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Pathology - Fat tissue necrosis
Definition: An inflammatory response to injured adipose tissue. Epidemiology: Prevalent. Aetiology: Trauma to the breast. • Following surgical intervention or radiation. Pathogenesis • Compromised adipocytes release their lipid contents, provoking an inflammatory response that leads to the formation of a palpable mass.
Presentation • The majority present with a breast mass that is firm and indurated.Can closely resemble breast carcinoma in clinical presentation. Macroscopy • The breast tissue exhibits yellow-white flecks of discolouration. Cytopathology: FNA cytology reveals foamy macrophages, multinucleated large cells, and background detritus. Histopathology: Degenerating adipocytes are observed, encircled by foamy macrophages, multinucleated giant cells, lymphocytes, and plasma cells. Subsequent alterations encompass fibrosis and calcification.
Prognosis: Benign with no elevated risk of breast cancer.
Definition: An inflammatory response to injured adipose tissue. Epidemiology: Prevalent. Aetiology: Trauma to the breast. • Following surgical intervention or radiation. Pathogenesis • Compromised adipocytes release their lipid contents, provoking an inflammatory response that leads to the formation of a palpable mass.
Presentation • The majority present with a breast mass that is firm and indurated.Can closely resemble breast carcinoma in clinical presentation. Macroscopy • The breast tissue exhibits yellow-white flecks of discolouration. Cytopathology: FNA cytology reveals foamy macrophages, multinucleated large cells, and background detritus. Histopathology: Degenerating adipocytes are observed, encircled by foamy macrophages, multinucleated giant cells, lymphocytes, and plasma cells. Subsequent alterations encompass fibrosis and calcification.
Prognosis: Benign with no elevated risk of breast cancer.
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Pathology - Acute mastitis
Definition • Acute inflammation of the breast.
Epidemiology • Prevalent. • The majority are linked to either lactation or duct ectasia.
Microbiology • Staphylococci and streptococci in nursing women. • Staphylococci or anaerobic bacteria in females with duct ectasia.
Pathogenesis
Cracks in the skin are believed to facilitate bacterial entry into the breast, while milk stasis encourages the onset of illness. The most prevalent presentation is a painful, erythematous breast. • The establishment of an abscess may result in a breast mass. Macroscopy A pronounced region of acute mastitis may yield a discernible bulk. • Purulent exudate may be evident alongside abscess development. Cytopathology Fine needle aspiration (FNA) of an inflammatory breast mass typically produces purulent material that microscopically reveals a high concentration of neutrophils.
Histopathology • Acute inflammation is evident inside the breast parenchyma. The convergence of the acute inflammatory process may result in the formation of an abscess cavity. The neighboring breast tissue may exhibit lactational alterations or duct ectasia.
Prognosis: Drainage and suitable antibiotic therapy typically lead to resolution.
Definition • Acute inflammation of the breast.
Epidemiology • Prevalent. • The majority are linked to either lactation or duct ectasia.
Microbiology • Staphylococci and streptococci in nursing women. • Staphylococci or anaerobic bacteria in females with duct ectasia.
Pathogenesis
Cracks in the skin are believed to facilitate bacterial entry into the breast, while milk stasis encourages the onset of illness. The most prevalent presentation is a painful, erythematous breast. • The establishment of an abscess may result in a breast mass. Macroscopy A pronounced region of acute mastitis may yield a discernible bulk. • Purulent exudate may be evident alongside abscess development. Cytopathology Fine needle aspiration (FNA) of an inflammatory breast mass typically produces purulent material that microscopically reveals a high concentration of neutrophils.
Histopathology • Acute inflammation is evident inside the breast parenchyma. The convergence of the acute inflammatory process may result in the formation of an abscess cavity. The neighboring breast tissue may exhibit lactational alterations or duct ectasia.
Prognosis: Drainage and suitable antibiotic therapy typically lead to resolution.
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Pathology -Vulvar carcinoma
Definition • A malignant epithelial neoplasm originating in the vulva.
