Female Genital Pathology, UTHSC Fall 2022 D2
Pathology
What does the External female genitalia include?
the hair-bearing skin (labia majora) and mucosa (labia minora)
Vulvitis
- Reactive inflammation in response to an exogenous stimulus, as the most common
cause of vulvitis
- Contact irritant dermatitis or contact allergic dermatitis
- Contact irritant eczematous dermatitis as well-defined erythematous weeping and
crusting papules and plaques
what are some contact irritants that can cause vulvitis?
urine, soaps, detergents, antiseptics, deodorants, or alcohol
what infections can cause vulvitis?
- Human papillomavirus (HPV) as the most important infectious in North America
- HSV-1 or HSV-2
- N. gonorrhoeae
- Treponema pallidum
Vulvitis: HSV infection
- Small ulcers coalesce to larger ulcers with serpentine borders
- Nuclear inclusions
Vulva: Nonneoplastic Epithelial Disorders: Lichen Sclerosus
- Smooth, white plaques that coalesce
- Parchment like
- Increased risk of squamous cell carcinoma
Vulva: Nonneoplastic Epithelial Disorders: Lichen Sclerosus Histopathologic
Features
• Thinning of epidermis
• Degeneration of basal cells
• Excessive keratinization
• Sclerosis of dermis
• Bandlike lymphocytic Infiltrate
Vulva Tumors
- Condylomas: any warty lesion of the vulva:
- Comdylomata lata, not commonly seen, occur in secondary syphilis
- Condylomata acuminate, more common, HPV-related
- Carcinomas
Condyloma Acuminatum
- Benign Genital warts caused by HPV types 6 & 11
- More often as multiple papillary elevated or flat lesions
Condyloma Acuminatum histopathologic features
- Papillary epithelial hyperplasia and hyperkeratosis
- Koilocytosis
Koilocytosis
A cytopathic change characterized by perinuclear cytoplasmic vacuolization and a
wrinkled nuclear contour (A hallmark of HPV infection)
, Carcinoma of the Vulva
- 3% of all female genital tract cancers
- 90% are squamous cell carcinoma
- Vulvar intraepithelial neoplasia as a precancerous lesion, clinically as leukoplakia
What are the two distinct forms of Vulvular SCC?
- High-risk HPV-related (HPV16)
- HPV-negative
High-risk HPV-related Vulvular SCC
less common, multifocal, occurs in middle-aged women, smokers, poorly differentiated
HPV-negative Vulvular SCC
unifocal, following a long history of reactive epithelial changes, principally lichen
sclerosus, well-differentiated keratinizing SCC
Vulvar Intraepithelial Neoplasia histology
- The term used instead of "dysplasia" in the genital pathology
- A precursor lesion for carcinoma
Endocervix
part of the cervix inside the uterus
Exocervix
part of the cervix outside the uterus
what are some of the many infections of the lower genital tract?
- Herpes
- Mulluscum Contagiosum
- Fungal: Candida Albicans
- Trichomonas Vaginalis
- Gardnerella Vaginalis
- Ureaplasa Urealyticum and Mycoplasma Hominis
- Chlamydia Trachomatis & Neisseria Gonorrhea
- Human Papillomavirus (HPV)
Candida Albicans
- Very common fungal infection
- Part of normal vaginal microflora
what is Symptomatic candidiasis is a result of?
disturbance in vaginal ecosystem: Diabetes, antibiotics, pregnancy,
immunosuppression, etc
Symptoms of Candida Albicans
Itching, erythema, curd-like white vaginal discharge
Histology of Candida Albicans
Pseudohyphae with acute angle branching
Trichomonas Vaginalis
- Large flagellated ovoid protozoa
- Yellow frothy vaginal discharge, dysuria, dyspareunia, potent smell
- Strawberry Cervix
The Vulvovaginal-Gingival Syndrome of Lichen Planus
- A variant of mucosal lichen planus characterized by erosions and desquamation of the
vulva, vagina, and gingiva.
