13.1 Vulva

Question 1

Bartholin Cyst

Answer 1

Cystic dilation of the Bartholin gland - arises due to inflammation and obstruction of gland

Question 2

What is the vulva lined with?

Answer 2

Squamous Epithelium

Question 3

Who does Bartholin cyst typically occur in?

Answer 3

Women of reproductive age

Question 4

What is the clinical presentation of bartholin cyst?

Answer 4

Unilateral painful cystic lesion in the lower vestibule adjacent to the vaginal canal

Question 5

Condyloma

Answer 5

Warty neoplasm of vulvar skin

Question 6

What is the most common cause of condyloma?

Answer 6

HPV Type 6 and 11

Question 7

What is characteristic of condylomas?

Answer 7

Koilocytes (crinkled nucleus in cells)

Question 8

What are the low risk HPVs?

Answer 8

HPV-6 and 11

Question 9

What are the high risk HPVs?

Answer 9

HPV-16, 18, 31 and 33

16 and 18 MOST common

Question 10

What is the classic lesion of the low risk HPVs?

Answer 10

Condyloma

Question 11

What is the main lesion with high risk HPVs?

Answer 11

Dysplasia that can eventually lead to carcinoma

Question 12

Lichen Sclerosis

Answer 12

Thinning of the epidermis and fibrosis of the dermis

Question 13

What are the presentations of lichen sclerosis?

Answer 13

Leukoplakia with parchment like vulvar skin

Question 14

Lichen Simplex Chronicus

Answer 14

Hyperplasia of vulvar squamous epithelium

Question 15

What are the presentations of lichen simplex chronicus?

Answer 15

Leukoplakia with thick leathery skin

Question 16

What is lichen simplex chronicus associated with?

Answer 16

Chronic irritation and scratching

Question 17

What is the risk of SCC with lichen simplex chronicus?

Answer 17

None

Question 18

What is the typical patient of lichen sclerosis?

Answer 18

Postmenopausal Women

Question 19

Vulvar Carcinoma

Answer 19

Arises from vulvar squamous epithelium - RARE

Question 20

How does vulvar carcinoma present?

Answer 20

Presents as leukoplakia

Question 21

What is the key non-HPV cause of vulvar carcinoma?

Answer 21

Longstanding lichen sclerosis

Question 22

What is the typical patient of non-HPV vulvar carcinoma?

Answer 22

Elderly women ~70 yrs

Question 23

Extramammary Paget Disease

Answer 23

Malignant epithelial cells in the epidermis of the vulva

Question 24

How does extramammary Paget disease present?

Answer 24

Red, pruritic ulcerated skin

Question 25

What is the staining of Paget cells (carcinoma)?

Answer 25

PAS+, keratin+ and S100-

Question 26

What is the staining of melanoma?

Answer 26

PAS-, keratin- and S100+