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13 Female Genital and Gestational > 13.1 Vulva > Flashcards

13.1 Vulva Flashcards

1
Q

Koilocytic change

  • appearance
  • cause
A
  • cells infected by HPV
  • ‘raisin’ koilocyte change
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1
Q

How to differentiate vulvar carcinoma types by age:

A

HPV related: usu 40-50s (infected in 20s)
non HPV related: >70s, elderly post-menopausal

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2
Q

If you see Paget’s disease of nipple, think what underlying problem?

If you see Paget’s disease of vulva, think what underlying problem?

A
  1. presence is usu due to underlying breast cancer
  2. usu no underlying cancer
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3
Q

Vulvar carcinoma, HPV related

  • what are the HPV types
  • risk factors, general population
  • arises from what precursor lesion
A
  • HPV 16,18,31,33
  • Think sexual transmission of HPV: multiple sex partners, early 1st age of intercourse.

Typically occurs in women 40-50, who were infected in 20s by HPV. takes 10-15 years to develop dysplasia.

-arises from VIN (vulvar intraepithelial neoplasia)

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3
Q

Female pt presents with white patches on vulva.

  • what’s your differential?
  • think what based on vulvar exam
  • think what based on pt’s age
A
  1. lichen sclerosis
  2. lichen simplex chronicus
  3. vulvar carcinoma (HPV and non HPV)
    - paper-thin (lichen sclerosis) vs leathery skin (lichen chronicus)
    - age: 40-50–HPV vulvar carcinoma
    - older, post menopausal–lichen chronicus, non HPV carcinoma
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4
Q

bartholin cyst

  • cause
  • population
A
  • cystic dilation of bartholin gland
  • arises due to inflamm and obstruction of gland
  • usu from STD, in women of reproductive age
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4
Q

Vulvar carcinoma

-how common among female genital cancers

A

-relatively rare, only a small % of female genital cancers

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5
Q

Extramammary Paget disease

  • what is it
  • clinical presentation
  • must distinguish from what that presents similarly?
A
  • malignant epithelial cells in the epidermis of vulva. Represents CIS, usu no underlying carcinoma. (However, Paget’s disease of nipple is almost always assoc with underlying carcinoma)
  • presents as erythematous, prurtic ulcerated vulvar skin
  • Melanoma (can occur on the vulva)
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7
Q

condyloma

  • histology
  • cancer risk?
A

genital warts

  • HPV-infected cells, so: raisin koilocyte change
  • rarely progress to carcinoma (HPV 6,11 are low risk)
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8
Q

Lichen simplex chronicus

-cancer risk

A

-benign, no increased risk of SCC

(as opposed to slightly increased risk with lichen sclerosis)

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8
Q

VIN

  • precursor to what
  • what is it characterized by
  • what causes it
A

vulvar intraepithelial neoplasia

-precursor dysplasia to vulvar carcinoma

characterized by: 1. koilocytic change (raisin)

  1. disordered cellular maturation
  2. nuclear atypia
  3. increased mitotic activity
    - can be caused by HPV infection (high risk)
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9
Q

Female pt presents with white patch on vulva with thick, leathery skin.

-think what

A

lichen simplex chronicus

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10
Q

condyloma

  • what is it
  • causes–most common, and 1 less common cause
A

-genital warts

Think STDs:

  1. HPV 6,11
  2. less common: secondary syphilis
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11
Q

Where does HPV infect in females?

(3)

A

think external to internal:

  1. Vulva
  2. vagina
  3. cervix
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12
Q

HPV:

-what kind of nucleic material in this virus?

A

DNA

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13
Q

non HPV vulvar carcinoma

  • cause
  • population
A

long standing lichen sclerosis

  • chronic inflamm and irritation lead to carcinoma
  • seen in elderly women (>70)
14
Q

HPV:

how to put viruses in categories

A

HPV

/ \

Low risk High risk

6,11 16,18,31,33

condyloma dysplasia, carcinoma

14
Q

Lichen sclerosis

  • characterized by what (2)
  • clinical presentation
A

think ‘think skin’ vs lichen simplex chronicus (thick skin)

  1. thinning of epidermis
  2. fibrosis (sclerosis ) of dermis (“lichen sclerosis)

presents as:
Leukoplakia with parchment-like vulvar skin “paper thin”

15
Q

Paget’s disease of vulva vs nipple

-what is different between the 2

A

Vulva: usu no underlying carcinoma

nipple: usu has underlying carcinoma

16
Q

How to distinguish extramammary Paget’s disease from melanoma?

3 markers

A

Paget cells: PAS+, keratin+, S100-

Melanoma: PAS-, keratin-, S100+

PAS: marker of mucus. only epithelial cells can make mucus

Keratin: only epithelial cells have keratin

S100: marker present in some tumors, like melanoma

(definitely know Keratin and S100)

18
Q

name important parts of vulva (4)

-what cell type lines this

A

female parts external to hymen: include

  1. labia majora
  2. labia minora
  3. mons pubis
  4. vestibule
    - squamous epithelium
20
Q

bartholin cyst

-clinical presentation

A
  • unilateral painful cystic lesion
  • located at lower vestibule, adjacent to vaginal canal
22
Q

How to differentiate lichen simplex chronicus from lichen sclerosis?

A

lichen simplex chronicus: thick, leathery skin

lichen sclerosis: thin paper-like skin

both are leukoplakia

24
Q

Lichen simplex sclerosis

  • characterized by what?
  • clinical presentation
  • assoc with what (2)
A

think ‘thick skin, leathery’

  • hyperplasia of vulvar squamous epithelium
  • presents as: leukopalkia with thick, leathery vulvar skin
  • assoc with:
    1. chronic irritation
    2. scratching
25
Q

Female middle-aged pt presents with white patch on vulva with paper-thin skin

-think what?

A

Lichen sclerosis

(‘paper thin’ skin on vulva’)

-slightly increased risk for SCC

26
Q

Lichen sclerosis

  • population
  • etiology
  • cancer risk?
A
  • postmenopausal women
  • unknown, possible autoimmune etiology
  • benign, but slightly increased risk for SCC (the vulvar carcinoma, non-HPV kind)
27
Q

Vulvar carcinoma

  • divided into what types
  • presentation (what else presents similarly?)
A
  • SCC of the vulvar epithelium
    1. HPV related (16,18,31,33)
    2. non-HPV related. (from long standing lichen sclerosis)
  • presents as leukoplakia. (similar to lichen sclerosis and lichen simplex chronicus)
28
Q

Lichen sclerosis:

-long term complication

A

Can rarely become vulvar carcinoma (non HPV)

-constant irritation and inflammation

13 Female Genital and Gestational (6 decks)

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