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Cervical Squamous Intraepithelial Lesions

Introduction Human papillomavirus (HPV) infection is now understood to be the underlying cause of squamous carcinogenesis in the cervix. Older diagnostic classifications of preinvasive disease based purely on descriptive correlation of histology with clinical behavior included dysplasia/carcinoma in situ (CIS; a four-grade system) and cervical intraepithelial neoplasia (CIN; a three-grade system). Each provided a convenient diagnostic spectrum against which patient samples could be matched, and both…

Biology of Cervical Squamous Neoplasia

Introduction In the past half-century, cytologic screening, particularly in high-resource settings, has dramatically decreased the burden of squamous cervical cancers, virtually all of which are caused by tissue-specific, persistent infection with human papillomavirus (HPV). The elucidation of the infectious etiology of this disease led to a Nobel Prize in 2008, and to development of preventative vaccines that became commercially available in 2006. This was a public…

Cervical Benign and Non-Neoplastic Conditions

Normal Structure Anatomy The cervix is the lower part of the uterus. A fibromuscular junction, usually referred to as the internal cervical os, marks the junction between the muscular corpus and the predominantly fibrous cervix. The cervix projects into the vagina at the vaginal vault and has supravaginal and vaginal portions of approximately equal lengths. The folds of mucosa between vagina and cervix are known as…

Vagina

The vagina acts as a barrier to many potentially invasive microorganisms. Accordingly, it is the site of a variety of infections, both sexually and nonsexually transmitted, and this, in fact, represents the predominant type of pathology of this organ. In contrast, neoplasms are relatively infrequent in this site, which is somewhat unexpected in view of the relationship between infection (e.g., human papillomavirus (HPV) infection) and the…

Vulvar Mesenchymal Neoplasms and Tumor-Like Conditions

Tumor-Like Conditions Fibroepithelial–StromAl Polyp (Pseudosarcoma Botryoides) Definition A benign polypoid growth that arises from the distinctive subepithelial stroma of the distal female genital tract. Clinical Features Fibroepithelial–stromal polyps, which are hormonally sensitive, most commonly occur in the vulvovaginal region of reproductive age women, often during pregnancy. They may, however, also occur in postmenopausal women on hormonal replacement therapy. Often, the polyps are incidental findings discovered during…

Vulvar Cysts, Adenocarcinoma, Melanocytic, and Miscellaneous Lesions

Cysts Follicular (‘Epidermoid’) Cyst Definition Follicular cyst is a cystic dilatation of the hair follicle epithelium. Clinical Features Follicular cyst presents as a solitary, creamy-white or yellowish lesion on the labium majus ( Figure 5.1 ). It is generally asymptomatic, but rupture may induce inflammation with enlargement, tenderness, erythema, and induration. Follicular cysts usually occur spontaneously and after age 30. Onset at an early age or…

Vulvar Squamous Lesions

Benign Squamous Neoplasms Condyloma Acuminatum Definition Condyloma acuminatum is a benign exophytic lesion caused by infection with low-risk human papillomavirus (HPV) subtypes, principally types 6 and 11. Clinical Features Condylomata are asymptomatic, usually multiple and often multifocal, presenting as papillary growths varying in size from barely visible on gross examination to several centimeters. Microscopic Features On histologic examination, the lesion consists of complex branching fibrovascular cores…

Vulvar Dermatoses and Infections

Introduction The most common diseases affecting the vulva are dermatologic, but the clinicians caring for patients with these complaints are usually gynecologists or family practitioners who may lack sophisticated diagnostic and therapeutic skills in skin diseases. Conversely, dermatologists may have interest and expertise in a subset of diseases in this organ. In summary, no single specialist is generally well trained to care for the full spectrum…

Disorders of Sexual Development

Chapter Outline Disorders of Genital Differentiation (Disorders Generally Associated with a Normal Chromosome Constitution and Normal Gonad) 18 Female Pseudohermaphroditism (Female Intersex) 18 Male Pseudohermaphroditism (Male Intersex) 22 Disorders of Sex Determination (Disorders Associated with Abnormal Sex Chromosomes and Abnormal Gonadal Formation) 30 Sexual Ambiguity Infrequent 31 Sexual Ambiguity Frequent 36 New insights into the biology of sexual development (see Chapter 1 ) and advances in…