Epidemiology: Rare, having a yearly incidence of 0.8 per 100,000 individuals. • Predominantly occurs in elderly women, though it may sometimes manifest in younger women.
Aetiology • Often unidentified in numerous instances. • Certain occurrences are associated with chronic vulval dermatoses, including lichen sclerosus and lichen planus. • The majority of instances occurring in younger women are correlated with high-risk HPV infection of the vulva.
Carcinogenesis • The majority of instances originate from a precursor lesion
identified as vulval intraepithelial neoplasia (VIN). VIN is a dysplastic lesion of the vulvar squamous epithelium, categorized into two types: classical and differentiated. The classical type is observed in young women and is associated with HPV infection. The differentiated type is observed in older women and is associated with chronic vulvar inflammation. Both VIN and vulval carcinomas exhibit genetic anomalies, including mutations in TP53 and PTEN.
Presentation • The majority present with a vulvar tumor that may undergo ulceration and hemorrhage.
Macroscopy • A vulvar tumor mass that may present as nodular, verrucous, or ulcerated. Histopathology • The majority of cases are squamous cell carcinomas, characterized by infiltrating malignant epithelial cells exhibiting squamous differentiation. • The squamous epithelium next to the tumor may demonstrate vulvar intraepithelial neoplasia (VIN).
Prognosis • The primary prognostic factors are tumor size, invasion depth, and the degree of lymph node metastasis. Tumors with a depth of invasion of 1 mm exhibit a little risk of lymph node metastasis and a favorable prognosis for cure following local excision. The 5-year survival rate for people with unilateral lymph node disease is 65%, but it decreases to 25% for those with bilateral disease.
Definition • A malignant epithelial neoplasm originating in the vulva.
Epidemiology: Rare, having a yearly incidence of 0.8 per 100,000 individuals. • Predominantly occurs in elderly women, though it may sometimes manifest in younger women.
Aetiology • Often unidentified in numerous instances. • Certain occurrences are associated with chronic vulval dermatoses, including lichen sclerosus and lichen planus. • The majority of instances occurring in younger women are correlated with high-risk HPV infection of the vulva.
Carcinogenesis • The majority of instances originate from a precursor lesion
identified as vulval intraepithelial neoplasia (VIN). VIN is a dysplastic lesion of the vulvar squamous epithelium, categorized into two types: classical and differentiated. The classical type is observed in young women and is associated with HPV infection. The differentiated type is observed in older women and is associated with chronic vulvar inflammation. Both VIN and vulval carcinomas exhibit genetic anomalies, including mutations in TP53 and PTEN.
Presentation • The majority present with a vulvar tumor that may undergo ulceration and hemorrhage.
Macroscopy • A vulvar tumor mass that may present as nodular, verrucous, or ulcerated. Histopathology • The majority of cases are squamous cell carcinomas, characterized by infiltrating malignant epithelial cells exhibiting squamous differentiation. • The squamous epithelium next to the tumor may demonstrate vulvar intraepithelial neoplasia (VIN).
Prognosis • The primary prognostic factors are tumor size, invasion depth, and the degree of lymph node metastasis. Tumors with a depth of invasion of 1 mm exhibit a little risk of lymph node metastasis and a favorable prognosis for cure following local excision. The 5-year survival rate for people with unilateral lymph node disease is 65%, but it decreases to 25% for those with bilateral disease.
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Pathology -Benign vulval tumours
Bartholin duct cysts
• Arise due to obstruction of a Bartholin’s gland duct.
• Present as painless lumps of the vulva in young women.
• Histologically, they are lined by transitional-type epithelium with areas
of squamous metaplasia.
Papillary hidradenoma
• Benign sweat gland tumour which usually presents in middle-aged
women as a small painless vulval lump.
• Histologically, they are well-circumscribed papillary tumours of the
dermis. The epithelium covering the papillae is double-layered, with
inner tall columnar cells and outer small myoepithelial cells.
Condylomas
• Solitary or multiple lesions related to certain types of human papilloma
virus (HPV) infection.
• Histologically, they show papillary squamous proliferations with
koilocytes (keratinocytes showing HPV cytopathic effect).
