04-25 PATH: Cervix, Vagina & Vulva Flashcards
1. Describe when to screen patients for cervical cancer and to know how to interpret the results 2. Describe the appearance of lichen sclerosis and contrast it with other vulvar dermatosis, and understand treatment as it relates to the disease process 3. Discuss the common presentation of a Bartholin gland cyst/abscess, and proper management as it relates to the pathophysiology of the process.
1
Q
OBJECTIVE: When should you screen for cervical cancer?
A
< 21 y/o - none
21-29 y/o - q3 yrs Pap ONLY (more if HIV+)
30-65 y/o - q3 yrs Pap alone
OR
q5 yrs Pap + HPV (if HPV neg)
>65 y/o - consider d/c if no + in tens years, HIV- etc.
2
Q
Cytology report says: LGSIL
- What does that mean?
- Management?
- Natural hx
A
Low-grade squamous intraepithelial lesion
- Either just koliocytosis (i.e. “condyloma”)
- Or CIN 1 (cervical intraepithelial neoplasm 1
Management
- Repeat pap in 6 months
- OR
- Pap + High-Risk HPV test q12 mos
Natural Hx
- Many self-resolve, especially those in younger pts
3
Q
What is the most common tumor of the uterus?
A
uterine fibroid
- a.k.a. leioma
4
Q
Cytology report says: HGSIL
- What does that mean?
- Management?
A
High-grade squamous intraepithelial lesion
Biopsy will show:
- CIN II = moderate dysplasia
- CIN III = severe dysplasia OR CIS (carcinoma in situ)
Management
- LEEP (loop electrode excision procedure)
- Cryotherapy
- Cone biopsy
5
Q
Staging HPV-related vaginal lesions
A
Same exact staging system as cervix, just ∆ CIN to VAIN
6
Q
Appearance of Lichen Sclerosus
A
- Classic crinkly atrophic appearing white epithelium with blanched appearance
- Can have thickened white plaques •Involvement from clitoris to perianal area is variable
- Hourglass configuration
- Skin tears and ulceration/purpura in a background of white/blanched thickened epithelium
- Extensive excoriation can be seen with severe pruritis
7
Q
Path of Lichen Sclerosus
A
8
Q
How do you ensure long-term drainage of a Bartholin’s gland abscess?
A
Word Catheter
- Placed for 2-4 weeks
- Tucked into vagina
- Promote formation of epithelialized tract
9
Q
Bartholin’s gland abscess vs Bartholin’s gland cyst
A
- cyst smaller, often asx
- small r/o becoming adenoCA in women >40 y/o, so remove in some pts based on their risk
- 0.1 – 5 % of vulvar malignancies
- Most commonly adenocarcinomas, squamous cell carcinomas •Incidence highest in women in 60’s
- Treatment: radical vulvectomy with bilateral inguinal and pelvic node dissection
