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Endo/Repro II Test 1 > 17. Benign and Malignant Condition of the Vulva/Vagina > Flashcards

17. Benign and Malignant Condition of the Vulva/Vagina Flashcards

1
Q

Ambigous genitalia of the vulva can present with what on PE?

A
  1. Clitormegaly/ clitoral agenesis
  2. Bifed clitoris
  3. Midline fusion of the labiascrotal folds
  4. Cloaca = no separation between the vagina and bladder
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2
Q

With ambiogus genitalia, careful examination is required: ____, ____, ____, ____

A
  1. PE
  2. Hormonal studies
  3. US
  4. Karyotyping
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3
Q

What is the difference between how female pseudohermaphroditism and male PH is caused?

A
  • Femal PseudoHerm = masculinization in utero of the female fetus due to hormonal problems: congenital adrenal hyperplasia, ingestion of exogenous hormones, androgen-secreting rumors
  • Male = mocasism and occurs with different degrees of virulization and mullerian development
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4
Q

Androgen insensitivity syndrome (46 XY)

  • What is it?
  • Is most commonly inherited how?
  • Results in what?
A
  • Genetic deficiency in androgen receptors
  • X-linked recessive
  • External female genitals: undescended testes, Mullerian inhibiting substances causes lack of mullerian duct development (no uterus or fallopian tubes)
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5
Q

What is Fox-Fordyce disease?

A

severe, itchy, raised yellow cysts in the axilla and labia majora and minor due to from keratin-plugged apocrine glands => inflammation.

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6
Q

What is the most common type of genital cyst?

A

Epidermal inclusion cyst = mobile, non-painful, spherical, and slow growing cyst that form when hair follicle is obstructed, causing the deeper part to swell to accomodate desquamted cells

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7
Q

Sebaceous cysts of the vulva are most commonly found where and contain what?

A
  • Small, smooth, nodular mass found on the inner surface of labia minora and majora
  • Contain a cheesy sebaceous material
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8
Q

What is the most common benign solid tumor of the vulva; what are its growth characteristics?

A
  • Fibromas
  • Slow growing, most range from 1-10cm => but can become gigantic (250 lbs!!!!)
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9
Q

What is at the rare conditions that occurs when 1 or more of the minor vestibular glands becomes infected?

A

Vulvar vestibulitis (vestibular adenitis) => Small (1-4mm) red dots on the vulva that are tender.

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10
Q

When does vulvar vestibullitis (adenitis) come to attention?

Treatment?

A
  1. Pain during sex (dypareunia)
  2. Vulvar pain
  • Treatment: topical estrogen/hydrocortison or surgery
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11
Q

What is a urethral caruncle?

What causes it in children/post-menopausal women?

A
  • Small, beefy, red outgrowth at the distal edge of the urethra.
    • Children = spontaneous prolapse of the urethral epithelium
    • Post-menopausal women = contraction of the hypoestrogenic vaginal epithelium => everts urethral epithelium
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12
Q

What is the treatment for labial agglutination?

A

Estrogen cream and massage to separate the labia majora

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13
Q

Vuvlvar hematomas (bruising) most often arise following what; how are they managed?

A
  • Arise following trauma i.e., bike injuries (straddle injury), birth trauma or sexual assault
  • Close observation and occasional surgical exploration may be warranted
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14
Q

Atrophic vaginitis: what is it, is due to what; treated how?

A
  • Minora regress, majora shrinks, no rugae on vagina, closed vagina
  • DT: loss of estrogen
  • Treatment: topical estrogen and oral estrogen to prevent recurrance
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15
Q

Linchen Simplex Chronicus

  • What is it?
  • Symptoms?
  • Biopsy:
  • Treatment
A
  • Thick epithelium (white/red thick epithelium) due to prolonged scratching
  • Pruritis = itching
  • Hyperkeratosis, acanthosis + elongated rete ridges, dense inflammatory infiltrate (lymphocytes) in superficial dermis
  • Steroid ointments and anti-itch agents
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16
Q

Linchen Sclerosis

  • MC occurs:
  • Symptoms?
  • Complications:
  • Biopsy:
  • Treatment
A
  • MC occurs: VULVA in MENOPAUSAL women
  • Symptoms: Pruritis, dysparenuria, burning pain
  • Complication: can progress to SQCC of the vulva
  • Biopsy: Hyperkeratosis + Thin epithethlium + hyaline zone in superficial dermis d/t edema and degeneration of collagen + inflamm cells in BM
  • Treatment: Clobetasol
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17
Q

What findings do you see in linchen sclerosis?

