This document summarizes common lesions of the female genital system, focusing on the vagina. It describes the most common causes of vaginitis as bacterial, fungal and protozoal infections like candidiasis and trichomoniasis. It also mentions benign tumors like cysts that can occur in the vagina, as well as rare primary malignancies including squamous cell carcinoma, adenocarcinoma, and embryonal rhabdomyosarcoma which typically presents as a polypoid "grape-like" mass in young children. Staging and characteristics of squamous cell carcinoma and adenocarcinoma of the vagina are also outlined.

1. FEMALE GENITAL SYSTEM:
VAGINAL LESIONS
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. VAGINA

3. VAGINITIS &
VULVOVAGINITIS
• Since vulva and vagina are anatomically close to each other, often
inflammation of one affects the other location.
• i) Bacterial e.g. streptococci, staphylococci, Escherichia coli,
Haemophilus vaginalis.
• ii) Fungal e.g. Candida albicans.
• iii) Protozoal e.g. Trichomonas vaginalis.
• iv) Viral e.g. Herpes simplex.

4. VAGINITIS &
VULVOVAGINITIS
• The most common causes of vaginitis are Candida (moniliasis) and
Trichomonas (trichomoniasis).
• The hyphae of Candida can be seen in the vaginal smears.
• Similarly, the protozoa, Trichomonas, can be identified in smears.
• These infections are particularly common in pregnant and diabetic
women and may involve both vulva and vagina.
• (adult vaginal mucosa is relatively resistant to gonococcal
infection because of its histology)

5. TUMOURS &
TUMOUR-LIKE
CONDITIONS

6. • Vaginal cysts such as Gartner’s duct (Wolffian) cyst lined by glandular
epithelium and vaginal inclusion cyst arising from inclusion of vaginal
epithelium are more common benign vaginal tumours
• Other uncommon benign tumours are papillomas, fi bromas, lipomas,
angiomas and leiomyomas
• Primary malignancies of the vagina are rare
• and include carcinoma (squamous cell carcinoma and adenocarcinoma)
• and embryonal rhabdomyosarcoma (sarcoma botryoides).

7. CARCINOMA OF VAGINA
• Primary carcinoma of the vagina is an uncommon tumour.
• Squamous cell dysplasia or vaginal intra epithelial neoplasia occur less
frequently as compared to the cervix or vulva and can be detected by
Pap smears.
• Invasive carcinoma of the vagina includes two main types:
• 1. Squamous cell carcinoma of vagina constitutes less than 2% of all
gynaecologic malignancies. The role of HPV types 16 and 18 in its
etiology
• 2. Adenocarcinoma of the vagina is much less frequent than squamous
cell carcinoma of the vagina. It may be endometrioid or mucinous type.

8. FIGO clinical staging of
carcinoma of the vagina

9. EMBRYONAL RHABDOMYOSARCOMA
(SARCOMA BOTRYOIDES)
• This is an unusual and rare malignant tumour occurring in
infants and children
• under 5 years of age.
• The common location is anterior vaginal wall.

10. EMBRYONAL RHABDOMYOSARCOMA
(SARCOMA BOTRYOIDES)
MORPHOLOGIC FEATURES
Grossly
• The tumour is charac terised by bulky and polypoid grape-like mass
(botryoides = grape) that fills and projects out of the vagina.
Histologically:
• 1. Groups of round to fusiform tumour cells are characteristically lying
underneath the vaginal epithelium, called cambium layer of tumour cells.
• 2. The central core of polypoid masses is composed of loose and myxoid
stroma with many infl ammatory cells.