Pathology

VALIDATION – Vulva, Vagina, Cervix, Fallopian Tubes & Placenta

OUTLINE  Organisms have round to oval shapes and pale green cytoplasm
I. HISTOLOGY  Occasionally, a single nucleus is visible as well as several discrete red
A. Vagina/Cervix granules
a. Trichomoniasis  Flagellum is most often NOT seen in Pap Smears
b. Bacterial Vaginosis
c. Cervicovaginal Candidiasis SCANNER
d. Squamous Cell Carcinoma (SCCA)
B. Placenta
a. Hydatidiform Mole
b. Choriocarcinoma
II. GROSS
A. Cervix
a. Cervical Carcinoma
B. Fallopian Tube
a. Tubal Pregnancy
C. Placenta
a. Molar Pregnancy/Hydatidifom Mole
b. Placenta Accreta

VAGINA/CERVIX
 If upon SCANNER view, the specimen just looks like dust, you are given
a clue that is most likely an epithelial smear taken from the vagina or
cervix #dedust

TRICHOMONIASIS
 Organ: Vagina or Cervix (NOT VULVA) LPO
 Etiologic agent: Trichomonas vaginalis

 Trichomonas vaginalis associated cellular change; i.e. coating of

intermediate squamous cells by neutrophils (often referred to as
“cannonball” or “popcorn ball” cells as indicated by the black arrows;
orange arrow shows the free Trichomonas.)  Still dust, however, dot-like basophilic organisms become apparent.

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 PATHOLOGY VALIDATION VULVA, VAGINA, CERVIX, FALLOPIAN TUBES & PLACENTA

HPO LPO

 Pointed in the image is a “clue cell”.

HPO
 Relatively large scale-like epithelial cells can be seen. Cytoplasm is
faintly eosinophilic with a centrally located nucleus.
 Also notice the abundance of neutrophils which may sometimes coat
squamous cells producing “cannonball” or “popcorn ball”.
 See the T.vaginalis within the cytoplasm of the epithelial cell. Note
eccentrically-placed nuclei.

NOTES:
 Copious, yellow, frothy vaginal discharge. May be associated with
discomfort, dyspareunia, dysuria.
 Fiery red appearance of the mucosa & severe dilatation of the mucosal
vessels  strawberry cervix

BACTERIAL VAGINOSIS
 Also called Bacterial Vaginitis
 Etiologic agent: Gardnerella vaginalis

SCANNER

 “Powdery” / “shaggy” film of coccobacilli in the background of a

vaginal smear.
 Clue cells are squamous cells covered by coccobacilli with extension to
the cell edges. The bacteria account for the velvety/shaggy/powdery
appearance.

NOTES:
 NOT an STD. It is merely an overgrowth of gram (-) coccobacilli.
 Clinically manifests as green-grey, fishy-odored vaginal discharge.
 Complications:
o Chorioamnionitis
o Premature Rupture of Membranes (PROM)
 Fun Fact: I went to prom once I was premature.

CERVICOVAGINAL CANDIDIASIS
 Organ: Cervix and/or Vagina
 Etiologic agent: Candida albicans (yeast) – normal flora
 It looks dusty so most probably it’s a smear sample.

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 PATHOLOGY VALIDATION VULVA, VAGINA, CERVIX, FALLOPIAN TUBES & PLACENTA

LPO NOTES:
 NOT an STD
 Extremely common.
 Curd-like vaginal discharge associated with severe pruritus.
In severe cases, mucosal ulcers form.

SQUAMOUS CELL CARCINOMA (SCCA)

 Organ: Cervix
 An invasive cervical carcinoma

SCANNER

 Dust.
 Fun Fact: dust has 0 calories! So, if you and yo mamma iz fat, eat dust.

HPO

 Note the purple-staining nests of neoplastic squamous cells.

LPO

 Keratin pearls are already apparent.

o So far, there is only one organ with keratin pearls in this period.
 Pointed in the slide is the Shish Kebab appearance (string-like thing) of So, if keratin pearls are seen #alamna.
the specimen formed by the hyphae of the fungi appearing to spear  Nests of neoplastic squamous cells invading the cervical stroma.
squamous cells together.

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 PATHOLOGY VALIDATION VULVA, VAGINA, CERVIX, FALLOPIAN TUBES & PLACENTA

HPO and super close-up XD SCANNER

 Sea of blood (yellow bracket) and islands of chorionic villi (black

arrows)

LPO

 Keratin pearl (pointer)

 Large, round ovoid nuclei with intercellular bridging.

NOTES:
 Most common complaint: Post-coital bleeding.
 High-grade squamous intra-epithelial lesion (HSIL) is the most
immediate precursor.
o Grading is based on the amount of solid tumor masses present.
 Large-cell keratinizing is the most common and well-differentiated.
o Well differentiated = better prognosis
 Spread widely into local structures and become disseminated to lymph
nodes in the pelvis.

PLACENTA
 To be able to ascertain that the organ involved is indeed the placenta, it
is imperative that you look at the SCANNER view.
st
 If it be bloody like the 1 days of the period of a woman with a wide-  Avascular chorionic villi (black arrows) with extensive stromal edema
set vagina...#alamna (seen as relatively widely-spaced) invested by a layer of hyperplastic
 There are only 2 placenta specimens: cytotrophoblast and syncytiotrophoblast.
o If the villi present as edematous, it is H.mole
o If there are no villi and is non-edematous-looking, it is
choriocarcinoma.

