a poor man's HPV test.
 
==Lichen sclerosus==
===General===
*Pruritis -> leads to scratching.
 
===Microscopic===
Features:<ref>[http://www.pathologyoutlines.com/vulva.html#lichensclerosis http://www.pathologyoutlines.com/vulva.html#lichensclerosis]</ref>
*Loss of rete ridges - '''key feature'''.
*Severe hyperkeratosis.
*Fibrosis of dermis with loss of adnexal structures<ref>NEED REF.</ref>
*Inflammation - often with eosinophils.
 
==Bartholin cyst==
===General===
*Common.
 
===Micro===
*Cyst with squamous or urothelial epithelium.<ref>[http://pathologyoutlines.com/vulva.html#bartholincyst http://pathologyoutlines.com/vulva.html#bartholincyst]</ref>
 
==See also==
*[[Gynecologic pathology]].
*[[Uterus]].
*[[Cervix]] - cervical intraepithelial neoplasia.
*[[Vulva]].
*[[Anus]] - anal intraepithelial neoplasia.
 
==References==
{{reflist|2}}
 
[[Category:Gynecologic pathology]]

Revision as of 16:05, 19 November 2010

This article addresses the basics of vulva, from a pathologic perspective.

Low grade pre-cancerous lesions (VIN) are typically HPV positive, while high grade pre-cancerous lesions and cancer are less often HPV positive.[1]

Most common malignancy of vulva:

  • Invasive squamous cell carcinoma.

Precursor lesion:

  • vulvar intraepithelial neoplasia (VIN).

VIN can be divided into:

  • Classic VIN, and
  • Differentiated VIN.
    • Differentiated VIN is mostly irrelevant as it is basically never seen alone, i.e. it usually accompanies cancer.

Classic VIN

Epidemiology

  • Classic VIN, like CIN, is associated with HPV and seen in younger women.

General

  • Classic VIN is graded like cervical pre-cancerous lesions:
    • VIN I.
      • Not common.
    • VIN II.
      • Not common.
    • VIN III.
      • Commonly seen.

DDx:

  • Condyloma (genital wart).
    • Most caused by HPV.

Micro. of classic VIN

  • Increased NC ratio.
  • Multinucleation.
  • Lack of maturation to surface (not very useful -- unlike in the cervix).[2]
  • Apical mitoses.

Differentiated VIN

Epidemiology

Histology

  • NOT graded like classic VIN.
  • Acanthosis (thickening of stratum spinosum) + elongation of rete ridges.

IHC for VIN

  • Classic VIN: p16+, p53-.
  • Differentiated VIN: p16-, p53+.

ASIDE: p16 can be thought of as a poor man's HPV test.

Lichen sclerosus

General

  • Pruritis -> leads to scratching.

Microscopic

Features:[3]

  • Loss of rete ridges - key feature.
  • Severe hyperkeratosis.
  • Fibrosis of dermis with loss of adnexal structures[4]
  • Inflammation - often with eosinophils.

Bartholin cyst

General

  • Common.

Micro

  • Cyst with squamous or urothelial epithelium.[5]

See also

References

  1. ↑ De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S (April 2009). "Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis". Int. J. Cancer 124 (7): 1626–36. doi:10.1002/ijc.24116. PMID 19115209.
  2. ↑ LAE. February 2009.
  3. ↑ http://www.pathologyoutlines.com/vulva.html#lichensclerosis
  4. ↑ NEED REF.
  5. ↑ http://pathologyoutlines.com/vulva.html#bartholincyst
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