vagina



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  • Normal

    • mucosa
      • epithelium
        • basal
        • parabasal
        • superficial cells (glycogen clearings)
      • lamina propria
        • stromal cells can be large, stellate, spindle
        • can have scattered floret type multinucleated cells
    • muscularis
    • adventitia

  • Non-neoplastic

    • Cysts
      • squamous inclusion cyst
      • gartner duct cyst
        • simple cuboidal epithelium
        • no cilia or mucin
      • mullerian cyst
        • mullerian duct epithelia
          • endocervical
          • endometrial
          • tubal
      • bartholin cyst
        • lining can be mucinous, squamous or transitional
    • atrophy
    • adenosis
    • endometriosis
    • vaginitis
      • infectious
      • atrophic vaginitis
      • idiopathic
        • desquamative inflammatory vaginitis
        • ligneous vaginitis
      • systemic
        • crohn disease
        • SJS
        • TTP
    • postoperative nodule
    • radiation
      • atrophy
      • fibrosis
      • reactive
    • tubal prolapse
      • mimicks adenocarcinoma

  • WHO neoplasms

    • Epithelial
      • squamous
        • VaIN
        • SCC
        • condyloma
          • has koilocytes
        • squamous papilloma
          • no koilocytes
          • simple branches
        • fibroepithelial polyp
      • glandular
        • adenocarcinoma
        • Mullerian papilloma
          • low-columnar epithelium
        • adenoma
          • tubular adenoma
          • tubulovillous adenoma
          • villous adenoma
      • other
        • adenosquamous carcinoma
        • adenoid cystic carcinoma
        • adenoid basal carcinoma
        • carcinoid
        • small cell carcinoma
        • undifferentiated carcinoma
    • mesenchymal
      • sarcoma botryoides
        • intact epithelium
        • cambium layer
          • condensed subepithelial rhabdomyoblasts in dense collagenous or myxoid stroma
      • leiomyosarcoma
      • low grade endometrioid stromal sarcoma
      • undifferentiated vaginal sarcoma
      • leiomyoma
      • rhabdomyoma
        • striations in rhabdoid cells
      • deep angiomyxoma
      • postoperative spindle cell nodule
    • mixed epithelial and mesenchymal
      • carcinosarcoma
      • adenosarcoma
      • malignant mixed tumor resembling synovial sarcoma
      • benign mixed tumor
    • melanocytic
      • melanoma
      • blue nevus
      • melanocytic nevus
    • misc
      • yolk sac tumor
      • dermoid cyst
      • PNET
      • adenomatoid tumor
    • lymphoma
    • metastasis

  • Clinical ddx

  • TNM (useful for grossing)

    • T1: vagina confined
    • T2: invades paravaginal tissue
    • T3: involves pelvic wall
    • T4: invades mucosa of bladder or rectum or beyond true pelvis
    • Regional nodes
      • upper 2/3 vagina
        • obturator
        • internal iliac (hypogastric)
        • external iliac
        • pelvic node NOS
      • lower 1/3 vagina
        • inguinal
        • femoral

  • Staging

    • I: T1
    • II: T2
    • III: T3 or N1
    • IVA: T4
    • IVB: M1
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