HYDATIDIFORM MOLE
 Also called a non-invasive mole in its most common variant...but it can
also be invasive.

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 PATHOLOGY VALIDATION VULVA, VAGINA, CERVIX, FALLOPIAN TUBES & PLACENTA

HPO  Sea of blood may be due to extensive hemorrhage and necrosis which
may be the result of the invasion of the blood vessel walls by
trophoblast cells.
 Aside from the blood it is also consists of thin strips of
syncytiotrophoblasts and cytotrophoblasts (black arrows)

LPO (upper image) / HPO (lower image)

 Disconnected mass of trophoblast cells showing mild cellular

pleomorphism.

NOTES:
 H.mole may be complete or partial:
o Complete mole:
 All villi are swollen.
 It is due to fertilization of empty ovum either by 1 or 2
sperms (diploid karyotype).
 Become choriocarcinoma 2% of the time.
o Partial mole:
 Only some villi are swollen
 It is due to fertilization of a non-empty ovum with 2 sperms
(triploid karyotype).
 Never become choriocarcinoma.
 Detected in pregnancies by a massive increase in hCG.
 p57 immunostaining may help in diagnosis.

CHORIOCARCINOMA
 Malignant tumor derived from trophoblast cells; it is consists entirely
of a dimorphic proliferation of syncytiotrophoblasts and
cytotrophoblasts.
SCANNER

 LPO: Again notice the clotted blood (white star) and the thin strips of
syncytiotrophoblasts and cytotrophoblasts (yellow bracket). The two
types of trophoblasts are arranged in alternating layers.
 HPO: The cell at the pointer is a multinucleated syncytiotrophoblasts
with atypia.

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 PATHOLOGY VALIDATION VULVA, VAGINA, CERVIX, FALLOPIAN TUBES & PLACENTA

NOTES: FALLOPIAN TUBE

 Rapidly invasive and metastasizes widely via lymphatics and the TUBAL PREGNANCY
bloodstream (lungs, brain, bone marrow, liver...)
 Responds well to chemotherapy.
 Clinically presents as bloody-brown fluid that seeps from the vagina.
 Does not produce chorionic villi.

CERVIX
CERVICAL CARCINOMA

 AKA Ectopic pregnancy in fallopian tube

 The irregular sausage-like dilated fallopian tube (right specimen) seen
in unruptured tubal pregnancy and the embryo (left specimen).
 The bluish discoloration of the tube is caused by hematosalpinx.
 It may contain a grossly or microscopically identifiable embryo.
 Take note of the cervical lip (red arrow) with a protruding bulky,
fungating mass (yellow bracket). Other noticeable structures are the  Its look is very peculiar, so just swallow it.
ovaries (green arrow) and the uterus (cyan bracket)  MICROCOPIC FINDINGS: Chorionic villi usually are found in the blood-
filled and dilated tubal lumen.
 Early lesions may be focally indurated, ulcerated or present as a slightly
elevated & granular area.
NOTES:
 More advanced tumors have 2 major types of gross appearances:
o Endophytic – are either ulcerated or nodular  This condition occurs when the fertilized ovum implants outside of the
uterine fundus which may be due to a previous infection (i.e.
o Exophytic – have a polypoid or papillary appearance; this sample
clearly has an exophytic mass. gonorrhea) causing fibrosis and scarring.
 Basically, their gross sample of cervical carcinoma looks like a mutated  Tubal pregnancy may proceed for several weeks (~6 weeks after the
chicken (or turkey if you be white #classAcitizen). LMP) but the enlargement can rupture the tube and lead to acute life-
threatening bleeding.
NOTES:
 Human Papilloma Virus (HPV) infection is the single most important
factor for cervical carcinoma, especially HPV 16 & 18.
 HPVs infect immature basal cells of the squamous epithelium in areas
of epithelial breaks, or immature metaplastic squamous cells present at
the squamocolumnar junction (transformation zone).

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 PATHOLOGY VALIDATION VULVA, VAGINA, CERVIX, FALLOPIAN TUBES & PLACENTA

PLACENTA PLACENTA ACCRETA

MOLAR PREGNANCY (upper image) & HYDATIDIFORM MOLE (lower image)

 Abnormal adherence of the placenta to the uterine wall so that

separation of the placenta does not occur after delivery of the
newborn.
 NOTE: hemostat grasping the umbilical cord
 Basically, it looks like something with leprosy...dark-colored leprosy.
 MICROSCOPIC FINDINGS: placental villi adhere to the myometrium.

NOTES:
 Partial or complete absence of decidua basalis.
 One of the most important causes of postpartum bleeding.
 Predisposing factors include placenta previa and history of previous
caesarean section.

“Then shall ye seek me, and find me, when ye shall search for me
with all your heart.” Jeremiah 29:13
 Massively enlarged, edematous chorionic villi give the characteristic
grapelike appearance.
o If you be white, you be saying this look like a lot more like caviar Edited by: RLim & JPelayo
rather than grapes #finedining #wineandcheese
o If you be still in the ghetto, you be calling this sago-like
appearance #taho #iprefertosaytapioca
 Swollen villi range from a few millimetres to more than 1cm in
diameter.

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