• Vaginal adenosis and clear cell adenocarcinoma are rare conditions with increased risk in females exposed to diethylstilbestrol (DES) in utero.
• Embryonal rhabdomyosarcoma (sarcoma botryoides) affects infants and young children (age <5), in whom it can cause a polypoid, “grapelike,” soft tissue mass that protrudes from the vagina. Microscopically, the mass is character-ized by polypoid epithelial growth with an underlying immature (cambium) proliferation of spindle-shaped tumor cells with rare cross-striations. Tumor cells are positive for desmin.
• Primary forms of vaginal squamous cell carcinoma are usually related to HPV infection; secondary forms are more common and are usually due to extension from a cervical cancer. Treatment is radiotherapy.
• Rhabdomyoma is a benign skeletal muscle tumor that can involve the vagina. It occurs in middle-aged women..
• Gartner duct cyst is a cyst of the lateral wall of the vagina that is due to persis-tence of a mesonephric (Wolffian) duct remnant. Urinary tract abnormalities may exist.
• Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is congenital absence of the upper part of the vagina and uterus. Patients present with primary amen-orrhea.
• Vaginitis/vaginosis: All of the following conditions require vaginal swab for definitive diagnosis; molecular diagnostic tests may be indicated in certain situations.
o Vulvovaginal candidiasis can occur spontaneously or from antibiotic therapy; it is not usually sexually transmitted. Symptoms include dis-charge and pruritis. Yeast cells and pseudohyphae are seen on micros-copy. Antimycotics are therapeutic.
o Bacterial vaginosis (BV) is implicated in preterm labor and pelvic inflammatory disease. Some patients are asymptomatic. BV is a sexually transmitted bacterial infection of polymicrobial origin (although it used to be attributed only to Gardnerella vaginalis); recurrence rate is high after treatment with antibiotics. “Clue cells” are squamous cells coated with coccobacilli that may be seen microscopically in swab material.
o Trichomonis vaginalis is a sexually transmitted motile protozoan. Most infected people are asymptomatic. It can also cause cervicitis, but “strawberry cervix” is not a consistent diagnostic feature. Antibiotics are therapeutic.