Vaginal intraepithelial neoplasia and squamous cell carcinoma

Primary carcinoma of the vagina is an extremely uncommon cancer (about 0.6 per 100,000 women yearly) accounting for about 1% of malignant neoplasms in the female genital tract. Almost all of these tumors are squamous cell carcinomas associated with high oncogenic risk HPVs. The greatest risk factor is a previous carcinoma of the cervix or vulva; 1% to 2% of women with an invasive cervical carcinoma eventually develop a vaginal squamous cell carcinoma. Squamous cell carcinoma of the vagina arises from a premalignant lesion, vaginal intraepithelial neoplasia, analogous to cervical squamous intraepithelial lesions (SILs, see under "Cervix"). Most often the invasive tumor affects the upper posterior vagina, particularly along the posterior wall at the junction with the ectocervix. The lesions in the lower two thirds of the vagina metastasize to the inguinal nodes, whereas upper lesions tend to involve the regional iliac nodes.

EMBRYONAL RHABDOMYOSARCOMA

Also called sarcoma botryoides, this uncommon vaginal tumor is most frequently found in infants and in children younger than 5 years of age and consists predominantly of malignant embryonal rhabdomyoblasts.20 These tumors tend to grow as polypoid, rounded, bulky masses that sometimes fill and project out of the vagina; they have the appearance and consistency of grapelike clusters (hence the designation botryoides = grapelike) (Fig. 22-13). On histologic examination, the tumor cells are small and have oval nuclei, with small protrusions of cytoplasm from one end, resembling a tennis racket. Rarely, striations can be seen within the cytoplasm. Beneath the vaginal epithelium, the tumor cells are crowded in a so-called cambium layer, but in the deep regions they lie within a loose fibromyxomatous stroma that is edematous and may contain many inflammatory cells. For this reason the lesions can be mistaken for benign inflammatory polyps, leading to unfortunate delays in diagnosis and treatment. These tumors tend to invade locally and cause death by penetration into the peritoneal cavity or by obstruction of the urinary tract. Conservative surgery, coupled with chemotherapy, seems to offer the best results in cases diagnosed sufficiently early.

CERVIX

The cervix is both a sentinel for potentially serious upper genital tract infections and a target for viruses and other carcinogens, which may lead to invasive carcinoma. Worldwide, cervical carcinoma is the second most common cancer in women, with an estimated 493,000 new cases each year, over half of which are fatal. In the United States, 11,150 women were diagnosed with cervical cancer and 3670 women died from this disease in 2007. The potential threat of cancer is central to Papanicolaou (Pap) smear screening programs and histologic interpretation of biopsy specimens by the pathologist.

Inflammations

Дата добавления: 2015-11-13