15. Vulva, Vagina, Cervix Flashcards
What is a Bartholin cyst?
Obstructed glands around the vulva
What is leukoplakia?
White patches on the vulva
What are the causes of leukoplakia on the vulva?
Vitiligo
Infectious eg. candida
Pre-neoplastic
Lichen sclerosis
What is lichen sclerosis et atrophicus?
Vulval skin produces white plaques
May develop dysplasia and malignancy
How does lichen sclerosis et atrophicus appear on histology?
Subepithelial fibrosis
Atrophy and scarring of epithelium
Band of hyalinisation
What is lichen sclerosis chronicus?
Chronic inflammation causing itching eg. allergic causes, appearance is due to scratching
Increased granularity in the upper epithelium causes whitening
How does lichen sclerosis chronicus appear on histology?
Acanthosis (increased squamous cells)
Hyperkeratosis
What is the treatment for lichen sclerosis chronicus?
Topical steroids
What are the benign neoplasms of the vulva?
Papillary hiradenoma Condyloma accuminatum (HPV)
What are the malignant tumours of the vulva?
Vulval intraepithelial neoplasia > SCC
Paget’s disease
Melanoma
What cells are involved in papillary hiradenoma?
Gland epithelial cells in the vulva
Which HPV strains cause condyloma accuminatum?
6 and 11
What is Vulval Intraepithelial Neoplasia?
High risk HPV causes VIN which can progress to carcinoma with advanced age or immunosuppression
What is differentiated VIN?
Unrelated to HPV
Due to p53 deletion or background inflammation
What factors determine the prognosis of SCC of the vulva?
Depth of invasion
Lymphatic invasion
What is Paget’s disease?
Involvement of epithelium by an adenocarcinoma (granular cytoplasm due to mucin production)
Results in a red, crusted skin lesion
Tumour cells in epithelium separated by a halo from other cells
What stain is Paget’s disease positive for?
PAS
What tumours can arise in the vagina?
SCC
Adenocarcinoma
Embryonal Rhabdomyosarcoma
What precursor is associated with SCC of the vagina?
VaIN
What event caused an increased rate of adenocarcinomas?
Synthetic oestrogen was given which had teratogenic effects on female babies
What is the most common appearance of adenocarcinomas of the vagina?
Clear cell
Which HPV viruses cause invasive tumours?
16 and 18
What cancers are caused by HPV 16 and 18?
SCC: CIN precursor
Adenocarcinoma: CGIN precursor
What tumours can affect the cervix?
80% SCC
15% adeno
Neuroendocrine
Adenosquamous
What is desmoplasia?
Strong WBC reaction in stroma
Good prognosis
What is the primary prevention of cervical cancer?
Vaccination
What is the secondary prevention of cervical cancer?
Screening: cytology and HPV testing
Cervical exam using colposcopy
Lesion excision
When is a colposcopy done?
If abnormal pap smear
Can be used for biopsy and excision
What is the most common excision used in cervical cancer?
Large loop excision of transformation zone
What genetic syndrome can cause adenocarcinoma of the cervix without HPV involvement?
Peutz-Jegher syndrome
