Female Genital Tract 1 Vulva 2 Vagina 3

Female Genital Tract 1 -Vulva 2 -Vagina 3 -Cervix 4 -Uterine corpus 5 -Ovary 6 -Placenta

Vulva

1 -Vulvitis Vulva 2 -Non-neoplastic epithelial disorders 3 -Tumor

Vulvar Leukoplakia Causes of vulvar leukoplakia: 1 -Vitiligo (loss of pigment) 2 -Inflammatory dermatosis: e. g. psoriasis 3 -Squamous intraepithelial neoplasms of the vulva (VIN) and invasive carcinoma 4 -Paget’s disease

3 -Vulvar Tumors 1 -Condyloma 2 -Intaepithelial V. Neoplasia 3 --Vulvar carcinoma 4 -Extramammary Paget’s disease 5 -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 Carcinoma Stromal 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 Carcinoma Initially 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 Carcinoma Surgery: treatment of choice for early stage lesions Local excision, radical vulvectomy, groin/pelvic LN dissection Radiotherapy: stage III and IV tumors Chemotherapy: Metastatic disease (low response rate)

Vaginal Intraepithelial Neoplasia (VAIN) and Carcinoma Uncommon, 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 polyp Inflammatory 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 Carcinoma Importance of early detection, adequate follow up and management. Histologic grading of precursor lesions: CIN I: Mild dysplasia CIN II: Moderate dysplasia CIN 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 Carcinoma Peak incidence CIN : 30 Y Invasive carcinoma: 45 y Risk factors 1 -Early age at first intercourse 2 -Multiple sexual partners 3 -A male partner with multiple previous sexual partners

Invasive Carcinoma of the Cervix 80 -95%: Squamous cell carcinomas Multifactorial disease Preventable Gross (macroscopic appearance) Fungating (exophytic) Ulcerative (endophytic) Infiltrative