D efinition — A stratified mucin-producing intraepithelial lesion with prominent columnar cell differentiation (also called stratified adenocarcinoma in situ [AIS]). Clinical Features Epidemiology Young women, most ranging in age from 20 to 40 years. High-risk human papillomavirus (HPV) associated. 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

D efinition — Precursor lesion to invasive endocervical adenocarcinoma. Clinical Features Epidemiology Average age at diagnosis is 38 years. Human papillomavirus (HPV) related (>90%), especially types 16 and 18 in roughly equal proportion. About half of cases have a concurrent squamous intraepithelial lesion (SIL). Positive association with oral contraceptive use, although a potential mechanism is unclear. You’re Reading a Preview Become a Clinical Tree membership for…

D efinition — A subtle pattern of endocervical adenocarcinoma in situ (AIS) which is frequently mistaken for reactive epithelial change. Clinical Features Epidemiology Young women; mean age at diagnosis is early 20s. Human papillomavirus (HPV) associated. 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

D efinition — A poorly differentiated nonkeratinizing squamous carcinoma with prominent lymphocytic infiltrates. Clinical Features Epidemiology A malignant cervical neoplasm. Most prevalent in the fourth to sixth decades of life. Human papillomavirus (HPV) testing of a few cases has been negative; thus its relationship to HPV is unclear. Unrelated to Epstein-Barr virus infection. You’re Reading a Preview Become a Clinical Tree membership for Full access and…

D efinition —A specific pattern of invasive carcinoma that either mimics crypt involvement or combines crypt involvement with invasion, thus mimicking noninvasive carcinoma. Clinical Features Epidemiology The same as conventional invasive squamous carcinoma. 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

D efinition —A malignant neoplasm of the cervix comprised of squamous epithelial cells. Variants include large-cell keratinizing, large-cell nonkeratinizing, and small-cell nonkeratinizing squamous cell carcinoma (SCC), as well as papillary SCC. Clinical Features Epidemiology Associated with high-risk human papillomavirus (HPV) infection and preexisting cervical intraepithelial neoplasia. The progression rate from a high-grade squamous intraepithelial lesion to invasive squamous cell carcinoma in a patient undergoing close follow-up…

D efinition —Early invasive squamous cell carcinoma (SCC) measuring no more than 3 mm in depth in the biopsy or conization specimen. Clinical Features Epidemiology Associated with high-risk human papillomavirus (HPV) infection and preexisting cervical intraepithelial neoplasia. Will be found in approximately 1 : 200 cone biopsies of high-grade squamous intraepithelial lesion (HSIL). Can be found at any age; median age around 35 to 40 years. You’re Reading a…

D efinition —A squamous intraepithelial lesion not amenable to precise grading (QSIL) that demonstrates features seen in both low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL). Clinical Features Epidemiology Typically encountered in reproductive-age women with atypical squamous cells of undetermined significance (ASCUS) or squamous intraepithelial lesion (SIL) on cervical cytology. You’re Reading a Preview Become a Clinical Tree membership for Full access and…

D efinition —Immature metaplastic or reserve cell proliferations with mild atypia and strong p16 immunostaining. Clinical Features Epidemiology Reproductive-age women. Inconsistent human papillomavirus (HPV) association. Typically present with atypical squamous cells of undetermined significance (ASCUS) cervical smear. 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

D efinition —Any one of the spectrum of alterations within the cervical epithelium of postmenopausal women, including squamous intraepithelial lesions (SILs). Clinical Features Epidemiology Occurs predominantly in postmenopausal women. Also can be seen in any low-estrogen state (postpartum, breast-feeding). 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

D efinition —The presence of two different human papillomavirus (HPV)–type specific lesions in the same specimen. Clinical Features Epidemiology Reproductive-age, sexually active women, in the vulva or anal region may be associated with immunosuppression but not specific for this condition. 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

D efinition —Immature condyloma represents an infection of the immature metaplastic cervical transformation zone epithelium by human papillomavirus (HPV) type 6 or 11. Also variably called squamous papilloma or papillary immature metaplasia; the most appropriate term is low-grade squamous intraepithelial lesion (LSIL) (immature condyloma). Clinical Features Epidemiology Reproductive-age, sexually active women. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited…

PITFALL D efinition —A variant of condyloma that presents as a grossly enlarged mass and appears to replace or cover the cervix and/or distal vagina. Clinical Features Epidemiology Sexually active, reproductive-age women. Uncommon. 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

D efinition and T erminology A precancerous lesion arising at the cervical squamocolumnar (SC) junction that displays near full-thickness atypia and variable maturation of the neoplastic epithelium. Should be associated always with high-risk human papillomaviruses (HPVs) and with HPV16 in 40% to 60% of cases depending on the cytologic presentation. Clinical Features Epidemiology Reproductive-age, sexually active women. You’re Reading a Preview Become a Clinical Tree membership…

D efinition —An infection of the mature ectocervical and/or metaplastic cervical transformation zone epithelium by human papillomavirus (HPV). Clinical Features Epidemiology Most commonly seen in sexually active, reproductive-age women. Can be diagnosed in any age group. Flat low-grade squamous intraepithelial lesions (LSILs) can be caused by either low- or high-risk HPV subtypes. Approximately one-half of ectocervical/metaplastic (squamocolumnar [SC] junction–negative) lesions contain high-risk HPVs in contrast to…

D efinition and T erminology An exophytic cervical condyloma represents an infection of the mature ectocervical or metaplastic cervical transformation zone epithelium by human papillomavirus (HPV) type 6 or 11 (low–cancer-risk subtypes). The most appropriate term is low-grade squamous intraepithelial lesion (LSIL). Clinical Features Epidemiology Reproductive-age, sexually active women. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become…

D efinition —A malignancy of skeletal muscle presenting as a polypoid vaginal mass in young girls. Clinical Features Epidemiology Uncommon. Usually seen in females under the age of 5 years. 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

PITFALL D efinition —A benign vaginal tumor composed of keratin-positive stromal cells. Clinical Features Epidemiology Uncommon. Seen in a wide age range (20 to 80 years), with a mean age of 40 years. 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

PITFALL D efinition —A very aggressive malignant tumor of dermal melanocytes arising in the vagina. Clinical Features Epidemiology Uncommon but not rare. Typically seen in postmenopausal women. May be more common in patients with a BRCA2 mutation. 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

D efinition —Epithelial malignancies that metastasize to the vagina. Clinical Features Epidemiology Patients with a primary carcinoma of another site. The vast majority are of endometrial origin. Over 90% of adenocarcinomas identified in the vagina are metastatic. 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