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Patient comes in and presents with:
Blateral Abdominal Pain and tenderness
Adnexal & and cervical tenderness (cervical discharge and Urinary frequency)
Possible Fever
What does she have?
What are some sequella?
- PID
- Fever with Gonococcal infections
- Ectopic pregnancys and Infertility.
- Recurrent infections
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What are some complications of PID
- Peritonitus, endocaritus, meningitus, arthritus
- Infertility
- Ectopic pregs
- Intestinal OPbstructions and adhesions
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What are the Malignant neoplasms of the Vagina?
- SCC
- Adenocarcinoma
- Rabdomyosarcoma
- Malignant melanoma
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What is Vaginal Adenosis associated with?
What is a maligant tumore of the vagina that has this same association?
What is it?
- DES exposure
- Adenocarcinoma
It is when the squamus cells are transformed to Columnar cells.
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What is VaIN?
What is is associated with?
it is Disordered growth confined to the epithelium
HPV
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What is the most common malignancy of the Vagina?
What age is affected?
What will you see clinically?
What is it assocaited with?
- SCC
- 60-70yoa
- Spotting,Dischange,Urinary tract fistulas
HPV 16 and 18
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Grape like lesions
Child
Hemorrhage with Myxoid change
What is it?
Where is it from?
how does it spread?
What do you see histologically?
- This is Rabdomyosarcoma
- a tumor of mesenchymal cells
- Local invasion
- See Rhabdomyoblasts
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What is Lichen Sclerosis?
Who is effected?
is it cancerous?
what do you see hystologically?
- it is atrophic change
- Elderly and post menopausal patients
- Non-neoplastic
- thinning of the epidermal Layer and loss of the Rete ridges
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What is Lichen Simplex Chronicus?
Will you see atypia? what if you do?
- It is Thickening of the Epithelial layer (acanthosis) and hyperkeratosis.
- You will not see atypia, but if you do it is not LSC, it is VIN1
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What are the Vulvular Tumors? (6)
Which are Benein?
- Papillary hidradenoma
- Condyloma acuminotum
- VIN
- SCC
- Extramammary Paget disease
- Malignant melanoma
- Fibroadenoma
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Venerial Warts
HPV 6,11
see Koliocytosis, Mitosis
What is it?
Does it regress?
How do you treat it?
- Condyloma Accuminata
- Frequently regresses
- Cryotheropy, Chemical/ Excision
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Condyloma Accuminata
See Koliocytes
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What is the most common Malignancy of the Vulvus?
What ages?
What is it associated with (risk factors)
- SCC
- Older women but now getting younger
- –HPV & VIN
- –Vulvar dystrophy
- –Immunodeficiency
- syndromes
- –Smoking
- –Diabetes mellitus
- –Granulomatous diseases (LGV, GI)
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VIN
What ages?
Associated with?
Can it progress? if so to what? What %
See in <40 and >60
Associated with HPV 16,18
Can progress to SCC 10% of the time
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- VIN
- See Hyperkeratosis and Thickened Epithelium
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What is Bowmens disease?
it is VIN when it goes the full thickness
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What are the Two types of Vulvular Cancer? and %
- Basaloid or warty (30%)
- and Keratinizing Squamus (70%)
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Basaloid or Warty
What age?
Is it HPV associated?
What do you see?
- Uusually reproductive age
- HPV related
- Immature basal like cells (basaloid)
- exophytic (warty)
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Keratinizing squamous
Age?
Where is it from?
Is it HPV associated?
—mean age = 76
- from lichen sclerosis or squamous hyperplasia
- Non HPV
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On Gross examination see a Solitary, Exophytic Mass in the Labia Majora(could be menora)
What is it?
What if it is assocaited with Condyloma? 
SCC
Then 10% are Multifocal (multible masses)
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What is this?
Verricous Carcinoma of the Vulva= This is a Non-HPV associated subtype of SCC
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What are the two tumors of the Vulva that are from the breast?
- Pagets disease
- Papillary hidradinoma
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What is this? Where is it from?
- This is a Papillary hidradenoma
- From the Breast tissure (sweat glands), seen as a Small descrete nodule that is Beneign
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What is Pagets disease?
What will you see Hystologically?
Info?
Where is the most likley place to see this?
What ethnicity and age?
Treatment?
- - It is a breast associated cancer in the Vulvus
- -see paget (halo) cells
- - In is PAS,Mucin, EMA, CEA positive
- -Perianal is most common
- - See in 70 year old Caucasion women
- -Wide excision.
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What is this
- This is Pagets Disease
- See Halo (paget) Cells
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