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Bartholin
Lichen sclerosis
Chronic atrophic vulvitis leads to atrophy, fibrosis,and scarring. Precancerous lesion Histological features are Hydropic degeneration of basal cells. Replacement of underlying dermis by dense collagenous fibrous tissue. Monoclonal band like lymphocyte infiltrate.
Acanthosis of vulval squamous epithelium with hyperkeratosis. The epithelium is thickened. Increased mitotic activity in basal and prickle layer
Papillary hidradenoma Condyloma accuminatum(veneral warts) Mucosal polyps Syphilitic condyloma latum
Malignant neoplasms
85% of malignant tumors are squamous cell carcinomas Others are basal cell carcinoma, melanoma and adenocarcinoma Predisposing factors are HPV 16,18 VIN Squamous cell hyperplasia Lichen sclerosis
HPV associated type develop as VIN lesions-discrete pigmented, hyperkeratotic and raised lesions.microscopicaly invasive growth pattern. Lichen sclerosis associated lesions nodules.microscopicaly exhibit invasive pattern with prominent keratinisation.
Vagina
Malignant neoplasms
Vaginal intraepithelial neoplasia & squamous cell carcinoma 1%of all malignant neoplasm in female genital tract risk factor is previous Ca of cervix or vulva Affects upper posterior vagina at junction with ectocervix
Adenocarcinoma
Increased frequency of clearcell adenocarcinoma among young women whose mothers are treated with diethyl stillbestrol during pregnancy Vaginal adenosis is precursor of the tumor Affect anterior wall of upper third vagina Vacuolated glycogen containing cells(clear cell ca)
Uncommon tumor Found in < 5 yr age group Polypoid, rounded bulky masses in grape like clusters Tennis racket like cells with oval nuclei
Cervix
Inflammations
Acute cervicitis-infiltration with acute inflammatory cells,erosion,reactive epithelial changes Chronic cervicitis-infiltration with lymphocytes, macrophages and plasma cells Endocervical polyps-small, sessile to large masses. composed of loose fibromatous stroma harboring dilated mucus secreting endocervical glands.
Cervical cancer
Most common genital Ca in India Invasive Ca- 40 to 45 yrs. 30 yrs for high grade precancers. Risk factors Early age at first intercourse Multiple sex partners Increased parity Male partner with multiple previous sex partners HPV infection(high risk type 16,18,31,33,35,39,45,51,52,56,58,59,68) Certain HLA and viral types Exposure to OCP and nicotine Genital infection (chlamydia)
CIN
They represent continuum of morphologic changes with indistinct boundaries. Do not invariably progress to cancer & may regress Associated with HPV
CIN
CIN I-nuclear enlargement & hyperchromasia in superficial epithelial cells, cytoplasmic halos(koilocytic atypia) also seen. CIN II-atypical cells in lowerlayers of squamous epithelium but abnormal differentiation towards prickle & keratinizing cell layer. CIN III-epithelium replaced by immature atypical cells exhibiting no surface differentiation. Atypical cells show changes in nucleo cytoplasmic ratio, nuclear pleomorphism, loss of polarity, increased mitotic figures including abnormal mitosis and hyperchromasia.
Normal cervix
Condyloma cervix
Cervical dysplasia
Fungating, ulcerating or infiltrative cancers Histologically-well differentiated(keratinizing) moderately differentiated(nonkeratinizing), poorly differentiated small cell squamous patterns.(specific risk with HPV-18)
CA cervix
Stage 0- Ca in situ (CIN III) Stage I- Ca confined to cervix Stage Ia- preclinical Ca diagnosed only by microscopy. Stage Ia1- stromal invasion< 3mm & no wider than 7mm. Stage Ia2- depth of invasion > 3mm & no greater than 5mm taken from base of epithelium, horizontal invasion not more than 7mm. Stage Ib- invasive Ca confined to Cx & greater than Stage Ia2
Staging contd.
Stage II- Ca extends beyond Cx but not on to pelvic walls. Ca involves vagina but not lower third. Stage III- Ca extended beyond on to pelvic walls. Ca involves lower third vagina. Stage IV- Ca extends beyond the true pelvis or has involved the mucosa of bladder or rectum. Metastatic dissemination.
Stage IV CA cervix
Infiltrating CA cervix
Other types
Adeno Ca- arise in endocervical glands. Adenosquamous Ca- mixed glandular & squamous pattern Clearcell adeno Ca of Cx- in DES exposed women.