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Pathology - Functional ovarian cysts
Definition • Ovarian follicles exhibiting pathogenic cystic alterations. • A suggested threshold distinguishing normal cystic follicles from functional cysts is 2.5 cm.
Terminology: Cysts originating from pre-ovulatory follicles are termed follicular cysts, whereas those arising from the corpus luteum are referred to as corpus luteum cysts.
Epidemiology: Highly prevalent.
Aetiology • Follicular cysts are believed to indicate dysfunction of the pituitary-ovarian axis. Corpus luteum cysts arise from severe hemorrhage within a corpus luteum.
Presentation • Nearly all are identified incidentally, either through imaging or by a surgeon examining the pelvis. • Large cysts may intermittently manifest as a pelvic mass. Macroscopy: Follicular cysts are often solitary and range in size from 2.5 to 10 cm. The structures are characterized by smooth contours and contain a transparent fluid. Corpus luteum cysts typically range in size from 2.5 to 5 cm. The cyst contains sanguineous fluid, and the wall is frequently yellow
Cytopathology . : The aspirated fluid from a follicular cyst comprises many granulosa cells characterized by spherical nuclei, coarse chromatin, and a narrow rim of cytoplasm. Nuclear grooves may be observed. Certain cysts may also comprise luteinized cells. Aspirated fluid from a corpus luteum cyst comprises blood, haemosiderin-laden macrophages, and many completely luteinized granulosa cells. These are sizable polyhedral cells characterized by copious finely granular cytoplasm. The nuclei are round to elliptical, exhibiting finely granular chromatin and conspicuous nucleoli. Nuclear grooves are absent. Histopathology Follicular cysts are composed of granulosa and theca cells, which may exhibit luteinization. Corpus luteum cysts have significant central hemorrhage. The lining consists of entirely luteinized granulosa and theca cells.
Prognosis: Functional ovarian cysts are completely benign. They are mostly of clinical significance, as big cysts may raise suspicion for a cystic neoplasm.
Definition • Ovarian follicles exhibiting pathogenic cystic alterations. • A suggested threshold distinguishing normal cystic follicles from functional cysts is 2.5 cm.
Terminology: Cysts originating from pre-ovulatory follicles are termed follicular cysts, whereas those arising from the corpus luteum are referred to as corpus luteum cysts.
Epidemiology: Highly prevalent.
Aetiology • Follicular cysts are believed to indicate dysfunction of the pituitary-ovarian axis. Corpus luteum cysts arise from severe hemorrhage within a corpus luteum.
Presentation • Nearly all are identified incidentally, either through imaging or by a surgeon examining the pelvis. • Large cysts may intermittently manifest as a pelvic mass. Macroscopy: Follicular cysts are often solitary and range in size from 2.5 to 10 cm. The structures are characterized by smooth contours and contain a transparent fluid. Corpus luteum cysts typically range in size from 2.5 to 5 cm. The cyst contains sanguineous fluid, and the wall is frequently yellow
Cytopathology . : The aspirated fluid from a follicular cyst comprises many granulosa cells characterized by spherical nuclei, coarse chromatin, and a narrow rim of cytoplasm. Nuclear grooves may be observed. Certain cysts may also comprise luteinized cells. Aspirated fluid from a corpus luteum cyst comprises blood, haemosiderin-laden macrophages, and many completely luteinized granulosa cells. These are sizable polyhedral cells characterized by copious finely granular cytoplasm. The nuclei are round to elliptical, exhibiting finely granular chromatin and conspicuous nucleoli. Nuclear grooves are absent. Histopathology Follicular cysts are composed of granulosa and theca cells, which may exhibit luteinization. Corpus luteum cysts have significant central hemorrhage. The lining consists of entirely luteinized granulosa and theca cells.
Prognosis: Functional ovarian cysts are completely benign. They are mostly of clinical significance, as big cysts may raise suspicion for a cystic neoplasm.
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Pathology - Uterine leiomyomas
Definition
Synonym • Fibroids. • Benign neoplasms of smooth muscle originating in the myometrium.
