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1

what does the vulva include? lined by what type of epithelium?

the skin and mucosa of the female genitalia external to the hymen (labia majora, minora, mons pubis, and vestibule) lined by squamous epithelium

2

bartholin cyst

cystic dilation of the bartholin gland due to inflammation and obstruction of the gland presents as a unilateral, painful cyst at the lower vestibule adjacent to the vaginal canal

3

bartholin gland

one is present on each side of the vaginal canal and produces mucus-like fluid that drains via ducts into the lower vestibule

4

condyloma

sexually transmitted warty neoplasm of vulvar skin, often large either condyloma acuminatum (HPV 6 or 11) or secondary syphilis (condyloma latum) ---HPV associated is characterized by koilocytes ---low risk, rarely progresses to carcinoma

5

lichen sclerosis

thinning of the epidermis and fibrosis(sclerosis) of the dermis; presents as a white patch (leukoplakia) with parchment like vulvar skin usually in postmenopausal women benign but slight increased risk for sq. cell carcinoma

6

lichen simplex chronicus

hyperplasia of the vulvar squamous epithelium; presents as leukoplakia with thick leathery vulvar skin; associated with chronic irritation and scratching --benign

7

vulvar carcinoma

arises from vulva squamous epithelium; RARE; may be due to high risk HPV 16 or 17 or non-HPV cause(long standing lichen sclerosis) presents as leukoplakia **use biopsy to distinguish from other causes of leukoplakia

8

risk factors for vulvar carcinoma

HPV exposure, multiple partners, early first age of sex, women of reproductive age

9

VIN

vulvar intraepithelial neoplasia a dysplastic precursor lesion characterized by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity **leads to vulvar carcinoma

10

which type of vulvar carcinoma is seen in elderly women?

non-hpv related due to long standing lichen sclerosis (chronic inflammation and irritation)

11

extramammary paget disease

malignant epithelial cells in the vulva epidermis; presents as erythematous, pruritic, ulcerated vulvar skin **carcinoma in-situ (no underlying cancer) must distinguish from melanoma!! paget cells are PAS+, keratin +, and S100-

12

what type of paget disease DOES have underlying carcinoma?

paget disease of the nipple

13

melanoma vs paget disease

M = PAS -, keratin -, S100 + P = PAS +, keratin +, S100-

14

vagina mucosa is lined by...

non-keratinizing squamous epithelium

15

adenosis

focal persistence of columnar epithelium in the upper vagina mech: during development, sq. epithelium from the lower 1/3 vagina grows upward to replace the columnar epithelium lining the upper 2/3 **increased incidence in females who were xposed to DES (diethylstilbestrol) in utero

16

clear cell adenocarcinoma of vagina

malignant proliferation of glands with clear cytoplasm; RARE but FEARED complication of DES-associated vaginal adenosis

17

what can adenosis due to DES progress to?

clear cell adenocarcinoma

18

embryonal rhabdomyosarcoma

malignant mesenchymal proliferation of immature skeletal muscle -presents as bleeding and grape-like mass protruding from the vagina or penis of a child (

19

desmin + and myogenin +

characteristic of rhabdomyoblasts --> embryonal rhabdomyosarcoma

20

vaginal carcinoma

arises from sq. epithelium lining the vagina mucosa; usually related to high risk HPV precursor lesion is VAIN (vaginal intraepithelial neoplasia)

21

where does vaginal carcinoma spread when it spreads to regional lymph nodes?

lower 1/3 of vagina --> inguinal nodes upper 2/3 --> iliac nodes

22

exocervix vs endocervix epithelium

exo = nonkeratinizing sq epithelium endo = single layer of columnar cells

23

HPV

sexually transmitted DNA virus that infects the lower genital tract, especially the cervix in the transformation zone infection is usually eradicated by acute inflammation; persistence leads to risk for cervical dysplasia (CIN) high risk HPV = 16, 18, 31, 33 low risk = 6, 11

24

high risk hpv vs low risk hpv

high = 16, 18, 31, 33 low = 6, 11

25

CIN

cervical intraepithelial neoplasia caused by high risk HPV characterized by koilocytic change, disordered maturation, atypia, and mitoses --progresses stepwise through 4 different grades (1 -->2-->3-->CIS) to become invasive sq. cell carcinoma

26

high risk HPV produces....

E6 and E7 proteins that result in increased destruction of p53 (by E6) and Rb (by E7), respectively loss of these tumor suppressor genes increases the risk for CIN

27

CIN1 CIN2 CIN3 CIS

1 - involves less than 1/3 of epithelium thickness; often regresses 2 - involves less than 2/3 of epi thickness 3 - slightly less than the entire thickness Carcinoma in situ - involved entire epithelial thickness

28

cervical carcinoma

invasive; arises in cervical epithelium; common in middle aged women (40-50) presents as vaginal bleeding, especially postcoital bleeding, or cervical discharge squamous cell is 80% of cases; adenocarcinoma is less common

29

risk factors for cervical carcinoma

high risk HPV, smoking, immunodeficiency (Cervical carcinoma is AIDS defining)

30

advanced cervical carcinoma often...

invades through the anterior uterine wall into the bladder, blocking the ureters --> hydronephrosis with postrenal failure can cause death