• Widespread vulval condylomas may be seen in the immunosuppressed
.
Granular cell tumour
• Uncommon neural tumour that may occur in the vulva.
• Histologically composed of nests of large polygonal cells with abundant
granular cytoplasm.
• The vast majority behave in a benign fashion.
Angiomyofi broblastoma
• Benign mesenchymal neoplasm that occurs almost exclusively in the
vulvovaginal region of young women.
• Presents as a small subcutaneous lump, often mistaken for a cyst.
• Histologically, they are well-circumscribed lesions composed of dilated
capillary-sized vessels set in an oedematous stroma containing many
plump epithelioid stromal cells.
Cellular angiofi broma
• Benign mesenchymal neoplasm presenting as a small painless
subcutaneous mass in the vulvovaginal region of reproductive age
women.
• Histologically, they are well-circumscribed cellular lesions composed of
bland spindle cells and many small thick-walled blood vessels.
Deep angiomyxoma
• Locally infi ltrative, but non-metastasizing, mesenchymal neoplasm that
presents as a large deep-seated mass in the pelvis and perineum of
reproductive age women.
• Histologically, they are infi ltrative, paucicellular tumours composed of
small numbers of bland spindle cells set in a myxoid stroma containing
thick-walled blood vessels
Bartholin duct cysts
• Arise due to obstruction of a Bartholin’s gland duct.
• Present as painless lumps of the vulva in young women.
• Histologically, they are lined by transitional-type epithelium with areas
of squamous metaplasia.
Papillary hidradenoma
• Benign sweat gland tumour which usually presents in middle-aged
women as a small painless vulval lump.
• Histologically, they are well-circumscribed papillary tumours of the
dermis. The epithelium covering the papillae is double-layered, with
inner tall columnar cells and outer small myoepithelial cells.
Condylomas
• Solitary or multiple lesions related to certain types of human papilloma
virus (HPV) infection.
• Histologically, they show papillary squamous proliferations with
koilocytes (keratinocytes showing HPV cytopathic effect).
• Widespread vulval condylomas may be seen in the immunosuppressed
.
Granular cell tumour
• Uncommon neural tumour that may occur in the vulva.
• Histologically composed of nests of large polygonal cells with abundant
granular cytoplasm.
• The vast majority behave in a benign fashion.
Angiomyofi broblastoma
• Benign mesenchymal neoplasm that occurs almost exclusively in the
vulvovaginal region of young women.
• Presents as a small subcutaneous lump, often mistaken for a cyst.
• Histologically, they are well-circumscribed lesions composed of dilated
capillary-sized vessels set in an oedematous stroma containing many
plump epithelioid stromal cells.
Cellular angiofi broma
• Benign mesenchymal neoplasm presenting as a small painless
subcutaneous mass in the vulvovaginal region of reproductive age
women.
• Histologically, they are well-circumscribed cellular lesions composed of
bland spindle cells and many small thick-walled blood vessels.
Deep angiomyxoma
• Locally infi ltrative, but non-metastasizing, mesenchymal neoplasm that
presents as a large deep-seated mass in the pelvis and perineum of
reproductive age women.
• Histologically, they are infi ltrative, paucicellular tumours composed of
small numbers of bland spindle cells set in a myxoid stroma containing
thick-walled blood vessels
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Pathology - Vulvar dermatoses
Eczemas • Frequently occur on vulval skin. • The two predominant forms are seborrhoeic dermatitis and irritating contact dermatitis. • Their looks resemble those found in other areas of the skin
Lichen simplex chronicus • Hyperkeratotic lesions likely indicative of a non-specific response to persistent pruritus. The labium majus is the primary location on the vulva. Histologically, there is significant epidermal thickening accompanied by hyperkeratosis and hypergranulosis.
Psoriasis • Vulval psoriasis generally presents as the flexural type, characterized by significant erythema and the absence of scaling. • The typical histological findings reveal regular psoriasiform epidermal hyperplasia accompanied by plaques of parakeratosis and a loss of the granular layer. Neutrophils are located within the parakeratosis. Vulval psoriasis may have unusual histology, complicating the diagnostic process.
