13.1 Vulva Flashcards
Define vulva
skin and mucosa external to the hymen
What 4 structures are part of the vulva
labia majora
labia minora
mons pubis
vestibule
What is the vulvar epithelium?
squamous
Where does the Bartholin gland drain
into the lower vestibule on each side of vaginal canal
What pop usually has a Bartholin cyst?
reproductive age (usually to STI)
CLinical presentation of Bartholin cyst
unilateral, painful cyst at lower vestibule adjacent to vaginal canal
define condyloma
warty neoplasm of the vulvar skin (can be in vagina or cervix too)–often large
What cuases condyloma
low-risk HPV infection
What are the low-risk HPV numbers?
6, 11
What are the low-risk HPV numbers? (4)
16, 18, 31, 33
histologic hallmark of a condyloma (describe the thing)
kiolocytic change - raisin nucleus
define Lichen SClerosis
thinning of epidermis and fibrosis of the underlying dermis
how does Lichen sclerosis present?
leukoplakia = “parchment like” vulvar skin
basically a white plaque
MC population seen with lichen sclerosis
post-menopausal women
Is lichen sclerosis benign or malignant
benign
what cancer is lichen sclerosis associted with
SqCC
what is cause/association of lichen simplex chronicus
chronic itching and scratching
how does lichen simplex chronicus present
leukoplakia with thick, leathery vulvar skin
define lichen simplex chronicus
hyperplasia of vulvar squamous epithelium
From what cell does vulvar carcinoma arise
squamous epithelium (all carcinomas arise from epithelial tissue)
how does vulvar carcinoma present
leukoplakia - need bx to diff from the lichens
what are 2 etiologies of vulvar carcinoma
HPV related or Non-HPV related
What HPV types is the HPV-related vulvar carcinoma due to?
high risk- types 16, 18, 31, 33
What precursor condition gives rise to HPV-related vulvar carcinoma
VIN- vulvar intraepithelial neoplasia
What are 4 chcs of VIN
koilocytic change, disordered cellular maturation, nuclear atypia, increased mitosis
What precursor condition gives rise to non-HPV-related vulvar carcinoma
long-standing lichen sclerosis (chronic inflammation)
What population most often has non-HPV-related vulvar carcinoma and why
elderly >70
it takes a while for the chroinic inflammation to cause carcinoma
define Extramammary Paget disease
malignant epithelial cells in the epidermis of the vulva
Extramammary Paget disease presnts as?
erythmatous, pruritic, ulcerated vulvar skin
What is diff bt Extramammary Paget disease and Paget disease of nipple other than location
Extramammary Paget disease is only in situ and unlike Paget disease of the nipple, represents no underlying carcinoma
What must Extramammary Paget disease be distinguished from
melanoma
What is marker profile for Melanoma (3)
PAS (-) - does not produce mucous- only epithleial cells
keratin (-) ONLY PRESent in epithelial cells
S100 (+) hallmark of melanoma
What is marker profile for extramammary pagets disease (3)
PAS (+) - produces mucuous
keratin (+) - int filament of epi cells
S100(-) only in melanoma
