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[Audio] The anatomy and physiology of the female genital system are being explored in this presentation..

[Audio] The learning objectives for this course include discussing various types of vulval pathologies, listing different types of neoplasms affecting the vagina, describing the anatomy of the cervix, discussing cervical neoplasms focusing on the role of human papillomavirus in their development, exploring the concept of HPV vaccination, and examining the natural history and progression of cervical neoplasms.

[Audio] Lichen Sclerosus and Lichen Simplex are two types of vulvar dystrophies. Lichen Sclerosus is characterized by the presence of white patches, which may occur in multiple areas, and it can also coexist with tumors in the cervix or vagina..

[Audio] Vulval intraepithelial neoplasia may present at any age. This inflammatory condition can lead to subepithelial fibrosis, atrophy, and scarring. Notably, it is associated with an increased risk of subsequent malignancies..

[Audio] The microscopic features that develop as a response to chronic itch are characterized by acanthosis, which is an abnormal but benign thickening of the prickle-cell layer of the skin, and hyperkeratosis. Furthermore, there may also be a variable inflammatory infiltrate of the dermis..

[Audio] Vulval neoplasms are either benign or malignant. The benign types comprise papillary hidradenoma and condyloma acuminatum. In contrast, the malignant types consist of carcinoma, vulval intraepithelial neoplasia, squamous cell carcinoma, Paget's disease, and melanoma..

[Audio] The vulva can present with various lesions, including those caused by human papillomavirus. Condyloma acuminatum is one such lesion, characterized by acanthosis, parakeratosis, hyperkeratosis, and evidence of HPV infection. This condition is often associated with low-risk viruses such as HPV 6 and 11. Another type of lesion is papillary hidradenoma, which is equivalent to an intraduct papilloma of the breast. Both of these conditions can cause significant discomfort and distress for patients..

[Audio] Vulval Intraepithelial Neoplasia presents with white patches, which may occur in multiple areas. The condition can also coexist with tumours in the cervix or vagina. High-risk human papillomavirus infection leads to vulval intraepithelial neoplasia, which can progress to carcinoma. The pathogenesis and grading system of vulval intraepithelial neoplasia are similar to those of cervical neoplasia. The risk of progression to an invasive tumour increases with age and immunosuppression..

[Audio] Vulval intraepithelial neoplasia, also known as usual vulval intraepithelial neoplasia, presents with white patches. This condition may affect multiple areas and can coexist with tumours in the cervix or vagina..

[Audio] Vulval intraepithelial neoplasia not related to human papillomavirus can occur, and it is characterized by the involvement of tumor suppressor genes such as p53. This type of neoplasia may develop rapidly, particularly in the presence of lichen sclerosus..

[Audio] Vulval intraepithelial neoplasia, also known as usual vulval intraepithelial neoplasia, accounts for approximately 90% of all vulval intraepithelial neoplasias. The aetiology of this condition is primarily attributed to high-risk human papillomavirus, particularly type 16. This virus can cause cellular changes leading to the development of vulval intraepithelial neoplasia. The age range affected by this condition varies, with younger women typically being between 30-50 years old, while older women tend to be postmenopausal, above the age of 50. Certain risk factors such as smoking and immunosuppression may contribute to the development of vulval intraepithelial neoplasia. The risk of squamous cell carcinoma progressing from vulval intraepithelial neoplasia is relatively low, around 10%, if left untreated. However, if treatment is not received, the risk of progression increases significantly, reaching up to 30-50%. Treatment options include surveillance, excision, imiquimod, and laser ablation. Surgical excision is often recommended due to the high risk of invasion associated with vulval intraepithelial neoplasia..

[Audio] Poor prognosis is associated with increased depth of invasion and presence of lymphovascular invasion..

[Audio] The extramammary Paget's disease of the vulva is characterized by the presence of malignant glandular epithelial cells, known as Paget cells, within the epidermis. These cells originate from apocrine glands, which are a type of post-pubertal sweat gland. The histological features include red crusted skin lesions with individual tumor cells in the epidermis, clear halos separating them from surrounding cells, and granular cytoplasm. The cells stain positively with PAS. This is an intraepithelial adenocarcinoma, a rare entity..

