Female Genital Tract Cancers Wassons material

Vulva => Non-Neoplastic Epithelial Disorders

Leukoplakia => White plaques may present a variety of benign, pre malignant of malignant lesions
Lichen Sclerosus Squamous cell
hyperplasia/Lichen
simplex chronicus







Vulva => Non-Neoplastic Epithelial Disorders
Leukoplakia => White plaques may present a variety of benign, pre malignant of malignant lesions

Lichen Sclerosus Squamous cell hyperplasia/Lichen simplex chronicus
Age Most common in post-menopausal, but can
strike all ages

Gross Appear as smooth, white plaques or papules
that may extend and coalesce
Surface is smooth and resembles parchment
Labia becomes atrophic and stiffened when
entire vuvla is affected
- Vaginal orifice is constricted

White plaques - Leukoplakia
Histology Thinned epidermis and disappearance of rete
pegs
Hydropic degeneration non basal cells
Superficial hyperkeratosis
Dermal fibrosis with scant perivascular,
mononuclear inflammatory cell infiltrate
Sclerotic Stroma

Thickened epidermis (acanthosis), expansion of stratum
granulosum
Significant surface hyperkeratosis
Increased mitotic activity in stratum basalis and spinosum
Sometimes pronounced leukocytic infiltration
Hyperplastic cells have no atypia

Pathology Cause unknown
Maybe Auto-immune
Activated T cells in subepithelial inflammatory
infiltrate

Non-specific condition from rubbing or scratching the skin

Notes Not pre-malignant
Symptomatic disease = chance of SCC
No increased pre-disposition to cancer
o Often present at margins of established cancer of vulva



Tumors of the vulva
Benign exophytic lesions
Condyloma acuminatum HPV induced Fibroepithelial polyp/ Squamous papilloma
Sexually transmitted, benign lesions


Gross Verrucous = Multifocal Wart-like appearance
Numerous Condylomas cycle the Intoitus. (opening
to the vagina)


Histo Acanthosis = Thickened epidermis
Hyperkeratosis
Koilocytic atypia = viral cytopathic changes
o Enlarged, Atypical nuclei
o Cytoplastic vacuolation
o Cytoplasmic perinuclear halo


Path HPV Low oncogenic risk HPVs - 6,11
Productive viral infection
Replication in squamous cells.
Life cycle ends in mature superficial cells
Koilocytotic atypia

Notes Not a precancerous lesions.
Squamous Neoplastic Lesions
VIN HPV induced Carcinoma
VIN Vulvar intraepithelial neoplasia
o Uncommon malignant neploasm 3% of
genital cancers in chicks. 2/3 in chicks >
60 years.


Gross Multifocal
Histo Squamous cell carcinomas MC
Begin as classic VIN lesions

Marked Nuclear Atypia

Path HPV 16
Notes Synonymous with carcinoma in situ (Bowen
disease
Precedes invasive carcinoma
Cancer risk increase with age
Spontaneous regression in the young




Glandular neoplastic Lesions
Papillary Hidradenoma Extramammary Paget disease
o Vulva contains modified apocrine sweat
glands and ectopic breast.

o Rare lesion similar to Paget
disease of the breast
o Paget cells show apocrine, eccrine,
and keratinocyte differentiation
and come from progenitor cells
o
o Sharply circumscribed nodule on labia
majora or interlabial folds
o Tendency to ulcerate may be confused
with carcinoma

o Pruritic, red, crusted, sharply
demarcated, maplike area usu
occurring on labia.

o Tumor identical in appearance to
intraductal papilloma of the breast
Vulva contains tissue closely resembling
breast
o Tumor consists of tubular ducts lined by
nonciliated columnar cell layer and
myoepithelial layer underneath
o Diagnostic microscopic feature -
large tumor cells single or in
clusters surrounded by halos.
o Fine granular cytoplasm
containing mucopolysaccharide.
Stains w/PAS, Alcian blue or
mucicarmine
o Paget cells show apocrine, eccrine,
and keratinocyte differentiation
and come from progenitor cells




o Consists of papillary projection
covered with two layers of cells
Upper columnar, secretory cells
Lower flattened myoepithelial
cells

o Unlike Paget dz of the nipple
(which is always assoc with
underlying ductal breast
carcinoma), vulvar lesions are
most frequently confined to the
skin and adjacent hair follicles and
sweat glands
o Prone to recurrence


Malignant Melanoma
Malignant melanoma
o Peak in 6
th
or 7
th
decade; Rare
o Wide spread dissemination. 5 year
survival < 32%
o Prognosis linked to depth of invasion.
Lesions deeper than 1mm over half are
fatal.
o CEA and Mucoploysaccharide
negative(both are in Pagets). Anti S100
protein positive.



Vagina
Vaginal Adenosis / Clear Cell Carcinoma Vaginal Intraepithelial Neoplasia (VAIN)














Squamous Cell Carcinoma Embryonal rhabdomyosarcoma