Epidemiology • Highly prevalent tumors identified in up to 75% of all women. Approximately 20% of women are affected by symptomatic fibroids. Aetiology The exact etiology remains ambiguous; nevertheless, contributing factors encompass race and parity, with black and nulliparous women exhibiting a higher susceptibility.
Pathogenesis • Hormonal tumors that predominantly affect women of reproductive age, exhibit rapid growth during pregnancy, and undergo regression post-menopause. Genetic research indicates that they are clonal neoplasms characterized by chromosomal abnormalities.
Presentation: Menorrhagia. • Subfertility: this is likely attributable to endometrial deformation, hindering implantation. • Pelvic pain: this may be associated with tumor infarction or torsion of a pedunculated fibroid. • Palpable mass: fibroids may attain sufficient size to be discerned abdominally.
Macroscopy • Well-defined, white, whorled tumors that typically protrude from the adjacent myometrium upon incision. • Frequently numerous and may be intramural or extend from the serosal surface (subserosal) or into the uterine cavity (submucosal). • Calcification is prevalent. Infarcted tumors exhibit a red coloration instead of white, a phenomenon referred to as 'red degeneration.'
Histopathology Classical fibroids consist of interlacing fascicles of unremarkable smooth muscle cells characterized by blunt-ended nuclei and eosinophilic cytoplasm. Regions of hyalinization and calcification are prevalent. Numerous histological variants are well-documented, all exhibiting benign behavior. These encompass cellular leiomyoma, highly cellular leiomyoma, mitotically active leiomyoma, and atypical leiomyoma.
Prognosis: Benign tumors exhibit no potential for malignant behavior. Uterine leiomyosarcoma Uterine leiomyosarcoma is a malignant neoplasm of smooth muscle originating in the myometrium. While rare, it constitutes the most prevalent uterine sarcoma. The swift growth of a uterine tumor may raise concerns for leiomyosarcoma; nevertheless, many cases are not identified prior to surgery and are presumed to be big fibroids.
Macroscopically, leiomyosarcomas are inadequately defined and typically do not protrude from the adjacent myometrium due to their infiltrative characteristics. They are more pliable than fibroids and may exhibit signs of necrosis.
Histologically, leiomyosarcomas are neoplasms of smooth muscle that exhibit several abnormal characteristics, including widespread cytological atypia, necrosis of tumor cells, and elevated mitotic activity. Leiomyosarcomas are aggressive tumors characterized by a propensity for local recurrence and metastasis, especially to the liver and lungs.
Definition
Synonym • Fibroids. • Benign neoplasms of smooth muscle originating in the myometrium.
Epidemiology • Highly prevalent tumors identified in up to 75% of all women. Approximately 20% of women are affected by symptomatic fibroids. Aetiology The exact etiology remains ambiguous; nevertheless, contributing factors encompass race and parity, with black and nulliparous women exhibiting a higher susceptibility.
Pathogenesis • Hormonal tumors that predominantly affect women of reproductive age, exhibit rapid growth during pregnancy, and undergo regression post-menopause. Genetic research indicates that they are clonal neoplasms characterized by chromosomal abnormalities.
Presentation: Menorrhagia. • Subfertility: this is likely attributable to endometrial deformation, hindering implantation. • Pelvic pain: this may be associated with tumor infarction or torsion of a pedunculated fibroid. • Palpable mass: fibroids may attain sufficient size to be discerned abdominally.
Macroscopy • Well-defined, white, whorled tumors that typically protrude from the adjacent myometrium upon incision. • Frequently numerous and may be intramural or extend from the serosal surface (subserosal) or into the uterine cavity (submucosal). • Calcification is prevalent. Infarcted tumors exhibit a red coloration instead of white, a phenomenon referred to as 'red degeneration.'
Histopathology Classical fibroids consist of interlacing fascicles of unremarkable smooth muscle cells characterized by blunt-ended nuclei and eosinophilic cytoplasm. Regions of hyalinization and calcification are prevalent. Numerous histological variants are well-documented, all exhibiting benign behavior. These encompass cellular leiomyoma, highly cellular leiomyoma, mitotically active leiomyoma, and atypical leiomyoma.
