Pathology Atlas: Vulva

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Pathology Atlas: Vulva

Condyloma
VIN
Paget Disease
Squamous Cell Carcinoma
Basal Cell Carcinoma
Melanoma
Leiomyosarcoma
Histiocytoma
Carcinoma in situ
Hidradenoma
Syringoma
Nevi
Fibroma
Neurofibroma
Granular cell tumor
Lymphangioma

Condyloma

Condylomata showing acanthosis, parakeratosis and koilocytotic changes.

Vulvar Intraepithelial Neoplasia (VIN)

Flat condyloma acuminatum/vulvar intraepithelial neoplasia (VIN) 1. There is lack of maturation in the lower one third of the epithelium and maturation with koilocytosis in the upper epithelium.

Vulvar intraepithelial neoplasia (VIN) 3, multifocal. Note raised pale lesions on outer minora and across fourchette.

Vulvar intraepithelial neoplasia (VIN) 3 (severe dysplasia), basaloid type. This intraepithelial lesion is composed of relatively uniform epithelial cells with little maturation and nuclear hyperchromasia.

Vulvar intraepithelial neoplasia (VIN) 3 (severe dysplasia/carcinoma in situ ), warty type. Atypical cells extend throughout the full thickness of the epithelium. There is nuclear pleomorphism with koilocytes near the surface.

VIN III. Note large irregular nuclei, loss of differentiation, and overlying hyperkeratosis (black arrow).

Paget Disease

Primary Paget disease (type 1). Note irregular patchy change present on lateral aspect of labium majus.

Primary Paget disease (type 1). Characteristic large, pale Paget cells are just above basal layer (magnification, ×500).

Type 3 Paget disease of the vulva (pagetoid urothelial intraepithelial neoplasia [PUIN]). The vulvar epithelium is infiltrated by clusters of high-grade urothelial carcinoma. The nuclei are hyperchromatic with irregular contours.

Squamous Cell Carcinoma

Locally extensive vulvar cancer arising from the posterior lateral vulva ( A) and extending onto the buttocks ( B ). Such cases are commonly associated with profound denial and embarrassment and are generally not resectable primarily.

Patient with vulvar cancer after 4 weeks ( A) and 6 weeks ( B) of chemoradiation. Extensive tumor resolution is observed and extensive skin reaction demonstrated. Further therapy by posterior exenteration offered local control.

Superficially invasive squamous cell carcinoma with vulvar intraepithelial neoplasia (VIN) 3. There is a marked inflammatory response.

Well-differentiated squamous carcinoma. Large cells with abundant cytoplasm form keratin pearls (magnification, ×80).

Poorly differentiated squamous cell carcinoma of the vulva. The tumor cells are nonkeratinized, without prominent intercellular bridges. The tumor has a “finger-like” pattern of invasion.

Adenoid-squamous pattern with pseudoglandular spaces lined by squamous cells (magnification, ×500).

Squamous cell carcinoma, warty or condylomatous type. The epithelium shows little cellular atypia and the tumor-dermal interface is infiltrative rather than pushing in appearance.

Basal Cell Carcinoma

Basal cell carcinoma. The tumor is composed of small, uniform hyperchromatic cells with peripheral palisading of the nuclei. Central necrosis is present focally.

Melanoma

Malignant melanoma. Large nevoid cells with prominent nucleoli extend down from dermoepidermal junction. Some contain pigment (magnification, ×400).

Leiomyosarcoma

Leiomyosarcoma of the vulva. The tumor is composed of fascicles of smooth muscle with nuclear atypia, characterized by enlarged, irregular, and hyperchromatic nuclei.