Female Genital Tract
chapter
11
Vulva, Vagina, and Anus
Fadi W Abdul-Karim, Theresa M Somrak and Bin Yang
Contents
In tro d u c tio n
V u lv a
S a m p le C o lle c t io n M e t h o d s
H is to lo g y
I n fe c tio u s a n d I n f la m m a t o r y D is e a s e s
N o n - n e o p la s tic E p ith e lia l D is o r d e r s o f t h e V u lv a
V u lv a r I n t r a e p ith e lia l N e o p la s ia
B e n ig n N e o p la s m s a n d T u m o r - L ik e C o n d it io n s
M a lig n a n t N e o p la s m s
V a g in a
S a m p le C o lle c t io n M e t h o d s
H is to lo g y
I n fe c tio u s a n d I n f la m m a t o r
y
D is e a s e s
V a g in a l S m e a rs f r o m p o s t h y s t e r e c t o m y p a tie n ts
C y s ts
D ie th y ls t ilb e s t r o l- R e la te d A b n o r m a lit ie s
B e n ig n N e o p la s m s a n d T u m o r - L ik e C o n d it io n s
V a g in a l I n t r a e p ith e lia l N e o p la s ia (V a IN )
M a lig n a n t N e o p la s m s
M e ta s ta tic T u m o r s
A n u s
H is to lo g y
S q u a m o u s C e ll C a r c in o m a a n d A n a l I n t r a e p ith e lia l N e o p la s ia (A IN )
A n o r e c ta l C y t o lo g y a n d S a lie n t F e a tu r e s
A d e q u a c y a n d S a m p le C o lle c t io n M e t h o d s
A n a l C y t o lo g ic S c r e e n in g G u id e lin e s
C o n c lu d in g R e m a rk s
Introduction
Vulvar and vaginal exfoliative cytology, although not a substi-
tute for biopsy, may provide valuable information about the
nature of a lesion without causing significant discomfort to a
patient.1,2 Although unsuspected cancer is rarely identified by
this approach, a wide variety of infectious and inflammatory
diseases, dermatologic diseases, and benign and malignant
tumors have characteristic cytologic features.3
Vulva
Sample Collection Methods
Technical success in procuring an optimal specimen from the
vulva depends on the method used.4 Scrapings are best obtained
by means of physical force using various instruments such as
the edge of a glass slide, a scalpel blade, or another scraping
instrument.2,3 Generally, the scalpel blade yields the best suit-
able preparation.2,3 A warm, moist saline towel or cloth placed
over the lesion to be sampled softens the superficial keratinized
layer, resulting in a more cellular specimen with reduction in the
amount of drying artifact. Vigorous scraping may be required
to dislodge cellular material covered by a thick layer of keratin,
which should be discarded prior to obtaining a more cellular
second scrape. Moist or ulcerated lesions may be sampled by
touching a glass slide directly against the lesion or by swabbing
the edge of the ulcer and spreading the material on a slide. All
slides should be immediately fixed with spray fixative or 95%
ethanol for optimal preservation. Pigmented lesions are per-
haps best sampled by biopsy unless the surface is ulcerated or
the specimen can easily be obtained through nonaggressive
methods. Fine-needle aspiration (FNA) cytology is particularly
useful in assessing palpable subcutaneous or submucosal lesions
of the vulva and vagina.2,5
Histology
The vulva is composed of the mons pubis, the labia majora,
the labia minora, the clitoris, the vestibule, and the Bartho-
lin's glands. Except for the Bartholin's glands, these structures
are covered by stratified squamous epithelium. The Bartholin's
glands are paired mucus-secreting glands located in the poste-
rior aspect of the labia majora. Their main excretory ducts are
lined by stratified squamous epithelium, as are the ducts of the
minor vestibular gland.
273
previous page 272 ComprehensiveCytopathology 1104p 2008 read online next page 274 ComprehensiveCytopathology 1104p 2008 read online Home Toggle text on/off