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Neoplastic Lesions of the Cervix

Squamous Columnar Junction and the Transformation Zone The squamous columnar junction (SCJ) is defined as the border between stratified squamous epithelium of the exocervix and glandular epithelium of the endocervix. The SCJ is constantly subjected to hormonal influences, and as a consequence, its anatomic location varies with age. At birth, the portio of most female neonates is lined by endocervical epithelium because of intrauterine exposure to…

Nonneoplastic Lesions of the Cervix

The uterine cervix is divided into ectocervix, endocervix, and transformation zone. The ectocervix is lined by mature glycogenated squamous epithelium comprised of basal and parabasal cells, which progressively mature as they move towards the mid and superficial layers. Maturation is characterized by an ascending increase in cytoplasmic volume, usually associated with intracellular glycogen, which appears as a clear perinuclear space imparting a “basket weave” appearance to…

Neoplastic Lesions of the Vagina

Primary neoplasms of the vagina, whether benign or malignant, are rare. Primary carcinomas are the most common malignant tumors and account for approximately 2% of all gynecologic malignancies. Among vaginal carcinomas, in situ and invasive squamous carcinomas are most frequent. As a general rule, when evaluating a malignant tumor involving the vagina, it is essential to exclude a metastatic origin. This chapter covers the most frequent…

Nonneoplastic Diseases of the Vagina

Congenital Anomalies Anatomic anomalies of the female reproductive tract occur in 7% of females. They can be secondary to defects in fusion of the Müllerian ducts or abnormal development of the urogenital sinus or cloaca in which the vagina is involved. These abnormalities can be divided in two categories: obstructive and nonobstructive. The obstructive anomalies of the Müllerian tract involving the vagina, which are typically diagnosed…

Mesenchymal Lesions of the Vulva and Vagina

Introduction Mesenchymal lesions that occur in the vulva and vagina can be separated into two general categories: (1) those that are relatively site-specific, i.e., they may occasionally occur at extragenital sites; and (2) those that occur more commonly at other sites but which may also involve this region. The former group is described in detail in this chapter. Most entities in the latter group have the…

Extramammary Paget Disease and Vulvar Melanocytic Lesions

Extramammary Paget Disease Extramammary Paget disease (EMPD) is defined as an intraepithelial adenocarcinoma that primarily involves the epidermis outside the breast. Clinical Features This lesion accounts for only 1% of vulvar cancers. EMPD typically occurs in postmenopausal white women and appears as an eczematous-type plaque, sometimes with excoriation ( Fig. 3.1A ), which can be clinically misdiagnosed as fungal infection or atrophic vaginitis; thus not infrequently…

Squamous Neoplasms of the Vulva

Preinvasive Vulvar Squamous Neoplasia In 1986 the International Society for the Study of Vulvar Disease (ISSVD) endorsed the term “vulvar intraepithelial neoplasia” (VIN) to describe in situ dysplastic conditions of the vulvar epithelium, to replace the myriad of other diagnostic terms for vulvar epithelial dysplasia, and to create a reporting framework. The ISSVD further divided VIN into two distinct types with distinct pathogenesis, morphology and risk…

Inflammatory Diseases of the Vulva

Introduction Almost any inflammatory dermatological condition occurring on nongenital skin can afflict the vulva. Histopathologic diagnosis in the vulva, however, is often complicated by its unique anatomy (where there is increased occlusion, friction, and moisture, causing a variety of secondary changes), delayed seeking of medical attention due to patient embarrassment, and the use of self-treatment regimens which may not be readily divulged to the treating clinician.…

Fetal to Maternal Hemorrhage

D efinition — Bleeding under low pressure into the placental parenchyma of fetal origin. Clinical Features Epidemiology Cause is unknown. Rarely severe, with massive fetal to maternal hemorrhage. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Distal Villous Pathology

D efinition — Abnormalities in distal villous maturation that occur late in pregnancy and are emblematic of underperfusion, including increased syncytial knots, distal villous hypoplasia (DVH), aggregated terminal villi, and chorangiosis. Clinical Features Epidemiology Seen as abnormal development of the distal villous tree as a consequence of multiple factors, including diabetes, smoking, anemia, pregnancy at high altitudes, and a number of genetic and epigenetic factors. Distal…

Meconium Staining

D efinition — Discoloration of the placenta and membranes due to staining with meconium. Clinical Features Epidemiology Meconium release is a relatively common event in term deliveries. Much debate exists about the pathologic nature of meconium and whether it represents a normal occurrence or is always pathologic. Meconium release is strongly associated with fetal stress near the time of delivery. You’re Reading a Preview Become a…

Placental Infarction

D efinition — Infarction of the fetal villi due to lack of intervillous perfusion. Clinical Features Epidemiology Localized infarction within term placentas is very common. Abnormal infarction occurs in the setting of the intervillous hemorrhage of abruption, thrombosis, or vasoconstriction of the maternal spiral arteries. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are…

Toxemia

D efinition — A hypertensive disorder that arises during pregnancy; there are five types. Clinical Features Epidemiology Hypertensive disorders that fall under the umbrella of “toxemia of pregnancy” are common occurrences. Their presentations are varied and described in the following section. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in…

Toxoplasmosis

D efinition — A parasitic infection often contracted by handling cat litter, which can result in significant fetal morbidity if primary maternal infection occurs in the first trimester. Clinical Features Epidemiology Affects approximately 3500 newborns each year in the United States. Primary maternal infection results in fetal transmission in 25% of cases. Particularly common in France. You’re Reading a Preview Become a Clinical Tree membership for…

Placenta Previa

D efinition — Placental implantation within the lower uterine segment, overlying the cervical os. Clinical Features Epidemiology Placenta previa is a common finding in early pregnancy. The majority of cases spontaneously resolve during gestation. Less than 1% of cases persist until delivery. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log…

Placenta Creta

D efinition — Abnormal adherence of the placenta to the uterine wall. Clinical Features Epidemiology Placenta creta occurs in 1 in 2500 pregnancies. Historically all subtypes of placenta cretas were rare. More than 80% of cases occur in patients with a prior cesarean section (C-section), and the rise in incidence is presumed to be due to the increased rate of C-section. Other risk factors include fibroids,…

Fetal Leukemia

D efinition — A primary white blood cell malignancy arising in the fetus. Clinical Features Epidemiology Fetal leukemia is exceedingly rare and has an incidence of approximately four to five per million live births. Fetal leukemia is the leading cause of neoplastic death in the neonate. All, or nearly all, infant leukemias are thought to originate in utero. You’re Reading a Preview Become a Clinical Tree…

Congenital Parvovirus Infection

D efinition — Fetal infection by the single-stranded DNA parvovirus B-19. Clinical Features Epidemiology Parvovirus infection is a common occurrence in adult life. Congenital parvovirus occurs when a woman who has not been exposed to parvovirus contracts the infection for the first time during her pregnancy. In this group of patients around 30% vertically transmit the infection to the fetus. Less than 5% of infected fetuses…

Hypertensive Bleeding (Ball-in-Socket) Infarct

D efinition — A localized form of abruption due to acute spiral arterial bleed into the basal parenchyma associated with maternal hypertension. Clinical Features Epidemiology Most commonly associated with maternal hypertension and preeclampsia. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here