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644        SectioN iii    RepRoductive  ` REPRODUCTIVE—PATHOlOgy                                                                                                     RepRoductive  ` REPRODUCTIVE—PATHOlOgy





               Vulvar pathology
                Non-neoplastic
                 Bartholin cyst and   Due to blockage of Bartholin gland duct causing accumulation of gland fluid. May lead to abscess
                 abscess               2° to obstruction and inflammation  A . Usually in reproductive-age females.
                Lichen sclerosus     Thinning of epidermis with fibrosis/sclerosis of dermis. Presents with porcelain-white plaques
                                      with a red or violet border. Skin fragility with erosions can be observed  B . Most common in
                                      postmenopausal women. Benign, but slightly increased risk for SCC.
                Lichen simplex       Hyperplasia of vulvar squamous epithelium. Presents with leathery, thick vulvar skin with
                 chronicus            enhanced skin markings due to chronic rubbing or scratching. Benign, no risk of SCC.
                Neoplastic
                Vulvar carcinoma     Carcinoma from squamous epithelial lining of vulva  C . Rare. Presents with leukoplakia, biopsy
                                       often required to distinguish carcinoma from other causes.
                                     HPV-related vulvar carcinoma—associated with high-risk HPV types 16, 18. Risk factors: multiple
                                       partners, early coitarche. Usually in reproductive-age females.
                                     Non-HPV vulvar carcinoma—usually from long-standing lichen sclerosus. Females > 70 years old.
                Extramammary Paget   Intraepithelial adenocarcinoma. Carcinoma in situ, low risk of underlying carcinoma (vs Paget
                 disease               disease of the breast, which is always associated with underlying carcinoma). Presents with
                                       pruritus, erythema, crusting, ulcers  D.
                                     A                    B                   C                    D















               Imperforate hymen     Incomplete degeneration of the central portion of the hymen. Accumulation of vaginal mucus at
                                      birth Ž self-resolving bulge in introitus. If untreated, leads to 1° amenorrhea, cyclic abdominal
                                      pain, hematocolpos (accumulation of menstrual blood in vagina Ž bulging and bluish hymenal
                                      membrane).



               Vaginal tumors
                Vaginal squamous cell  Usually 2° to cervical SCC; 1° vaginal carcinoma rare.
                 carcinoma
                Clear cell           Affects women who had exposure to DES in utero.
                 adenocarcinoma
                Sarcoma botryoides   Embryonal rhabdomyosarcoma variant.
                                     Affects girls < 4 years old; spindle-shaped cells; desmin ⊕.
                                     Presents with clear, grape-like, polypoid mass emerging from vagina.

















          FAS1_2019_15-Repro.indd   644                                                                                 11/7/19   5:52 PM
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