Podcast
Questions and Answers
How does Differentiated VIN (dVIN) typically manifest compared to Usual VIN (uVIN)?
How does Differentiated VIN (dVIN) typically manifest compared to Usual VIN (uVIN)?
- dVIN primarily affects younger women, while uVIN is more common in postmenopausal women.
- dVIN has a lower risk of progression to squamous cell carcinoma (SCC) compared to uVIN.
- dVIN often develops against a background of lichen sclerosus and is not typically HPV-related, unlike uVIN. (correct)
- dVIN is more frequently associated with high-risk HPV strains compared to uVIN.
Which feature is vital in distinguishing Paget disease of the vulva from other vulvar malignancies?
Which feature is vital in distinguishing Paget disease of the vulva from other vulvar malignancies?
- Occurrence in younger, premenopausal women.
- Invasion of tumor cells into the dermis.
- Association with HPV infection.
- Presence of red crusted skin lesions containing tumor cells in the epidermis. (correct)
What is the primary significance of desmoplasia in the context of cervical cancer staging and prognosis?
What is the primary significance of desmoplasia in the context of cervical cancer staging and prognosis?
- It is a marker for early microinvasion, indicating a very low risk of progression.
- It is used to differentiate between squamous cell carcinoma and adenocarcinoma.
- It indicates the presence of HPV and its direct impact on cancer cell morphology.
- It reflects the pattern of invasion and has been shown to be an important prognostic factor. (correct)
Which of the following features is most indicative of condyloma acuminatum?
Which of the following features is most indicative of condyloma acuminatum?
How does the presence of lymphovascular invasion typically influence the prognosis in vulvar squamous cell carcinoma?
How does the presence of lymphovascular invasion typically influence the prognosis in vulvar squamous cell carcinoma?
What distinguishes embryonal rhabdomyosarcoma (sarcoma botryoides) from other vaginal tumors in terms of patient demographics and presentation?
What distinguishes embryonal rhabdomyosarcoma (sarcoma botryoides) from other vaginal tumors in terms of patient demographics and presentation?
What is the crucial role of the Toll-like receptor 7 (TLR7) agonist, imiquimod, in the management of vulvar intraepithelial neoplasia (VIN)?
What is the crucial role of the Toll-like receptor 7 (TLR7) agonist, imiquimod, in the management of vulvar intraepithelial neoplasia (VIN)?
What cellular change is characteristic of Lichen Simplex Chronicus?
What cellular change is characteristic of Lichen Simplex Chronicus?
What distinguishes Lichen Sclerosus from Lichen Simplex Chronicus?
What distinguishes Lichen Sclerosus from Lichen Simplex Chronicus?
How does a prior history of Diethylstilbestrol (DES) exposure impact the risk profile for developing gynecological malignancies?
How does a prior history of Diethylstilbestrol (DES) exposure impact the risk profile for developing gynecological malignancies?
Which of the following best describes the role of HPV in the pathogenesis of cervical cancer?
Which of the following best describes the role of HPV in the pathogenesis of cervical cancer?
How do current cervical screening guidelines incorporate HPV testing, and what is its significance in preventing cervical cancer?
How do current cervical screening guidelines incorporate HPV testing, and what is its significance in preventing cervical cancer?
What factors influence the decision to perform a colposcopy following abnormal cervical screening results, and how does this procedure aid in diagnosis and management?
What factors influence the decision to perform a colposcopy following abnormal cervical screening results, and how does this procedure aid in diagnosis and management?
What is the significance of koilocytosis in the context of HPV infection and its relation to cervical neoplasia?
What is the significance of koilocytosis in the context of HPV infection and its relation to cervical neoplasia?
Which aspects of the HPV life cycle are most critical in determining whether an infection will result in cervical cancer?
Which aspects of the HPV life cycle are most critical in determining whether an infection will result in cervical cancer?
How does FIGO staging provide prognostic information and guide treatment strategies?
How does FIGO staging provide prognostic information and guide treatment strategies?
What key features differentiate squamous cell carcinoma from adenocarcinoma in terms of etiology, location, and morphology?
What key features differentiate squamous cell carcinoma from adenocarcinoma in terms of etiology, location, and morphology?
How does the understanding of the HPV life cycle inform strategies for cervical cancer prevention and treatment?
How does the understanding of the HPV life cycle inform strategies for cervical cancer prevention and treatment?