A
  • Thin, white, skin that looks like parchment paper
  • Figure 8/ key-hole vagina: Loss of labia minor, regression of majora, constriction of hole, clitoris can become inverted/trapped
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18
Q

What is seen with lichen planus and what are the sx’s?

A
  • Purplish, polygonal papules that look erosive
  • Sx’s: vulvar burning, severe insertional dyspareunia
  • Tx: topical and systemic steroids
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19
Q

What is vulvar-vaginal-gingival syndrome?

A

When linchen planus involves the vulva, vagina and mouth

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20
Q

What does a imperforate hymen look like if detected after birth vs after period?

A
  • After birth = bulging membrane in opening of vagina that blocks mucus
  • After period = thin, blue structure that blocks period blood.
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21
Q

Transverse vaginal septums are most commonly found where in the vagina and may only become apparent when?

A
  • Upper and middle 1/3 of the vagina
  • May only become apparent when sex is impeded bc a small sinus tract or perforation will allow period flow
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22
Q

Midline longitudinal vaginal septum creates what?

A

Double vagina

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23
Q

What is the most extreme vaginal anomly?

A

Vaginal agenesis = NO vagina except for most distal part that is derived from urogenital sinus.

24
Q

What is Rokintansky-Kuster-Hauser Syndrome?

A

Mullerian agenesis characterizd by NO uterus but SPARES fallopian tubes

25
Q

What is the most common vulvovaginal tumor?

A

Bartholin’s Cyst

26
Q

Bartholin’s cysts are typically (uni-/bilateral); how does size dictate symptoms and when must you biopsy?

A
  • Typically unilateral swelling
  • < 3cm => usually asymptomatic
  • Need to biopsy in women 40+ y/o to rule out a Bartholin’s carcinoma!
27
Q

What is Bartholin Gland Abcess?

2 Treatment options?

A
  • Infection of Bartholin cysts
  • - Word catheterization: leave in catheter for 4-6 wks to drain secretions
  • - Marsupialization: creates a new duct opening by suturing the cyst wall onto vaginal mucosa
28
Q

What 4 structural changes of the vagina can occur over time?

A
  1. Cystocele (prolapsed bladder) => anterior vaginal prolapse (
  2. Rectocele (prolapsed rectum) => posterior vaginal prolapse
  3. Uterine prolapse
  4. Fistula
29
Q

Vulvar neoplasms

  • MC type of cancer in vulva
  • MC occur in
  • MC symptoms
  • Which precursor lesion is linked to cancer?
A
  • Squamous cell carcinoma of the vulva
  • Postmenopausal women (65YO)
  • Chronic itching
  • VIN III
30
Q

What is VIN III usual-type vs. differentiated-type?

A
  • - Usual-type: assoc w/ HPV (16/18), smoking, and immunocompromised states; occur in younger (35-65 y/o)
  • - Differentiated-type: is NOT assoc. w/ HPV or smoking –> more commonly w/ vuvlar dermatologic conditions, such as Lichen Sclerosus; older (55-85 y/o)
31
Q

DX and MC treatment for VIN Type III.

A
  • Dx = biopsy
  • Tx=
    • Local superficial surgical excision (w 5mm margins)
    • If small lesions on the clitoris, labia minor or perianal => laser therapy.
32
Q

Paget’s disease of the vuvla is most common in whom and what are the signs/sx’s?

A
  • Postmenopausal W females
  • Itching and tenderness are common —> map-like lesions: well-demarcated fiery red background + white plaque-like lesions (looks like eczema)
33
Q

How does Squamous Cell Vulvar Carcinoma spread?

A
  1. Direct extension: vagina, urethra, anus
  2. Lymph: regional LN
  3. Blood: distant sites (lung, liver, bone)
34
Q

What is the management for SCC of the vulva?