Lichen planus • May occur in people with generalized disease or be confined to the genital area. The lesions are purple, flat-topped, and glossy papules. Erosive illness may manifest, perhaps resulting in scarring. Histologically, a band-like infiltrate of inflammatory cells comprising lymphocytes, histiocytes, and plasma cells is observed. The superficial epidermis exhibits basal cell injury and may be either thickened or atrophic. Lichen planus presents a marginally elevated risk for the emergence of vulval intraepithelial neoplasia (VIN) and squamous cell carcinoma.
Lichen sclerosus is an inflammatory dermatosis of indeterminate etiology, predominantly affecting the anogenital skin in women. Clinically, there are white papules and plaques with a wrinkled surface. There may be regions of atrophy and hemorrhage. Pruritus, burning sensations, and dyspareunia are prevalent symptoms. The epidermis exhibits histological thinning and interface alteration. A band of hyalinization is present beneath the epidermis, accompanied by a persistent inflammatory cell infiltrate. Lichen sclerosus is associated with a slight increase in the risk of developing vulvar intraepithelial neoplasia (VIN) and squamous cell carcinoma.
Eczemas • Frequently occur on vulval skin. • The two predominant forms are seborrhoeic dermatitis and irritating contact dermatitis. • Their looks resemble those found in other areas of the skin
Lichen simplex chronicus • Hyperkeratotic lesions likely indicative of a non-specific response to persistent pruritus. The labium majus is the primary location on the vulva. Histologically, there is significant epidermal thickening accompanied by hyperkeratosis and hypergranulosis.
Psoriasis • Vulval psoriasis generally presents as the flexural type, characterized by significant erythema and the absence of scaling. • The typical histological findings reveal regular psoriasiform epidermal hyperplasia accompanied by plaques of parakeratosis and a loss of the granular layer. Neutrophils are located within the parakeratosis. Vulval psoriasis may have unusual histology, complicating the diagnostic process.
Lichen planus • May occur in people with generalized disease or be confined to the genital area. The lesions are purple, flat-topped, and glossy papules. Erosive illness may manifest, perhaps resulting in scarring. Histologically, a band-like infiltrate of inflammatory cells comprising lymphocytes, histiocytes, and plasma cells is observed. The superficial epidermis exhibits basal cell injury and may be either thickened or atrophic. Lichen planus presents a marginally elevated risk for the emergence of vulval intraepithelial neoplasia (VIN) and squamous cell carcinoma.
Lichen sclerosus is an inflammatory dermatosis of indeterminate etiology, predominantly affecting the anogenital skin in women. Clinically, there are white papules and plaques with a wrinkled surface. There may be regions of atrophy and hemorrhage. Pruritus, burning sensations, and dyspareunia are prevalent symptoms. The epidermis exhibits histological thinning and interface alteration. A band of hyalinization is present beneath the epidermis, accompanied by a persistent inflammatory cell infiltrate. Lichen sclerosus is associated with a slight increase in the risk of developing vulvar intraepithelial neoplasia (VIN) and squamous cell carcinoma.
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Pathology - Scrotal disorders
Epidermoid cysts are a common source of scrotal cutaneous lumps, characterized by yellow keratinous debris and squamous epithelium with epidermoid-type keratinization.
Scrotal calcinosis is a rare condition that causes numerous calcified nodules on the scrotal skin. The dystrophic calcification is likely caused by ancient epidermoid cysts.
Angiokeratomas are benign vascular lesions that appear as several tiny blue/red lesions on the scrotal skin. Histologically, they are made up of dilated vascular channels in the papillary dermis, accompanied by hyperplasia and hyperkeratosis of the epidermis.
Fournier’s gangrene • Diabetes and immunosuppression are the main risk factors for this clinical variant of necrotizing fasciitis which affects the penis, scrotum, perineum, and abdominal wall of men. • It is a polymicrobial infection caused by a mix of aerobic and anaerobic bacteria. • Histology reveals a severe necrotizing inflammatory process involving the skin and deep subcutaneous tissue. • Mortality rates range from 15-20%.
