Female Genital Tract1-Vulva

2-Vagina3-Cervix

4-Uterine corpus5-Ovary

6-Placenta

Vulva

Vulva1-Vulvitis

2-Non-neoplastic epithelial disorders

3-Tumor

Vulvar Leukoplaki

aCauses of vulvar leukoplakia:

1-Vitiligo (loss of pigment)2-Inflammatory dermatosis: e.g. psoriasis

3-Squamous intraepithelial neoplasms of the vulva (VIN) and invasive carcinoma4-Paget’s disease

3-Vulvar Tumors1-Condyloma

2-Intaepithelial V. Neoplasia3--Vulvar carcinoma

4-Extramammary Paget’s disease5-Melanoma

Vulvar Intraepithelial

Neoplasia (VIN)

VIN I: mild dysplasia, lower third.

VIN II: moderate dysplasia, lower two thirds.

VIN III (CIS): Severe dysplasia, full thickness.

Vulvar CarcinomaStromal invasion.

1-3% of all female genital cancers, > 60 years of age.

2-Increasing Incidence of VIN (40-60 y).

3-90% of malignancies are squamous cell carcinomas, 10%: adenocarcinomas, basal cell carcinomas, and melanomas.

Vulvar CarcinomaInitially a leukoplakia-type lesion, progresses to overt exophytic (elevated) or endophytic (ulcerated) lesion.

Management and prognosis depend on size of tumor, depth of invasion, lymphatic

involvement , and presence of metastasis .STAGE

5 year survival :Stage I (tumor < 2 cm): 60-80%

Larger tumor with metastasis: 10%

Vulvar CarcinomaSurgery: treatment of choice for early stage lesions

Local excision, radical vulvectomy, groin/pelvic LN dissection

Radiotherapy: stage III and IV tumorsChemotherapy: Metastatic disease (low response rate)

Vaginal Intraepithelial Neoplasia (VAIN) and

CarcinomaUncommon, VAIN are graded I, II, and III (~VIN)Elderly females (>60 y)Preexisting or concurrent cervical or vulvar Neoplasia or carcinoma is sometimes present.

Endocervical polypInflammatory polypoid masses.

Smooth surface composed of columnar mucus-secreting cells (endocervical epithelium) with underlying cystically dilated glands filled with mucus. Stromal edema inflammatory mononuclear cells.

Squamous metaplasia and ulceration.

Cervical Intraepithelial Neoplasia (CIN) and

CarcinomaImportance of early detection, adequate follow up and management.Histologic grading of precursor lesions:CIN I: Mild dysplasiaCIN II: Moderate dysplasiaCIN III : Severe dysplasia/carcinoma in situ

Cervical Intraepithelial Neoplasia (CIN) and

Carcinoma

Cytologic grading of precursor lesions

1 )LOW GRADE SQUAMOUS INTRAEPITHELIAL LESIONS

[CIN I and Condylomas (koilocytosis)]

2 )HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESIONS

[CIN II, CIN III/CIS]

Cervical Intraepithelial Neoplasia (CIN) and

CarcinomaPeak incidenceCIN : 30 YInvasive carcinoma: 45 yRisk factors

1-Early age at first intercourse2-Multiple sexual partners

3-A male partner with multiple previous sexual partners

Invasive Carcinoma of the Cervix

80-95% :Squamous cell carcinomasMultifactorial disease

PreventableGross (macroscopic appearance)

Fungating (exophytic)Ulcerative (endophytic)

Infiltrative