Pathology
What does the External female genitalia include?
the hair-bearing skin (labia majora) and mucosa (labia minora)
Vulvitis
- Reactive inflammation in response to an exogenous stimulus, as the most common
cause of vulvitis
- Contact irritant dermatitis or contact allergic dermatitis
- Contact irritant eczematous dermatitis as well-defined erythematous weeping and
crusting papules and plaques
what are some contact irritants that can cause vulvitis?
urine, soaps, detergents, antiseptics, deodorants, or alcohol
what infections can cause vulvitis?
- Human papillomavirus (HPV) as the most important infectious in North America
- HSV-1 or HSV-2
- N. gonorrhoeae
- Treponema pallidum
Vulvitis: HSV infection
- Small ulcers coalesce to larger ulcers with serpentine borders
- Nuclear inclusions
Vulva: Nonneoplastic Epithelial Disorders: Lichen Sclerosus
- Smooth, white plaques that coalesce
- Parchment like
- Increased risk of squamous cell carcinoma
Vulva: Nonneoplastic Epithelial Disorders: Lichen Sclerosus Histopathologic
Features
• Thinning of epidermis
• Degeneration of basal cells
• Excessive keratinization
• Sclerosis of dermis
• Bandlike lymphocytic Infiltrate
Vulva Tumors
- Condylomas: any warty lesion of the vulva:
- Comdylomata lata, not commonly seen, occur in secondary syphilis
- Condylomata acuminate, more common, HPV-related
- Carcinomas
Condyloma Acuminatum
- Benign Genital warts caused by HPV types 6 & 11
- More often as multiple papillary elevated or flat lesions
Condyloma Acuminatum histopathologic features
- Papillary epithelial hyperplasia and hyperkeratosis
- Koilocytosis
Koilocytosis
A cytopathic change characterized by perinuclear cytoplasmic vacuolization and a
wrinkled nuclear contour (A hallmark of HPV infection)
, Carcinoma of the Vulva
- 3% of all female genital tract cancers
- 90% are squamous cell carcinoma
- Vulvar intraepithelial neoplasia as a precancerous lesion, clinically as leukoplakia
What are the two distinct forms of Vulvular SCC?
- High-risk HPV-related (HPV16)
- HPV-negative
High-risk HPV-related Vulvular SCC
less common, multifocal, occurs in middle-aged women, smokers, poorly differentiated
HPV-negative Vulvular SCC
unifocal, following a long history of reactive epithelial changes, principally lichen
sclerosus, well-differentiated keratinizing SCC
Vulvar Intraepithelial Neoplasia histology
- The term used instead of "dysplasia" in the genital pathology
- A precursor lesion for carcinoma
Endocervix
part of the cervix inside the uterus
Exocervix
part of the cervix outside the uterus
what are some of the many infections of the lower genital tract?
- Herpes
- Mulluscum Contagiosum
- Fungal: Candida Albicans
- Trichomonas Vaginalis
- Gardnerella Vaginalis
- Ureaplasa Urealyticum and Mycoplasma Hominis
- Chlamydia Trachomatis & Neisseria Gonorrhea
- Human Papillomavirus (HPV)
Candida Albicans
- Very common fungal infection
- Part of normal vaginal microflora
what is Symptomatic candidiasis is a result of?
disturbance in vaginal ecosystem: Diabetes, antibiotics, pregnancy,
immunosuppression, etc
Symptoms of Candida Albicans
Itching, erythema, curd-like white vaginal discharge
Histology of Candida Albicans
Pseudohyphae with acute angle branching
Trichomonas Vaginalis
- Large flagellated ovoid protozoa
- Yellow frothy vaginal discharge, dysuria, dyspareunia, potent smell
- Strawberry Cervix
The Vulvovaginal-Gingival Syndrome of Lichen Planus
- A variant of mucosal lichen planus characterized by erosions and desquamation of the
vulva, vagina, and gingiva.
