13.1 Vulva Flashcards
Koilocytic change
- appearance
- cause
- cells infected by HPV
- ‘raisin’ koilocyte change
How to differentiate vulvar carcinoma types by age:
HPV related: usu 40-50s (infected in 20s)
non HPV related: >70s, elderly post-menopausal
If you see Paget’s disease of nipple, think what underlying problem?
If you see Paget’s disease of vulva, think what underlying problem?
- presence is usu due to underlying breast cancer
- usu no underlying cancer
Vulvar carcinoma, HPV related
- what are the HPV types
- risk factors, general population
- arises from what precursor lesion
- 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)
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
- lichen sclerosis
- lichen simplex chronicus
- 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
bartholin cyst
- cause
- population
- cystic dilation of bartholin gland
- arises due to inflamm and obstruction of gland
- usu from STD, in women of reproductive age
Vulvar carcinoma
-how common among female genital cancers
-relatively rare, only a small % of female genital cancers
Extramammary Paget disease
- what is it
- clinical presentation
- must distinguish from what that presents similarly?
- 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)
condyloma
- histology
- cancer risk?
genital warts
- HPV-infected cells, so: raisin koilocyte change
- rarely progress to carcinoma (HPV 6,11 are low risk)
Lichen simplex chronicus
-cancer risk
-benign, no increased risk of SCC
(as opposed to slightly increased risk with lichen sclerosis)
VIN
- precursor to what
- what is it characterized by
- what causes it
vulvar intraepithelial neoplasia
-precursor dysplasia to vulvar carcinoma
characterized by: 1. koilocytic change (raisin)
- disordered cellular maturation
- nuclear atypia
- increased mitotic activity
- can be caused by HPV infection (high risk)
Female pt presents with white patch on vulva with thick, leathery skin.
-think what
lichen simplex chronicus
condyloma
- what is it
- causes–most common, and 1 less common cause
-genital warts
Think STDs:
- HPV 6,11
- less common: secondary syphilis
Where does HPV infect in females?
(3)
think external to internal:
- Vulva
- vagina
- cervix
HPV:
-what kind of nucleic material in this virus?
DNA
non HPV vulvar carcinoma
- cause
- population
long standing lichen sclerosis
- chronic inflamm and irritation lead to carcinoma
- seen in elderly women (>70)
HPV:
how to put viruses in categories
HPV
/ \
Low risk High risk
6,11 16,18,31,33
condyloma dysplasia, carcinoma
Lichen sclerosis
- characterized by what (2)
- clinical presentation
think ‘think skin’ vs lichen simplex chronicus (thick skin)
- thinning of epidermis
- fibrosis (sclerosis ) of dermis (“lichen sclerosis)
presents as:
Leukoplakia with parchment-like vulvar skin “paper thin”
Paget’s disease of vulva vs nipple
-what is different between the 2
Vulva: usu no underlying carcinoma
nipple: usu has underlying carcinoma
How to distinguish extramammary Paget’s disease from melanoma?
3 markers
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)
name important parts of vulva (4)
-what cell type lines this
female parts external to hymen: include
- labia majora
- labia minora
- mons pubis
- vestibule
- squamous epithelium
bartholin cyst
-clinical presentation
- unilateral painful cystic lesion
- located at lower vestibule, adjacent to vaginal canal
How to differentiate lichen simplex chronicus from lichen sclerosis?
lichen simplex chronicus: thick, leathery skin
lichen sclerosis: thin paper-like skin
both are leukoplakia
Lichen simplex sclerosis
- characterized by what?
- clinical presentation
- assoc with what (2)
think ‘thick skin, leathery’
- hyperplasia of vulvar squamous epithelium
- presents as: leukopalkia with thick, leathery vulvar skin
- assoc with:
1. chronic irritation
2. scratching