Scrotal squamous cell cancer. • A uncommon cancer that has historically been linked to occupational exposure to toxins among chimney workers.
Epidermoid cysts are a common source of scrotal cutaneous lumps, characterized by yellow keratinous debris and squamous epithelium with epidermoid-type keratinization.
Scrotal calcinosis is a rare condition that causes numerous calcified nodules on the scrotal skin. The dystrophic calcification is likely caused by ancient epidermoid cysts.
Angiokeratomas are benign vascular lesions that appear as several tiny blue/red lesions on the scrotal skin. Histologically, they are made up of dilated vascular channels in the papillary dermis, accompanied by hyperplasia and hyperkeratosis of the epidermis.
Fournier’s gangrene • Diabetes and immunosuppression are the main risk factors for this clinical variant of necrotizing fasciitis which affects the penis, scrotum, perineum, and abdominal wall of men. • It is a polymicrobial infection caused by a mix of aerobic and anaerobic bacteria. • Histology reveals a severe necrotizing inflammatory process involving the skin and deep subcutaneous tissue. • Mortality rates range from 15-20%.
Scrotal squamous cell cancer. • A uncommon cancer that has historically been linked to occupational exposure to toxins among chimney workers.
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Pathology - Penile disorders
Lichen sclerosus • Penile lichen sclerosus (balanitis xerotica obliterans) is an inflammatory condition mostly affecting the foreskin or glans penis. • The majority of cases manifest in adulthood with phimosis. • Macroscopically, the impacted regions have a whitish and atrophic appearance. • Histologically, there is epidermal atrophy and hyperkeratosis accompanied by underlying bands of hyalinized collagen and a persistent inflammatory cell infiltrate.
Lichen planus • Penile involvement frequently occurs in patients with widespread lichen planus (see p. 288). • The lesions frequently affect the glans penis. • Histological examination reveals a band-like inflammatory infiltrate next to the epithelium. The infiltrate frequently comprises plasma cells, whereas cutaneous lesions are predominantly characterized by lymphocytes and macrophages.
Zoon's balanitis typically manifests as a singular erythematous lesion in uncircumcised older males. It clinically resembles penile Bowen's disease. Histological examination reveals epidermal thinning, spongiosis, lozenge-shaped keratinocytes, and a dense band-like inflammatory infiltrate abundant in plasma cells.
Condylomas are induced by an infection with the human papillomavirus (HPV), typically types 6 and 11. Predominantly observed in sexually active young males. • Macroscopically, condylomas manifest as either flat or frond-like papillary excrescences. • Histologically, they exhibit a papillomatous squamous proliferation characterized by koilocytes (keratinocytes exhibiting HPV-induced cytopathic alterations).
Peyronie's disease • Commonly referred to as penile fibromatosis, albeit likely not associated with other kinds of fibromatosis (see p. 318). • Individuals aged 40–60 have thickening of the corpus cavernosa, resulting in penile discomfort and curvature during erection. • Histological analysis of excised tissue reveals hypocellular collagenous scar tissue accompanied by clusters of chronic inflammatory cells.
Penile cancer • Uncommon neoplasm that typically develops on the glans penis of older males. Risk factors including HPV infection, tobacco use, phimosis, and chronic lichen sclerosus. Circumcision correlates with a decreased risk. Macroscopically, they present as exophytic lumps that may undergo ulceration. The majority are histologically classified as squamous cell carcinomas, originating from regions of squamous dysplasia, occasionally referred to as penile intraepithelial neoplasia.
Lichen sclerosus • Penile lichen sclerosus (balanitis xerotica obliterans) is an inflammatory condition mostly affecting the foreskin or glans penis. • The majority of cases manifest in adulthood with phimosis. • Macroscopically, the impacted regions have a whitish and atrophic appearance. • Histologically, there is epidermal atrophy and hyperkeratosis accompanied by underlying bands of hyalinized collagen and a persistent inflammatory cell infiltrate.
