13.1 Vulva

Question 1

Define vulva

Answer 1

skin and mucosa external to the hymen

Question 2

What 4 structures are part of the vulva

Answer 2

labia majora
labia minora
mons pubis
vestibule

Question 3

What is the vulvar epithelium?

Answer 3

squamous

Question 4

Where does the Bartholin gland drain

Answer 4

into the lower vestibule on each side of vaginal canal

Question 5

What pop usually has a Bartholin cyst?

Answer 5

reproductive age (usually to STI)

Question 6

CLinical presentation of Bartholin cyst

Answer 6

unilateral, painful cyst at lower vestibule adjacent to vaginal canal

Question 7

define condyloma

Answer 7

warty neoplasm of the vulvar skin (can be in vagina or cervix too)–often large

Question 8

What cuases condyloma

Answer 8

low-risk HPV infection

Question 9

What are the low-risk HPV numbers?

Answer 9

6, 11

Question 10

What are the low-risk HPV numbers? (4)

Answer 10

16, 18, 31, 33

Question 11

histologic hallmark of a condyloma (describe the thing)

Answer 11

kiolocytic change - raisin nucleus

Question 12

define Lichen SClerosis

Answer 12

thinning of epidermis and fibrosis of the underlying dermis

Question 13

how does Lichen sclerosis present?

Answer 13

leukoplakia = “parchment like” vulvar skin

basically a white plaque

Question 14

MC population seen with lichen sclerosis

Answer 14

post-menopausal women

Question 15

Is lichen sclerosis benign or malignant

Answer 15

benign

Question 16

what cancer is lichen sclerosis associted with

Answer 16

SqCC

Question 17

what is cause/association of lichen simplex chronicus

Answer 17

chronic itching and scratching

Question 18

how does lichen simplex chronicus present

Answer 18

leukoplakia with thick, leathery vulvar skin

Question 19

define lichen simplex chronicus

Answer 19

hyperplasia of vulvar squamous epithelium

Question 20

From what cell does vulvar carcinoma arise

Answer 20

squamous epithelium (all carcinomas arise from epithelial tissue)

Question 21

how does vulvar carcinoma present

Answer 21

leukoplakia - need bx to diff from the lichens

Question 22

what are 2 etiologies of vulvar carcinoma

Answer 22

HPV related or Non-HPV related

Question 23

What HPV types is the HPV-related vulvar carcinoma due to?

Answer 23

high risk- types 16, 18, 31, 33

Question 24

What precursor condition gives rise to HPV-related vulvar carcinoma

Answer 24

VIN- vulvar intraepithelial neoplasia

Question 25

What are 4 chcs of VIN

Answer 25

koilocytic change, disordered cellular maturation, nuclear atypia, increased mitosis

Question 26

What precursor condition gives rise to non-HPV-related vulvar carcinoma

Answer 26

long-standing lichen sclerosis (chronic inflammation)

Question 27

What population most often has non-HPV-related vulvar carcinoma and why

Answer 27

elderly >70

it takes a while for the chroinic inflammation to cause carcinoma

Question 28

define Extramammary Paget disease

Answer 28

malignant epithelial cells in the epidermis of the vulva

Question 29

Extramammary Paget disease presnts as?

Answer 29

erythmatous, pruritic, ulcerated vulvar skin

Question 30

What is diff bt Extramammary Paget disease and Paget disease of nipple other than location

Answer 30

Extramammary Paget disease is only in situ and unlike Paget disease of the nipple, represents no underlying carcinoma

Question 31

What must Extramammary Paget disease be distinguished from

Answer 31

melanoma

Question 32

What is marker profile for Melanoma (3)

Answer 32

PAS (-) - does not produce mucous- only epithleial cells
keratin (-) ONLY PRESent in epithelial cells
S100 (+) hallmark of melanoma

Question 33

What is marker profile for extramammary pagets disease (3)

Answer 33

PAS (+) - produces mucuous
keratin (+) - int filament of epi cells
S100(-) only in melanoma