Prognosis: Benign tumors exhibit no potential for malignant behavior. Uterine leiomyosarcoma Uterine leiomyosarcoma is a malignant neoplasm of smooth muscle originating in the myometrium. While rare, it constitutes the most prevalent uterine sarcoma. The swift growth of a uterine tumor may raise concerns for leiomyosarcoma; nevertheless, many cases are not identified prior to surgery and are presumed to be big fibroids.
Macroscopically, leiomyosarcomas are inadequately defined and typically do not protrude from the adjacent myometrium due to their infiltrative characteristics. They are more pliable than fibroids and may exhibit signs of necrosis.
Histologically, leiomyosarcomas are neoplasms of smooth muscle that exhibit several abnormal characteristics, including widespread cytological atypia, necrosis of tumor cells, and elevated mitotic activity. Leiomyosarcomas are aggressive tumors characterized by a propensity for local recurrence and metastasis, especially to the liver and lungs.
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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 - Fibrocystic change
Definition: A series of modifications in the breast that represent natural, but amplified, reactions to hormonal influences.
Epidemiology • Highly prevalent. • Present in over one-third of premenopausal adult females. Aetiology • A condition driven by hormonal factors in response to estrogens.
Pathogenesis • The mechanism remains rather ambiguous; nevertheless, some researchers hypothesize that the initial event involves apocrine metaplasia of the breast ducts. • The secretions generated by these cells result in ductal dilatation and cyst development.
Presentation • The primary characteristic is breast nodularity and lumpiness. • Cyclical discomfort may also be present.
Macroscopy • The breast tissue exhibits a firm, rubbery consistency. • Cysts are typically discernible, presenting a brown or bluish coloration.
Cytopathology • Aspirates from cysts reveal debris, foamy macrophages, and apocrine cells. • Aspirates from non-cystic regions consist of cohesive fragments of bland ductal epithelial cells with numerous background naked bipolar nuclei.
Histopathology • Characterized by several histological alterations, including cystic transformation, apocrine metaplasia, adenosis, moderate epithelial hyperplasia, and stromal hyperplasia.
Prognosis: Benign with no elevated risk for later invasive breast carcinoma.
Definition: A series of modifications in the breast that represent natural, but amplified, reactions to hormonal influences.
Epidemiology • Highly prevalent. • Present in over one-third of premenopausal adult females. Aetiology • A condition driven by hormonal factors in response to estrogens.
Pathogenesis • The mechanism remains rather ambiguous; nevertheless, some researchers hypothesize that the initial event involves apocrine metaplasia of the breast ducts. • The secretions generated by these cells result in ductal dilatation and cyst development.
Presentation • The primary characteristic is breast nodularity and lumpiness. • Cyclical discomfort may also be present.
Macroscopy • The breast tissue exhibits a firm, rubbery consistency. • Cysts are typically discernible, presenting a brown or bluish coloration.
Cytopathology • Aspirates from cysts reveal debris, foamy macrophages, and apocrine cells. • Aspirates from non-cystic regions consist of cohesive fragments of bland ductal epithelial cells with numerous background naked bipolar nuclei.
Histopathology • Characterized by several histological alterations, including cystic transformation, apocrine metaplasia, adenosis, moderate epithelial hyperplasia, and stromal hyperplasia.
Prognosis: Benign with no elevated risk for later invasive breast carcinoma.
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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 - Fibroadenoma
Definition • A benign fibroepithelial tumor of the breast.
Epidemiology: Prevalent. • Predominantly affects young women aged 20 to 30 years.
Aetiology • The majority of experts consider them to be neoplastic proliferations of fibroblasts inside the specialized connective tissue of the intralobular stroma.
Pathogenesis • The proliferating neoplastic fibroblasts inside the intralobular stroma entrap and compress terminal duct lobular units and interlobular stroma, resulting in the formation of a well-defined nodular mass.
Macroscopy • Well-defined, movable breast masses often measuring 3 cm or less. • The cut surface is generally solid, whorled, and grey-white in hue.