Embryology

Introduction Understanding normal development of the embryonic genital tract gives insight into many disorders encountered in the female. These can range from relatively simple arrests of development or malformation (described by organ) to more complex abnormalities of sexual development that result from dysembryogenesis (see Chapter 2 ), and, in some cases, to help understand the origin of some tumors, particularly sex cord–stromal and germ cell tumors…

Hematolymphoid tumors of the oral cavity

Non-Hodgkin lymphoma (NHL) is the second most common malignancy to arise in the oral cavity after squamous cell carcinoma, yet only accounts for 3.5% of all oral cavity malignancies. Among all lymphomas, oral cavity NHLs are rare, representing approximately 2% of all extranodal lymphomas. Most patients are older although immunosuppressed patients may be of a younger age. Patients often have presenting symptoms clinically of a discrete…

Nonodontogenic intraosseous tumors and inflammatory/reactive conditions

As with odontogenic cysts and tumors, any nonodontogenic tumor may cause jaw and facial swelling, pain, mobility of teeth, resorption of teeth roots, teeth displacement, and paresthesia. The symptoms and signs depend on the size of lesions, how long the lesions have been present, how rapidly they are growing, whether they are benign or malignant, and the involvement of nerves, especially the inferior alveolar nerve that…

Nonodontogenic cysts, cyst-like lesions, and myospherulosis

True cysts Nasopalatine duct (incisive canal) cyst This is the most common nonodontogenic cyst of the jawbones. Clinical and radiographic findings This is most frequently encountered in the fourth and fifth decades of life with a slight male predilection, and it presents as a painless swelling of the anterior palate immediately posterior to the central incisors; teeth are vital but may have been endodontically treated on…

Odontogenic tumors

Odontogenic tumors are classified as follows: (1) epithelial tumors with mature fibrous stroma without ectomesenchyme, (2) mixed epithelial and mesenchymal tumors, and (3) mesenchymal tumors with or without scarce epithelium (usually in the form of rests) ( Fig. 15.1 ). Epithelial tumors putatively result from activation of odontogenic rests and mesenchymal tumors from precursor multipotent mesenchymal cells that recapitulate formation of the dental papilla, dental follicle,…

Odontogenic cysts

The tooth develops from the dental lamina, an ingrowth of the lining of the primitive stomodeum, and the dental lamina develops tooth buds for the primary and the permanent dentition ( Fig. 14.1 ). After odontogenesis, remnant epithelium is left behind as rests and these are present within the gingiva and alveolar mucosa, the periodontal ligament around the teeth and in the jaw bones. The epithelium…

Salivary gland neoplasms

This chapter discusses salivary gland tumors that occur with high frequency in the oral cavity with the understanding that even salivary gland tumors that tend to occur mostly in the major glands may also occur in the minor glands. Intraoral minor salivary gland neoplasms account for approximately 1% of non–hospital-based biopsy services, with 60% of these being benign. The basic unit of minor and major salivary…

Inflammatory salivary gland disorders

Mucocele The term mucocele sometimes is used to include both extravasation and retention mucoceles. Only the extravasation type should be termed mucocele while the retention type is a salivary duct cyst. They have different sites of occurrence, etiopathogenesis, and histopathology. Clinical findings Mucoceles are most common in the first three decades of life; they manifest as dome-shaped, faintly bluish, sessile nodules most commonly located on the…

Leukoplakia, erythroplakia, oral dysplasia, and squamous cell carcinoma

Oral epithelial dysplasia is one of the most challenging entities for a pathologist. This chapter provides histopathologic features for the diagnosis of oral epithelial dysplasia, including HPV-associated oral dysplasia and guidance on how to distinguish dysplastic lesions from lesions exhibiting reactive atypia. It provides histopathologic features on the variants of oral carcinoma including carcinoma in children. Leukoplakia, erythroplakia, and dysplasia Leukoplakia and its clinical variants are…