What diagnostic findings are most critical for distinguishing between high-grade squamous intraepithelial lesion (HSIL) and invasive squamous cell carcinoma on cervical biopsy?
What diagnostic findings are most critical for distinguishing between high-grade squamous intraepithelial lesion (HSIL) and invasive squamous cell carcinoma on cervical biopsy?
In the context of managing cervical intraepithelial neoplasia (CIN), what factors guide the decision between ablative (e.g., cryotherapy, laser ablation) and excisional (e.g., LLETZ, cone biopsy) methods?
In the context of managing cervical intraepithelial neoplasia (CIN), what factors guide the decision between ablative (e.g., cryotherapy, laser ablation) and excisional (e.g., LLETZ, cone biopsy) methods?
How does the histological evaluation of cervical biopsies aid in differentiating between cervical glandular intraepithelial neoplasia (CGIN) and invasive adenocarcinoma?
How does the histological evaluation of cervical biopsies aid in differentiating between cervical glandular intraepithelial neoplasia (CGIN) and invasive adenocarcinoma?
What are the key differences in the usual management approaches for Usual VIN (uVIN) versus Differentiated VIN (dVIN), and how do these differences reflect variations in etiology and risk of progression?
What are the key differences in the usual management approaches for Usual VIN (uVIN) versus Differentiated VIN (dVIN), and how do these differences reflect variations in etiology and risk of progression?
How do the features of Paget disease of the vulva differ from those of melanoma?
How do the features of Paget disease of the vulva differ from those of melanoma?
What role does HPV play in squamous cell carcinoma?
What role does HPV play in squamous cell carcinoma?
Which form of VIN is associated with older women, not HPV related, and has a high risk of SCC progression, and has lichen sclerosus a risk factor?
Which form of VIN is associated with older women, not HPV related, and has a high risk of SCC progression, and has lichen sclerosus a risk factor?
Which benign tumor is equivalent to intraduct papilloma of the breast?
Which benign tumor is equivalent to intraduct papilloma of the breast?
Why is there great risk of invasive tumors in cases with immunosuppression?
Why is there great risk of invasive tumors in cases with immunosuppression?
Which is a common screening to prevent cervical cancer?
Which is a common screening to prevent cervical cancer?
How do lesion excisions assist in preventing Cervical Cancer?
How do lesion excisions assist in preventing Cervical Cancer?
Flashcards
Lichen Sclerosus
Lichen Sclerosus
A common vulvar dystrophy that can occur at any age and is associated with subepithelial fibrosis, atrophy, and scarring.
Lichen Simplex Chronicus
Lichen Simplex Chronicus
A non-specific diagnosis characterized by microscopic features that develop as a response to chronic itching.
Benign Vulval Neoplasms
Benign Vulval Neoplasms
Benign tumors like papillary hidradenoma (equivalent to intraduct papilloma of the breast) and condyloma acuminatum
Malignant Vulval Neoplasms
Malignant Vulval Neoplasms
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Vulval Intraepithelial Neoplasia
Vulval Intraepithelial Neoplasia
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Differentiated VIN
Differentiated VIN
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Usual VIN (uVIN)
Usual VIN (uVIN)
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Differentiated VIN (dVIN)
Differentiated VIN (dVIN)
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Vulval squamous cell carcinoma prognosis
Vulval squamous cell carcinoma prognosis
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Paget Disease (of vulva)
Paget Disease (of vulva)
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Tumors of the Vagina
Tumors of the Vagina
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Types of cervical carcinoma
Types of cervical carcinoma
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HPV Life Cycle in Cervix
HPV Life Cycle in Cervix
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Cytology
Cytology
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Colposcopy
Colposcopy
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Lesion excision
Lesion excision
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Study Notes
- The lecture is about the pathology of the female genital tract
- The class is for year 2 pathology students
- The lecturer is Professor Paul Murray
- The date of the lecture is 2025
