15. Vulva, Vagina, Cervix

Question 1

What is a Bartholin cyst?

Answer 1

Obstructed glands around the vulva

Question 2

What is leukoplakia?

Answer 2

White patches on the vulva

Question 3

What are the causes of leukoplakia on the vulva?

Answer 3

Vitiligo
Infectious eg. candida
Pre-neoplastic
Lichen sclerosis

Question 4

What is lichen sclerosis et atrophicus?

Answer 4

Vulval skin produces white plaques

May develop dysplasia and malignancy

Question 5

How does lichen sclerosis et atrophicus appear on histology?

Answer 5

Subepithelial fibrosis
Atrophy and scarring of epithelium
Band of hyalinisation

Question 6

What is lichen sclerosis chronicus?

Answer 6

Chronic inflammation causing itching eg. allergic causes, appearance is due to scratching
Increased granularity in the upper epithelium causes whitening

Question 7

How does lichen sclerosis chronicus appear on histology?

Answer 7

Acanthosis (increased squamous cells)

Hyperkeratosis

Question 8

What is the treatment for lichen sclerosis chronicus?

Answer 8

Topical steroids

Question 9

What are the benign neoplasms of the vulva?

Answer 9

Papillary hiradenoma
Condyloma accuminatum (HPV)

Question 10

What are the malignant tumours of the vulva?

Answer 10

Vulval intraepithelial neoplasia > SCC
Paget’s disease
Melanoma

Question 11

What cells are involved in papillary hiradenoma?

Answer 11

Gland epithelial cells in the vulva

Question 12

Which HPV strains cause condyloma accuminatum?

Answer 12

6 and 11

Question 13

What is Vulval Intraepithelial Neoplasia?

Answer 13

High risk HPV causes VIN which can progress to carcinoma with advanced age or immunosuppression

Question 14

What is differentiated VIN?

Answer 14

Unrelated to HPV

Due to p53 deletion or background inflammation

Question 15

What factors determine the prognosis of SCC of the vulva?

Answer 15

Depth of invasion

Lymphatic invasion

Question 16

What is Paget’s disease?

Answer 16

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

Question 17

What stain is Paget’s disease positive for?

Answer 17

PAS

Question 18

What tumours can arise in the vagina?

Answer 18

SCC
Adenocarcinoma
Embryonal Rhabdomyosarcoma

Question 19

What precursor is associated with SCC of the vagina?

Answer 19

VaIN

Question 20

What event caused an increased rate of adenocarcinomas?

Answer 20

Synthetic oestrogen was given which had teratogenic effects on female babies

Question 21

What is the most common appearance of adenocarcinomas of the vagina?

Answer 21

Clear cell

Question 22

Which HPV viruses cause invasive tumours?

Answer 22

16 and 18

Question 23

What cancers are caused by HPV 16 and 18?

Answer 23

SCC: CIN precursor
Adenocarcinoma: CGIN precursor

Question 24

What tumours can affect the cervix?

Answer 24

80% SCC
15% adeno
Neuroendocrine
Adenosquamous

Question 25

What is desmoplasia?

Answer 25

Strong WBC reaction in stroma

Good prognosis

Question 26

What is the primary prevention of cervical cancer?

Answer 26

Vaccination

Question 27

What is the secondary prevention of cervical cancer?

Answer 27

Screening: cytology and HPV testing
Cervical exam using colposcopy
Lesion excision

Question 28

When is a colposcopy done?

Answer 28

If abnormal pap smear

Can be used for biopsy and excision

Question 29

What is the most common excision used in cervical cancer?

Answer 29

Large loop excision of transformation zone

Question 30

What genetic syndrome can cause adenocarcinoma of the cervix without HPV involvement?

Answer 30

Peutz-Jegher syndrome