Pathology of the Vulva and Vagina.pdf

Pathology of the Vulva and Vagina Virus: Herpes Human papillomavirus (HPV) molluscum contagiosum virus Bacteria Gardinerella Actinomycete (IUD) Syphilis Gonorrhea Chlamydia trachomatis: Most common STD Fungi: Candida Parasites: Trichomonas Herpes Relatively common HSV1 (orally) HSV2 (sexually) o Neo...

Pathology of the Vulva and Vagina Virus: Herpes Human papillomavirus (HPV) molluscum contagiosum virus Bacteria Gardinerella Actinomycete (IUD) Syphilis Gonorrhea Chlamydia trachomatis: Most common STD Fungi: Candida Parasites: Trichomonas Herpes Relatively common HSV1 (orally) HSV2 (sexually) o Neonatal herpes associated with vaginal delivery in women with third-trimester genital herpes (HSV2) Commonly asymptomatic, depending on location One or more painful vesicular lesions until rupture and ulceration (heals in few weeks) Diagnosis: Pathological findings and HSV detection (PCR) Treatment: Antiviral (acyclovir, valacyclovir, etc) Genital Herpes o Clusters of vesicles, later coalescent ulcers o Ground glass appearance (intranuclear viral particles) o Multinucleation o Molding of nuclei o Margining of chromatin Genital Warts “Condyloma acuminatum” Sexually transmitted infection by human papillomavirus (HPV) Spread through oral, anal, and genital sexual contact Associated with increased risk of HPV-associated neoplasms May have abnormal cervical changes Risk factors: Multiple sexual partners Unprotected intercourse History of sexually transmitted infections Smoking Pathology: Pearly, filiform, fungating, cauliflower, or plaque like growth Koilocytes with raisin-like nuclei and cytoplasmic halo Genital warts Koilocytes with raisin like nuclei and cytoplasmic halo Bacterial Vaginosis Most common vaginal infection for reproductive-age women Sexually transmitted Alteration of flora from elevated pH assoc w various causes of Gardnerella vaginalis and other bacteria Fishy odor, thin, greyish-white vaginal discharge, vulvar irritation Diagnosis: Whiff test: Fishy odor produced by adding KOH to discharge Pathology: Clue cells: Squamous cells covered by coccobacilli Treatment: Antibiotics (metronidazole, clindamycin, etc) Candida Asymptomatic or presents with thick white discharge Assoc w: Immunosuppression Antibiotics Changes in vaginal pH Diagnosis: Pap or KOH wet mount- Acute inflammation and pseudohyphae (budding yeast cells) Trichomonas “Parasite Trichomonas vaginalis” Primary risk factor: Multiple sexual partners Yellow-green or gray-white vaginal discharge with a strong odor Many are asymptomatic Pear-shaped, oval, or round cyanophilicprotozoa seen on Pap smear Pelvic Inflammatory Dz Infectious and inflammatory disorder of the upper female genital tract (uterus, fallopian tubes, pelvic structures) Gonorrhea and chlamydia are common causes Chronic inflammation/scarring contributes to infertility or ectopic pregnancy (esp. gonococcal infections) Treatment: Antibiotics (against gonorrhea, chlamydia, etc) Pathology of Vulva Anatomy: Skin and mucosa outside hymen (labias, mons pubis, and vestibules) Histology: Lined by keratinized squamous epithelium o 1. Bartholin cyst: Infection/inflammation of Batholin gland o 2. Lichen sclerosus: Chronic lymphocyte-mediated skin disease o 3. Extramammary Paget Disease: Intraepithelial adenocarcinoma Bartholin Cyst Bartholin's glands o On each side of the vaginal opening o Produce mucus-like fluid to lubricate the vagina Blockage of Bartholin gland duct causes accumulation of gland fluid o May be infected by chlamydia, gonorrhea, E. coli o May lead abscess secondary to obstruction and inflammation Painful swelling Lichen Sclerosus Thinning of the epidermis and fibrosis (sclerosis) of the dermis Skin disease characterized by white patches o Can be hemorrhagic, eroded, or ulcerated. It may extend to the anus o Very itchy and scratchy skin Caused by hormonal imbalance, abnormality in the immune system Benign - increased risk of squamous cell carcinoma Extramammary Paget Dz Intraepithelial adenocarcinoma Slow-growing skin condition Malignant epithelial cells in the epidermis of vulva (carcinoma in situ) Commonly in elderly women Pruritic, erythema, crusting, ulcers (painful, associated with a burning sensation) Histology: o Slowly expanding, erythematous or eczematous, focally eroded or crusted plaques o Clusters of large cells , pale cytoplasm, irregular hyperchromic nuclei, intraepidermal ONLY Treatment: o Wide local excision o Topical chemo o Radiotherapy o Photodynamic therapy o CO2 laser ablation Pathology of Vagina Anatomy: Canal leading to the cervix Histology: Non-keratinizing squamous epithelial cell o 1. Squamous cell carcinoma o 2. Clear cell carcinoma o 3. Embryonal rhabdomyosarcoma (infants) Clear Cell Carcinoma Rare malignancy of cervix or vagina Associated with maternal diethylstilbestrol (DES) o Nonsteroidal estrogen o Used to prevent miscarriage, premature birth o Removed from market bc related to reproductive abnormalities Female babies: Reproductive tract abnormalities o Abnormal uterus, cervix o Vaginal adenosis o Vaginal clear cell adenocarcinoma o High rate of infertility Squamous Cell Carcinoma Very rare Almost always involves HPV Same risk factors as cervical cancer o Rarely a primary tumor of the vagina o Most commonly: extension of cervical carcinoma Sarcoma Botryoides: Embryonal Rhabdomyosarcoma variant Rare vaginal tumors of young girls May also develop in boys o “Paratesticular tumors” o Scrotal or inguinal enlargement Derives from embryonal rhabdomyoblasts o Immature muscle cells Occurs in children < 5 years old (2/3 under age 2) in anterior vaginal wall Clear, grape-like mass growing from the vagina (botryoid = appearance of a bunch of grapes) May invade the peritoneum -> obstruct the bladder Treatment: o Surgery o Chemotherapy o Radiation therapy Prognosis: Usually good prognosis Desmin o Muscle filament o Part of Z-disks in sarcomeres o Marker of rhabdomyosarcoma o 99% of rhabdomyosarcomas positive for desmin Cases A 22-yr woman with watery vaginal discharge in her third trimester. History of type I diabetes and gonorrheal urethritis. Colposcopic examination reveals a 0.8 cm ulcer at the cervix with bleeding. Biopsy of the ulcer reveals diffuse neutrophilic infiltrate with scattered atypical squamoid multinucleated cells with ground glass. The peripheral of nuclei are much darker. A.) Candida Infection B.) Herpes Infection b A 17yr female with vaginal burning and thin vaginal discharge with a fishy odor. Sexually active with several partners. Speculum exam reveals thin, grayish vaginal discharge. No erosion, bleeding, or abnormal growth. Saline wet mount reveals squamous cells covered by coccobacilli. KOH mount reveals no fungal elements but produces a strong fishy odor. What is the cause of her presentation? o Bacterial Vaginosis