Cytopathology • Aspirates exhibit cellularity, featuring numerous branching sheets of cohesive, bland ductal epithelial cells alongside a substantial presence of naked bipolar nuclei in the background. • Fragments of stromal material may also be observed.
Histopathology • Histological examination reveals a well-circumscribed multinodular tumor distinct from the adjacent breast tissue. Each nodule comprises an enlarged myxoid intralobular stromal compartment populated by inconspicuous spindled fibroblastic cells. The terminal duct lobular unit is constricted into narrow channels. • Narrow strands of interlobular stroma exist between each nodule of the fibroadenoma. • Mature lesions frequently exhibit fibrosis and calcification.
Prognosis: • Benign lesions exhibiting no potential for malignant behavior. Surgical excision through straightforward 'shelling out' is nearly invariably curative with minimal likelihood of recurrence.
Phyllodes tumors
Phyllodes tumors are a category of potentially aggressive fibroepithelial neoplasms. These are rare tumors that often manifest as a progressively enlarging breast lump in women over 50 years of age. Some are believed to originate from pre-existing fibroadenomas. Macroscopically, the tumors typically present as big, fleshy, lobulated masses exhibiting regions of cystic alteration. Histologically, these are fibroepithelial tumors characterized by the excessive proliferation of neoplastic stromal cells, resulting in a disordered and heterogeneous morphology of the epithelial component. The stroma exhibits variability in cellularity and the composition of the extracellular matrix. Substantial stromal nodules extending into cystic cavities generate distinctive 'leaf-like' projections. All phyllodes tumors possess the potential for local recurrence and are typically managed with extensive local resection. In actuality, the majority do not reappear, even after uncomplicated enucleation. Phyllodes tumors may acquire the ability to spread, however this occurrence is exceedingly rare.
Definition • A benign fibroepithelial tumor of the breast.
Epidemiology: Prevalent. • Predominantly affects young women aged 20 to 30 years.
Aetiology • The majority of experts consider them to be neoplastic proliferations of fibroblasts inside the specialized connective tissue of the intralobular stroma.
Pathogenesis • The proliferating neoplastic fibroblasts inside the intralobular stroma entrap and compress terminal duct lobular units and interlobular stroma, resulting in the formation of a well-defined nodular mass.
Macroscopy • Well-defined, movable breast masses often measuring 3 cm or less. • The cut surface is generally solid, whorled, and grey-white in hue.
Cytopathology • Aspirates exhibit cellularity, featuring numerous branching sheets of cohesive, bland ductal epithelial cells alongside a substantial presence of naked bipolar nuclei in the background. • Fragments of stromal material may also be observed.
Histopathology • Histological examination reveals a well-circumscribed multinodular tumor distinct from the adjacent breast tissue. Each nodule comprises an enlarged myxoid intralobular stromal compartment populated by inconspicuous spindled fibroblastic cells. The terminal duct lobular unit is constricted into narrow channels. • Narrow strands of interlobular stroma exist between each nodule of the fibroadenoma. • Mature lesions frequently exhibit fibrosis and calcification.
Prognosis: • Benign lesions exhibiting no potential for malignant behavior. Surgical excision through straightforward 'shelling out' is nearly invariably curative with minimal likelihood of recurrence.
Phyllodes tumors
Phyllodes tumors are a category of potentially aggressive fibroepithelial neoplasms. These are rare tumors that often manifest as a progressively enlarging breast lump in women over 50 years of age. Some are believed to originate from pre-existing fibroadenomas. Macroscopically, the tumors typically present as big, fleshy, lobulated masses exhibiting regions of cystic alteration. Histologically, these are fibroepithelial tumors characterized by the excessive proliferation of neoplastic stromal cells, resulting in a disordered and heterogeneous morphology of the epithelial component. The stroma exhibits variability in cellularity and the composition of the extracellular matrix. Substantial stromal nodules extending into cystic cavities generate distinctive 'leaf-like' projections. All phyllodes tumors possess the potential for local recurrence and are typically managed with extensive local resection. In actuality, the majority do not reappear, even after uncomplicated enucleation. Phyllodes tumors may acquire the ability to spread, however this occurrence is exceedingly rare.
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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 -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 - 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.