Lichen planus • Penile involvement frequently occurs in patients with widespread lichen planus (see p. 288). • The lesions frequently affect the glans penis. • Histological examination reveals a band-like inflammatory infiltrate next to the epithelium. The infiltrate frequently comprises plasma cells, whereas cutaneous lesions are predominantly characterized by lymphocytes and macrophages.
Zoon's balanitis typically manifests as a singular erythematous lesion in uncircumcised older males. It clinically resembles penile Bowen's disease. Histological examination reveals epidermal thinning, spongiosis, lozenge-shaped keratinocytes, and a dense band-like inflammatory infiltrate abundant in plasma cells.
Condylomas are induced by an infection with the human papillomavirus (HPV), typically types 6 and 11. Predominantly observed in sexually active young males. • Macroscopically, condylomas manifest as either flat or frond-like papillary excrescences. • Histologically, they exhibit a papillomatous squamous proliferation characterized by koilocytes (keratinocytes exhibiting HPV-induced cytopathic alterations).
Peyronie's disease • Commonly referred to as penile fibromatosis, albeit likely not associated with other kinds of fibromatosis (see p. 318). • Individuals aged 40–60 have thickening of the corpus cavernosa, resulting in penile discomfort and curvature during erection. • Histological analysis of excised tissue reveals hypocellular collagenous scar tissue accompanied by clusters of chronic inflammatory cells.
Penile cancer • Uncommon neoplasm that typically develops on the glans penis of older males. Risk factors including HPV infection, tobacco use, phimosis, and chronic lichen sclerosus. Circumcision correlates with a decreased risk. Macroscopically, they present as exophytic lumps that may undergo ulceration. The majority are histologically classified as squamous cell carcinomas, originating from regions of squamous dysplasia, occasionally referred to as penile intraepithelial neoplasia.
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Pathology - Urethral disorders
Urethritis • Typically induced by sexually transmitted infections. • Categorized as gonococcal and non-gonococcal urethritis. • Non-gonococcal urethritis is more prevalent, with the majority of cases attributed to C. trachomatis. Patients commonly report a sense of urethral pruritus. Gonococcal urethritis results from infection with Neisseria gonorrhoeae. Patients typically exhibit a more purulent exudate and dysuria. Gram staining of urethral discharge can identify N. gonorrhoeae as intracellular Gram-negative diplococci. If these organisms remain undetected, however a significant presence of neutrophils confirms urethritis, non-gonococcal urethritis is inferred. Detection of C. trachomatis is typically accomplished by molecular techniques, as culture is both slow and inaccurate.
Prostatic urethral polyp • Lesion of the prostatic urethra comprising prostatic epithelium. • Commonly manifests as haematuria. • Morphologically, they are papillary lesions protruding into the prostatic urethra. • Histologically, they consist of densely packed prostatic-type glands enveloped by urothelium.
Urethral caruncle • A rather prevalent polypoid lesion located in the distal urethra of women. • Exhibits dysuria and intermittent bleeding. • The caruncle appears as a polypoid mass at the urethral meatus. • Histological examination reveals a dense infiltrate of inflammatory cells abundant in blood vessels, covered by hyperplastic epithelium.
Urethral carcinomas • These neoplasms are infrequent, yet more prevalent in females. • Typically diagnosed at an advanced stage with a dismal prognosis. • The majority are squamous cell carcinomas (70%) originating in the distal urethra near the meatus. • The remaining cases consist of urothelial carcinomas (20%) or adenocarcinomas (10%), typically originating in the proximal urethra.
Malignant melanoma is uncommon, however thoroughly documented in the urethra. • They manifest as polypoid or ulcerated masses in the urethra. Histologically, they consist of aberrant epithelioid or spindle-shaped cells. Often amelanotic, which may result in diagnostic challenges. The immunohistochemical reactivity of malignant cells for melanocytic markers (S100, HMB-45, Melan-A) aids in confirming the diagnosis.
