11
Vulva, Vagina, and Anus
Fig. 11.15 Rhabdosarcoma. (A) Histology (H&E x HP); (B) cytology (Papanicolaou xHP), Primitive spindled rhabdomyoblasts, save with differentiation
features. Spindled small cells on vaginal scrape.
Fig. 11.16 Vaginal metastasis of leiomyosarcoma. (A) Histology (H&E x HP); (B) cytology. Spindled cell sarcoma and a cluster of large spindle cells with
nuclear enlargement and overlapping on vaginal scrape (Papanicolaou xHP).
which presents as a tail-like projection or as a broad band
(Fig. 11.15B). Nuclei are eccentric, and macronucleoli may occa-
sionally be noted. Immunohistochemical, electron microscopic,
or cytogenetic studies are helpful in establishing the diagnosis.
Although rhabdomyosarcoma may be suspected on the basis of
cellular evidence, a specific diagnosis requires confirmation by
biopsy. Recurrent or persistent neoplasms may be more readily
identified by cellular studies.
Key features of rhabdomyosarcoma on vaginal scrape:
• Numerous small cells;
• Round to oval or elongated;
• Cytoplasm present as tail-like projection;
• Eccentric nuclei; and
• Ancillary studies necessary for diagnosis.
Rare primary neoplasms
Stromal sarcomas, leiomyosarcomas
(Figs. 11.16A, 11.16B), and
malignant melanomas
(Figs. 11.17A, 11.17B) are rare primary neo-
plasms of the vagina. Other benign and malignant mesodermal
tumors that have been noted include lipoma, hemangioma,
lymphangioma, fibrous histiocytoma, and lymphoma.
Metastatic Tumors
Metastatic carcinoma to the vulva is extremely rare. Reported
primary sites include endometrium, breast, lung, and kidneys.78-80
Neoplasms metastatic to the vulva and vagina occur either
through direct extension or hematogenous or lymphatic spread
from neoplasms of the female genital tract.81 Metastatic tumors
make up 84% of all neoplasms of the vagina. In the vagina,
the cervix was the most common primary site, followed by the
endometrium, the colon-rectum (Figs. 11.18A, 11.18B), and the
ovary (Fig. 11.19) .82 Other primary sites include urinary bladder,
breast, and kidney.83 Histopathologically and cytologically, most
metastatic diseases show the same degree of differentiation as
the primary tumor. Metastatic implants may be associated with
ulceration and tumor diathesis, making it impossible to differ-
entiate them cytologically from primary vaginal tumors. Correla-
tion with the clinical history cannot be overemphasized.
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