Tumors of the Cervix, Vagina, and Vulva

"The addition of a new fascicle on tumor and tumor-like lesions of the female lower genital tract is of paramount importance. The ubiquitous nature of the Human Papillomavirus (HPV), added to the susceptibility of critical cell populations in the female genital epithelium to its oncogenic effects, contribute to the still high prevalence of pre-malignant and malignant epithelial lesions of the cervix, vagina, and vulva. A direct effect of this, cervical cancer is still the leading cause of morbidity and mortality among women in low-income countries in which access to health preventive (HPV vaccines, cervicovaginal cytology screening), diagnostic and therapeutic measures are insufficient. Even in high income countries, the pathologist encounters genital lesions associated with HPV infection on a routine basis. While the classification and characteristics of these lesions have remained relatively constant over the years, shifts in nomenclature have indeed occurred, and a comprehensive review of its rather diverse histomorphology and differential diagnosis is required. An equally thorough review is needed for the expanding spectrum of epithelial neoplasia independent from HPV infection. The current World Health Organization (WHO) classification of female genital tract tumors now bases the categorization of lower genital epithelial neoplasia on HPV status, which represents a pivotal change: one that recognizes the biologic and clinical differences between HPV-associated and HPV-independent neoplasms. The latter group, largely underrecognized until recently, is still evolving in terms of categorization and nomenclature. To this end, we adhere to the WHO-endorsed terminology but complement the discussion with both historic and recently proposed alternatives, as appropriate. Although female lower genital tract pathology is largely dominated by epithelial tumors and epithelial-like lesions, the pathologist will eventually encounter mesenchymal, melanocytic, hematopoietic, and miscellaneous disorders. This fascicle provides a comprehensive discussion of these categories with emphasis on their widening clinical and pathologic spectrum as well as their evolving molecular landscape."--