Urethritis • Typically induced by sexually transmitted infections. • Categorized as gonococcal and non-gonococcal urethritis. • Non-gonococcal urethritis is more prevalent, with the majority of cases attributed to C. trachomatis. Patients commonly report a sense of urethral pruritus. Gonococcal urethritis results from infection with Neisseria gonorrhoeae. Patients typically exhibit a more purulent exudate and dysuria. Gram staining of urethral discharge can identify N. gonorrhoeae as intracellular Gram-negative diplococci. If these organisms remain undetected, however a significant presence of neutrophils confirms urethritis, non-gonococcal urethritis is inferred. Detection of C. trachomatis is typically accomplished by molecular techniques, as culture is both slow and inaccurate.
Prostatic urethral polyp • Lesion of the prostatic urethra comprising prostatic epithelium. • Commonly manifests as haematuria. • Morphologically, they are papillary lesions protruding into the prostatic urethra. • Histologically, they consist of densely packed prostatic-type glands enveloped by urothelium.
Urethral caruncle • A rather prevalent polypoid lesion located in the distal urethra of women. • Exhibits dysuria and intermittent bleeding. • The caruncle appears as a polypoid mass at the urethral meatus. • Histological examination reveals a dense infiltrate of inflammatory cells abundant in blood vessels, covered by hyperplastic epithelium.
Urethral carcinomas • These neoplasms are infrequent, yet more prevalent in females. • Typically diagnosed at an advanced stage with a dismal prognosis. • The majority are squamous cell carcinomas (70%) originating in the distal urethra near the meatus. • The remaining cases consist of urothelial carcinomas (20%) or adenocarcinomas (10%), typically originating in the proximal urethra.
Malignant melanoma is uncommon, however thoroughly documented in the urethra. • They manifest as polypoid or ulcerated masses in the urethra. Histologically, they consist of aberrant epithelioid or spindle-shaped cells. Often amelanotic, which may result in diagnostic challenges. The immunohistochemical reactivity of malignant cells for melanocytic markers (S100, HMB-45, Melan-A) aids in confirming the diagnosis.
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Pathology - Vaginal neoplasms
Vaginal carcinoma • Rare relative to cervical and vulvar carcinomas. • Predominantly squamous cell carcinomas originating from a precursor dysplastic lesion termed vaginal intraepithelial neoplasia (VAIN).
• Risk factors encompass HPV infection, tobacco use, and immunosuppression. • Prognosis is typically unfavorable, with a 5-year survival rate of approximately 60%. Fibroepithelial stromal polyp • Benign lesion of the distal female genital system, primarily affecting the vagina, but may also occur in the vulva. • Hormonal-responsive lesions manifesting in women of reproductive age as tiny polypoid masses.
• Histologically, they consist of a central fibrovascular core enveloped by hyperplastic squamous epithelium. Stellate and multinucleate stromal cells are generally observed within the core next to the epithelial surface.
Genital rhabdomyoma • A benign tumor exhibiting skeletal muscle differentiation, predominantly found in the vagina. • Typically manifests in middle-aged women with symptoms associated with a mass lesion. • Histologically characterized by a disorganized proliferation of spindle cells featuring abundant, brightly eosinophilic cytoplasm with cross-striations.
Embryonal rhabdomyosarcoma is a malignant tumor exhibiting skeletal muscle differentiation, which may develop in the vagina of children. The majority of cases occur in children under 5 years of age, presenting with vaginal hemorrhage. A tumor may be observed protruding through the vaginal entrance. • Macroscopically, the tumor consists of edematous polypoid nodules protruding from the vaginal wall. • Histologically, the tumor comprises tiny round and spindle-shaped cells aggregated beneath the squamous epithelium of the vaginal wall. Certain tumor cells have prominently eosinophilic cytoplasm, with potential visibility of cytoplasmic cross-striations. The prognosis post-treatment is typically outstanding, with 10-year survival rates above 90%.
Vaginal carcinoma • Rare relative to cervical and vulvar carcinomas. • Predominantly squamous cell carcinomas originating from a precursor dysplastic lesion termed vaginal intraepithelial neoplasia (VAIN).
