D efinition —An uncommon primary adenocarcinoma of the vagina, associated with in utero exposure to synthetic estrogen. Clinical Features Epidemiology Rare, except in women who were exposed to diethylstilbestrol (DES) in utero. The risk in DES-exposed women is estimated to be between 1 : 1000 and 1 : 5000 individuals. The peak age at diagnosis for DES-exposed women is 20, and it is rarely seen in women over 40. In…

D efinition —A malignant neoplasm of the vagina comprised of squamous epithelial cells with prominent papillary architecture. Clinical Features Epidemiology Associated with high-risk human papillomavirus (HPV) infection and may follow preexisting cervical intraepithelial or invasive neoplasia. Usually older women, in the sixth to ninth decades. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are…

D efinition —Iatrogenically induced atrophic changes seen in the vaginal mucosa following radiation therapy. Clinical Features Epidemiology Common occurrence following radiation therapy. 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 —Human papillomavirus (HPV)–related proliferation of the vaginal mucosa that leads to extensive, full-thickness loss of maturation of the vaginal epithelium. Clinical Features Epidemiology Patients present at a slightly older age than those with cervical dysplasia, with the majority presenting around 55 to 57 years of age for high-grade dysplasia. The advanced age is thought to lead to an increased incidence of invasive disease in…

D efinition —Human papillomavirus (HPV)–related proliferation of the vaginal mucosa that leads to extensive, full-thickness loss of maturation of the vaginal epithelium. Clinical Features Epidemiology Patients present at a slightly older age than those with cervical dysplasia, with the majority presenting around 55 to 57 years of age for high-grade VAIN. The advanced age is thought to lead to an increased incidence of invasive disease in…

D efinition —Human papillomavirus (HPV)–related proliferation of the vaginal mucosa. Clinical Features Epidemiology Patients present at a slightly older age than those with cervical dysplasia, with the majority presenting around 40 years of age. Sixty-five percent of patients with vaginal intraepithelial lesion (VAIL) have concurrent or prior cervical dysplasia. HPV is responsible for the majority of lesions, and predisposing factors include previous cervical intraepithelial neoplasia (CIN),…

PITFALL D efinition —Villiform remnants of hymenal ring. Clinical Features Epidemiology Typically seen in young women of reproductive age. No symptoms. Not related to human papillomavirus (HPV). 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 mass-forming, proliferative focus of misplaced endometrial glands and stroma within the vagina. Clinical Features Epidemiology Uncommon; vaginal endometriosis accounts for less than 10% of all endometriosis, with the most common form being traditional endometriosis composed of glands and stroma (as opposed to the mass-forming “polypoid” variety). You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become…

D efinition —Congenital glandular differentiation present within the vaginal mucosa. Clinical Features Epidemiology Prior to the use of diethylstilbestrol (DES) and in patients not exposed to DES the incidence of vaginal adenosis was rare. In patients who were exposed to DES the incidence of adenosis approaches one third. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…

D efinition —A fibrovascular response to injury comprised of small vascular structures, loose stroma, and admixed inflammation. Clinical Features Epidemiology Affects all age groups; vaginal granulation tissue is commonly seen after surgery in the vaginal cuff. 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 —Protrusion of the fallopian tube into the vagina. Clinical Features Epidemiology Occasionally affects women after simple hysterectomy. 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 —Infiltration of the perianal squamous epithelium by mucin-producing neoplastic cells associated with an anorectal neoplasm. Also called type 2 Paget's disease. Clinical Features Epidemiology Uncommon; represents only 1% to 2% of vulvar malignancies. The average age at presentation is 65 years; the majority of patients are over 60 years. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited…

D efinition —Malignant tumors arising from the epithelium of the anal canal. Clinical Features Epidemiology Rare; incidence is estimated at 7 per million women and 9 per million men. Incidence is increasing at a rate of approximately 2% a year. Squamous cell carcinomas (SCC) account for 80% of cases; risk factors include human papillomavirus (HPV), human immunodeficiency virus (HIV), anal intercourse, and number of sexual partners.…

D efinition —A high-grade, human papillomavirus (HPV)–associated, in situ lesion of the squamous anal mucosa. Clinical Features Epidemiology Associated with oncogenic HPV types (16 and 18). Increased risk with HPV, human immunodeficiency virus (HIV), anal intercourse, and multiple sexual partners. 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 human papillomavirus (HPV)–related exophytic lesion of the perianal skin and anal canal. Clinical Features Epidemiology Associated with low-risk HPV infection (types 6 and 11). Increased incidence with immunosuppression, including human immunodeficiency virus (HIV). Other risk factors include anal intercourse, other sexually transmitted diseases, and multiple sexual partners. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited…

D efinition —A rare, benign, spindle cell proliferation that occurs in the vulva of prepubertal women. Clinical Features Epidemiology Rare. Prepubertal women, age ranging between 4 and 12 years (median age is 8 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

D efinition —A (usually) benign soft tissue tumor of the vulva of presumably neural crest lineage. Clinical Features Epidemiology Uncommon. Can occur at any age, with a mean age of presentation of 50 years. More common in African-American women. 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 discrete vascular ectasia with overlying epidermal hyperplasia. Clinical Features Epidemiology Typically seen in women under age 50. Typically sporadic but also associated with Fabry's disease (deficiency of lysosomal alpha-galactosidase). 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 solitary, benign, polypoid lesion of the vagina composed of bland rhabdomyoblasts. Clinical Features Epidemiology Middle-aged women. 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 malignant frequently biphasic tumor of soft tissue. Clinical Features Epidemiology Rare. Encountered in all age groups, mostly in the second and third decades. t(X:18) translocation (representing a fusion of SYT [at 18q11] with either SSX1 or SSX2 [at Xp11]) linked to pathogenesis and prognosis. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…