Learning Objectives
- Discuss Vulval Pathologies
- List Neoplasms of Vagina
- Describe the anatomy of the cervix
- Discuss Cervical Neoplasms with emphasis on the role of HPV in aetiology
- Discuss HPV vaccination
- Discuss the natural history and progression of cervical neoplasms
Vulvar Dystrophies
- Lichen Sclerosus
- Lichen Simplex
Lichen Sclerosus (et Atrophicus)
- May present at any age
- It is an inflammatory condition
- It can lead to Subepithelial fibrosis, Atrophy, and Scarring
- It is associated with risk of subsequent malignancies
Lichen Simplex Chronicus
- Is a non-specific diagnosis
- Microscopic features develop in response to chronic itch
- Acanthosis appears by thickening of the prickle-cell layer of the skin
- Hyperkeratosis is a feature
- Variable inflammatory infiltrate of the dermis
Vulval Neoplasms
- Can be benign or malignant
- Benign: Papillary Hidradenoma and Condyloma Acuminatum
- Malignant: Carcinoma (VIN (precursor) → SCC and Paget) and Melanoma
Benign tumors
- Papillary hidradenoma is equivalent to intraduct papilloma of the breast
- Condyloma acuminatum: Acanthosis, Parakeratosis, Hyperkeratosis, and Evidence of HPV infection
Condyloma acuminatum & HPV
- Koilocytosis is present
- HPV 6 & 11 are low-risk viruses
- Parakeratosis refers to incomplete maturation of epidermal keratinocytes
- In parakerotosis there is abnormal retention of nuclei in the stratum corneum
Vulval Intraepithelial Neoplasia
- High-risk HPV leads to VIN which leads to Carcinoma
- Similar pathogenesis (and grading system) as cervix
- Risk of progression to invasive tumor increases with Age and Immunosuppression
Usual VIN
- Otherwise known as vulval intraepithelial neoplasia
- High-risk HPV can lead to VIN and then Carcinoma
- It has a similar pathogenesis and grading system to the cervix
- The risk of progression to an invasive tumor increases with age and immunosuppression
Differentiated VIN
- it is Not HPV related
- Tumor suppressor genes are involved, p53
- May develop quickly on the background of lichen sclerosus
VIN Comparison
Usual VIN (uVIN)
- Aetiology: High-risk HPV (especially HPV 16)
- Age: Younger women (30–50 years)
- Risk factors: Smoking, immunosuppression
- Risk of SCC Progression: Lower (~10%) if untreated
- Management: Surveillance, excision, imiquimod, laser ablation
- Imiquimod stimulates the immune system by activating Toll-like receptor 7 (TLR7)
- This leads to increased production of interferon-α (IFN-α) and other cytokines, enhanced cytotoxic T-cell activity against infected or dysplastic cells, and induction of apoptosis in HPV-infected cells
Differentiated VIN (dVIN)
- Aetiology: Not HPV-related
- Age: Older women (postmenopausal, >50 years)
- Risk factors: Lichen sclerosus
- Risk of SCC Progression: High (~30–50%) if untreated
- Management: Surgical excision preferred due to high risk of invasion
Vulva: Squamous Cell Carcinoma
- Poor prognosis is associated with increased depth of invasion
- Poor prognosis is associated with presence of lymphovascular invasion
Paget Disease (of Vulva)
- Red crusted skin lesion with clusters/individual tumor cells in epidermis
- Clear halo separates it from surrounding cells
- Granular cytoplasm which is PAS positive
- Intraepithelial adenocarcinoma characterized by malignant glandular epithelial cells (Paget cells) within the epidermis
- Paget cells originate from apocrine glands, a type of post-pubertal sweat gland
Vagina Tumors
- Squamous cell carcinoma: HPV-associated, VaIN = precursor (Vaginal Intraepithelial Neoplasia)
- Adenocarcinoma: DES exposure
- Clear cell carcinoma
- Embryonal Rhabdomyosarcoma: Sarcoma botryoides
Additional information on DES
- Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen.
- It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy
Cervical Carcinoma
- Squamous cell carcinoma accounts for 80% of cases
- Adenocarcinoma accounts for 15% of cases
- Other rarer tumors include neuroendocrine carcinoma and adeno-squamous carcinoma
HPV Life Cycle in the Cervix
- Pathogenesis involves initial latency inside the epithelial cell with a low proliferation rate
- As the virus enters the lytic cycle, the proliferation rate increases
- Viruses are assembled, leave the keratinocytes, and repeat the infection cycle
Staging of Cervical Cancer
- FIGO or TNM systems are very similar
- Microinvasion defines early squamous cell carcinoma with depth <3mm, posing a very low risk
- Recent studies emphasize the importance of the pattern of invasion, particularly desmoplasia
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