• Risk factors encompass HPV infection, tobacco use, and immunosuppression. • Prognosis is typically unfavorable, with a 5-year survival rate of approximately 60%. Fibroepithelial stromal polyp • Benign lesion of the distal female genital system, primarily affecting the vagina, but may also occur in the vulva. • Hormonal-responsive lesions manifesting in women of reproductive age as tiny polypoid masses.
• Histologically, they consist of a central fibrovascular core enveloped by hyperplastic squamous epithelium. Stellate and multinucleate stromal cells are generally observed within the core next to the epithelial surface.
Genital rhabdomyoma • A benign tumor exhibiting skeletal muscle differentiation, predominantly found in the vagina. • Typically manifests in middle-aged women with symptoms associated with a mass lesion. • Histologically characterized by a disorganized proliferation of spindle cells featuring abundant, brightly eosinophilic cytoplasm with cross-striations.
Embryonal rhabdomyosarcoma is a malignant tumor exhibiting skeletal muscle differentiation, which may develop in the vagina of children. The majority of cases occur in children under 5 years of age, presenting with vaginal hemorrhage. A tumor may be observed protruding through the vaginal entrance. • Macroscopically, the tumor consists of edematous polypoid nodules protruding from the vaginal wall. • Histologically, the tumor comprises tiny round and spindle-shaped cells aggregated beneath the squamous epithelium of the vaginal wall. Certain tumor cells have prominently eosinophilic cytoplasm, with potential visibility of cytoplasmic cross-striations. The prognosis post-treatment is typically outstanding, with 10-year survival rates above 90%.
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Pathology -Vaginal infections
Bacterial vaginosis is the most prevalent cause of abnormal vaginal discharge, resulting from the proliferation of anaerobic bacteria, including Gardnerella vaginalis and Bacteroides species. • The metabolic byproducts of these bacteria comprise volatile amines that provide a characteristic fishy odor to the discharge. • There is an absence of true inflammation in the vaginal wall, so the term vaginosis is utilized instead of vaginitis.
Vulvovaginal candidiasis, commonly referred to as 'thrush.'• A prevalent infection in young women caused by Candida albicans. The usual manifestation is vulvovaginal pruritus and burning, dyspareunia, and dysuria. A copious white discharge is prevalent. • Wet mount microscopy of the specimen reveals fungal pseudohyphae. The organism can additionally be cultivated in the microbiology laboratory. • Persistent Candida infections may indicate underlying diabetes mellitus or immunosuppression.
Trichomoniasis • A sexually transmitted infection caused by the flagellate protozoan, Trichomonas vaginalis. • The male partner is often asymptomatic, and around fifty percent of infected women are likewise asymptomatic. Women exhibiting symptoms typically report vaginal pruritus and a thin, frothy, malodorous discharge. Dyspareunia and dysuria may also manifest. • Wet mount microscopy of the discharge reveals motile trichomonads
Bacterial vaginosis is the most prevalent cause of abnormal vaginal discharge, resulting from the proliferation of anaerobic bacteria, including Gardnerella vaginalis and Bacteroides species. • The metabolic byproducts of these bacteria comprise volatile amines that provide a characteristic fishy odor to the discharge. • There is an absence of true inflammation in the vaginal wall, so the term vaginosis is utilized instead of vaginitis.
Vulvovaginal candidiasis, commonly referred to as 'thrush.'• A prevalent infection in young women caused by Candida albicans. The usual manifestation is vulvovaginal pruritus and burning, dyspareunia, and dysuria. A copious white discharge is prevalent. • Wet mount microscopy of the specimen reveals fungal pseudohyphae. The organism can additionally be cultivated in the microbiology laboratory. • Persistent Candida infections may indicate underlying diabetes mellitus or immunosuppression.
Trichomoniasis • A sexually transmitted infection caused by the flagellate protozoan, Trichomonas vaginalis. • The male partner is often asymptomatic, and around fifty percent of infected women are likewise asymptomatic. Women exhibiting symptoms typically report vaginal pruritus and a thin, frothy, malodorous discharge. Dyspareunia and dysuria may also manifest. • Wet mount microscopy of the discharge reveals motile trichomonads
