Vulva

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Figure 30.1 Fibroadenoma of vulva arising from ectopic breast tissue

 Figure 30.2 Lichen simplex chronicus, with hyperkeratosis, epidermal hyperplasia, and chronic inflammation of the underlying stroma. There is no significant atypia

 Figure 30.3 Clinical appearance of vulvar lichen sclerosus

Figure 30.4 Lichen sclerosus of vulva. A thick hypocellular edematous layer is bounded by atrophic epidermis on one side and inflamed stroma on the other

 Figure 30.5 Large condyloma of vulva

Figure 30.6 Whole mount of condyloma acuminatum of vulva

 Figure 30.7 Papillomatous shape of vulvar condyloma

 Figure 30.8 Prominent koilocytotic changes in vulvar epithelium

  Figure 30.9 "Block" immunoreactivity for p16, with strong nuclear and cytoplasmic staining of all cells of at least the basal third of the epithelium, in HSIL (VIN2/3), as a surrogate test for the presence of oncogenic HPV

 Figure 30.10 Typical microscopic appearance of HSIL (VIN2/3)

 Figure 30.11 Differentiated VIN (dVIN), showing basal epithelial atypia

  Figure 30.12 Gross Appearance of Invasive Squamous Cell Carcinoma of Vulva. A, Tumor of labium majus. B, Tumor of clitoris. C, Tumor involving both labia. D, Huge tumor mass involving all vulvar structures

  Figure 30.13 Basaloid-pattern invasive squamous cell carcinoma of vulva, a pattern typical of HPV-associated vulvar squamous cell carcinoma. Note the peripheral palisading and deep basophilic staining pattern

 Figure 30.14 Microscopic appearance of invasive well-differentiated keratinizing squamous cell carcinoma of vulva. Such tumors are typically HPV-independent

  Figure 30.15 Superficial Invasive Squamous Cell Carcinoma. A, Low-power appearance. B, High-power view, showing small clusters of tumor cells detaching from the in situ component and invading a heavily inflamed stroma. All invasive cells are present within 1 mm of the overlying epidermal-dermal junction

  Figure 30.16 Cut surface of verrucous carcinoma of vulva. (Courtesy of Dr Pedro J Grases Galofré; from Grases Galofré PJ. Patología gine- cológica. Bases para el diagnóstico morfológico. Barcelona: Masson; 2002)

Figure 30.17 Bulbous pegs of well-differentiated squamous cells infiltrate the stroma in vulvar verrucous carcinoma 

  Figure 30.18 A and B, Clinical and gross appearance of vulvar Paget disease. In both cases the disease is very extensive

  Figure 30.19 A and B, Low- and medium-power appearances of vulvar Paget disease. The large clear tumor cells are distinct from the malpighian layer

  Figure 30.20 Cytokeratin 7 expression in vulvar Paget disease

Figure 30.21 Hidradenoma papilliferum of vulva. This tumor probably arises from ectopic breast tissue

Figure 30.22 Basal cell carcinoma of vulva. It is important to distinguish this tumor from squamous cell carcinoma, especially the basaloid variant of the latter

  Figure 30.23 Gross appearance of vulvar malignant melanoma. The tumor is large, polypoid, deeply pigmented, and ulcerated

  Figure 30.24 Malignant Melanoma of Vulva. A, Superficially spreading type, showing typical intraepidermal growth of pagetoid cells. B, Melanoma growing in the form of fascicles of spindle cells and simulating a mes- enchymal neoplasm

 Figure 30.25 Aggressive angiomyxoma protruding in a polypoid fashion through one of the labia 

 Figure 30.26 Cut surface of vulvar aggressive angiomyxoma. The tumor is soft, gelatinous, and appears encapsulated

  Figure 30.27 Microscopic appearance of aggressive angiomyxoma. The lesion is hypocellular and features large-sized vessels

 Figure 30.28 Vulvar angiomyofibroblastoma. Rows of small oval cells are separated by fibrous strands

  Figure 30.29 Angiofibroma of vulva. The microscopic appearance is reminiscent of nasopharyngeal angiofibroma. (Slide courtesy of Dr. Robert E Scully, Boston, MA)

 Figure 30.30 Vulvar polyp containing reactive stromal cells, some of which are multinucleated

  Figure 30.31 A rare example of solitary fibrous tumor involving soft tissues of vulva

Figure 30.32 Granular cell tumor of vulva

Figure 30.33 Large carcinoma arising from the Bartholin gland

 Figure 30.34 Bartholin gland carcinoma of transitional type, a variant of HPV-associated squamous cell carcinoma

 Figure 30.35 Bartholin gland carcinoma of adenoid cystic type