A
    • Radical vulvectomy and regional lymphadenectomy
      1. or
    • Wide local excision of the tumor w/ inguinal LN dissection
      1. or
  3. If postive nodes => pre-op radiation
35
Q

What do the lesions of verrucous carcinoma of the vuvla look like; what kind of tx is contraindicated?

A
  • Cauliflower-like lesions and can be confused w/ condyloma

- Radiation = contraindicated because it may cause anaplastic transformation

36
Q

What is tx for Batholin’s gland carcinoma?

A

Radical vulvectomy and bilateral lymphadenectomy w/ post-op radiation

37
Q

When is the diagnosis of vaginal intraepithelial neoplasia (VAIN) usually considered?

A

When an abnormal pap in a woman who is status post-hysterectomy or has no cervical lesion

38
Q

MC type of vaginal cancer?

treatment

A
  • Squamous cell carcinoma
  • Radiation or chemo radiation; if lower 1/3 affected => remove groin nodes and if upper vagina is involved => surgery
39
Q

Vagina is lined by what type of epithelium?

A

Non-keratinizing stratified squamous epithelium

40
Q

Describe the NL flora of the vagina

A

Lactobacilli makes lactic acid and H202 to keep the pH of the vagina at (3.8-4.2) and can protect against STIs.

41
Q

What can alter NL flora of the vagina?

A
  1. ABX
  2. Douching
  3. Sex (semen can increase to 7.2 for 6-8 hours and vaginal transudate has a pH of 7.4)
  4. Foreign bodies (retained tampon)
42
Q

Vaginal Discharge

  • Inspect what?
  • Use ______ to determine the vaginal pH.
  • When collecting sample for investigation of vaginal discharge where do you take the sample from?
A
  • Color, smell, texture, amount
  • Nitrazine paper = pH
  • Sample discharge from posterior fornix and place on slide
    *
43
Q

What is the most common cause of vaginitis?

A

Bacterial vaginosis (BV), which is often polymicrobial but Gardnerella vaginalis is most common.

44
Q

Bacterial Vaginosis

  • RF
  • SX
A
  • RF = new/many sex partners, smoking, IUD, douching
  • Sx=
      1. Many asymptomatic
      1. Thin, milky, fishy discharge, ESP after sex
45
Q

Diagnosis of Gardnerella vaginalis as cause of vaginitis can be made with what 3 findings?

A
  1. Saline wet mount = “clue cells” = epithelial cells covered w bacteria
  2. 10% KOH-positive whiff test
  3. Vaginal pH >4.5
46
Q

What is treatment for Gardnerella vaginalis?

Treat other partner?

A
  • 500 mg Metronidazole BID x 7 days
  • No bc not a STD
47
Q

2nd most common cause of vaginal infections and symptoms

A
  • Vulvovaginal candiasis =
    • [itching, burning, irritation, dysparenia]
    • Often little to no discharge, but if present = white and clump
48
Q

RF for vulvaginal candiasis

A
  1. T2DM
  2. ABX
  3. Increased estrogen (OCP/pregnancy)
  4. Immunosupressed
49
Q

Diagnosis of vuvlovaginal candidiasis made via what 2 findings?

A
  1. 10% KOH wet prep = + for budding yeast (pseudohyphae)
  2. Vaginal pH < 4.5
50
Q

Treatment for vulvovaginal candidiasis?

A
  • Diflucan
  • Vaginal application w/ synthetic imidazoles (miconazole, terconazole, etc.)
51
Q

Symptoms T. vaginalis?

A
  1. 50% are asymptomatic
  2. IF SX:
    1. Green-yellow “frothy” discharge
    2. Strawberry cervix
    3. Dysparenia, irritation
52
Q

How is diagnosis of T. vaginalis made?

A
  1. Saline wet mount reveals motile trichomonads
  2. pH >4.5
  3. Strawberry cervix
53
Q

What is the treatment for T. vaginalis; treat partner?

A
  1. Metronidazole
  2. YES bc STD.
54
Q
A
55
Q

pH in

    • Bacterial vaginosis
    • Candiasis
    • Trichomonas
A
  1. > 4.5 (basic)
  2. < 4.5 (acidic)
  3. > 4.5 (basic

Endo/Repro II Test 1 (23 decks)

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