[Audio] Squamous cell carcinoma is a type of cancer that can occur in the female genital tract. This type of cancer is associated with human papillomavirus, or HPV. Another type of cancer that can occur in this area is vaginal intraepithelial neoplasia, or VaIN. This is a precursor to squamous cell carcinoma and is also caused by HPV. Adenocarcinoma is another type of cancer that can occur in the female genital tract, and it is often linked to exposure to diethylstilbestrol, or DES. Clear cell carcinoma and embryonal rhabdomyosarcoma are less common types of cancer that can occur in this area. Sarcoma botryoides is a rare type of cancer that occurs in the vagina..

[Audio] The mature squamous cells, which are typically seen in areas such as the vulva, vagina, and cervix, form the lining of these structures. In contrast, immature squamous cells can be found in areas where there has been abnormal growth or transformation, such as in cases of cancer. Columnar glandular cells, which are typically found in the cervix, line the canal and produce mucus, playing an important role in maintaining the health of the cervix and preventing infection..

[Audio] Squamous cell carcinoma accounts for approximately 80 percent of all cervical cancers, while adenocarcinoma makes up around 15 percent. There are also other, less common types of tumors, including neuroendocrine carcinoma and adeno-squamous carcinoma..

[Audio] The virus assembly and release of L1, L2, and L3 proteins occur in terminally differentiated keratinocytes. Cell proliferation and high-level episomal replication of El, E2, E4, E5, E6, and E7 genes take place during latent infection and low-level episomal replication of El and E2 genes in basal epithelial cells. The lysogenic cycle of HPV involves the integration of viral DNA into the host genome, resulting in the expression of viral genes..

HPV and cervical cancer. Progression Normal Regression HPV infection Cervix cross-section CINI CIN2 CIN3 Cervical cancer Persistant infection (1-10 years) Invasive cancer.

Cervical cancer incidence.

[Audio] The staging of cervical cancer is crucial in determining the prognosis and treatment options for patients. The FIGO and TNM systems are used to stage cervical cancer, and they share similarities. For microinvasive squamous cell carcinoma, where the depth of invasion is less than 3 millimeters, the risk is considered very low. However, recent studies have highlighted the importance of the pattern of invasion, particularly desmoplasia, in predicting patient outcomes.

[Audio] The vulva is the external female genital area, which includes the labia, clitoris, and opening of the vagina. The vagina is the muscular canal that connects the cervix to the outside of the body. The cervix is the lower part of the uterus that opens into the vagina. It's a crucial area for reproductive health, and any abnormalities can have significant consequences. As we've discussed earlier, cervical neoplasms are a common issue, and understanding their natural history and progression is vital for effective prevention and treatment strategies. This image illustrates the importance of regular cervical screenings, including cytology and HPV testing, to detect any potential issues early on. By examining the cervix through colposcopy, healthcare providers can identify lesions and take necessary action to prevent further progression..

[Audio] Cervical glandular intraepithelial neoplasia, also known as CGIN, is a condition where abnormal cells are present within the glands of the cervix. This can progress to adenocarcinoma, a type of cancer. There are many different subtypes of CGIN, some of which are related to human papillomavirus, or HPV. The most common subtype is usually mucinous, but there are other types as well. Not all cases of CGIN are caused by HPV, however..

[Audio] Cervical screening is essential for preventing cervical neoplasms. This can be accomplished through regular cytology and HPV testing. Additionally, a thorough cervical examination, also known as colposcopy, should be conducted to detect any abnormalities. If abnormal cells are found, lesion excision may be necessary..

[Audio] Assessing for dyskaryosis, squamous cells, and glandular cells is crucial in identifying any potential abnormalities in the female genital tract. By examining these cells, it is possible to determine whether they are within normal parameters or if there are any signs of dysplasia or cancer. This information is essential in guiding further treatment and management decisions..