00:01
Our topic here is still
vulvar pathology.
00:04
I’ll tell you at some point when
we actually leave this behind,
but this is going to be an
infection of the vulvar region.
00:11
This, obviously, is referring
to what's known as your HPV.
00:15
And these would be the low-risk strains
since we’re talking about wart.
00:16
since we’re talking about wart.
00:19
Now, the warts here are
going to be quite obvious
when you actually see it.
00:24
And the type of histologic picture
that you’d find with HPV,
and specifically,
condyloma acuminata,
is accumulation of koilocytes
if that helps you.
00:36
The reason that I’m emphasizing
or exaggerating such a
pronunciation is because
you cannot afford to get
acuminata confused with
condylomata lata.
00:46
Condylomata lata is
found with syphilis.
00:50
This is condyloma acuminata or acuminatum,
and you’re accumulating koilocytes
if that helps you,
HPV.
00:58
Branching, tree-like proliferation
of stratified squamous epithelium
supported by fibrous stroma
is what we’re seeing here
on this histologic picture.
01:09
There’s branching, tree-like
proliferation of stratified squamous,
underlying fibrosis.
01:15
There will be thickened
epithelium with koilocytes.
01:19
Koilocytes are these
cells that are appearing
as being blank or pale or empty.
01:27
And then you find a peripherally
located hyper-eosinophilic nucleus.
01:32
Nuclear atypia in surface cells
with perinuclear vacuolization.
01:37
So there’s going
to be a clear halo
in which then the nucleus has
been pushed out to the side,
which will then appear
as being darkened.
01:45
You’ve seen this
in microbiology.
01:47
I just wish to reinforce something
that you’ve seen already.
01:51
These would be the low-risk strains
of HPV for warts, 6 and 11.
01:55
Please do not forget about
condyloma acuminata with warts.
02:00
Now what you’re seeing
here on gross examination
is exactly what you’d expect
with warts on your left.
02:05
There’s absolutely no way
that you can miss this.
02:08
On the right, the condyloma acuminata,
accumulation of koilocytes.
02:12
And the cell that you see
there in the middle there
are those clear
vacuolizations or clear halo.
02:18
And the nucleus will then appear as being
hyper-eosinophilic or
a little bit darker.
02:24
These are koilocytes.
02:26
We should point out to you there
will be another Paget's --
Excuse me.
02:29
another vulvar disease we’ll take a
look at known as Paget’s disease
of the vulva, and those cells
will be quite different.
02:36
They will not have
clear vacuoles.
02:38
It is important that you know
the histologic pictures of
some of these conditions.