2. Vulva

Question 1

Disorders of the vulva

Answer 1

1. Bartholin cyst
2. Non-neoplastic epithelial disorders:
   - Lichen sclerosus
   - Lichen simplex chronicus
3. Neoplasms:
   - Benign
   i. Hidradenoma
   ii. Condylomas

• Malignant
  i. Vulva intraepithelial neoplasia
  ii. Squamous cell carcinoma
  iii. Paget’s disease

Question 2

Epidemiology of Bartholin cyst

Answer 2

Peak incidence: women in the reproductive age group

Question 3

Pathogenesis of Bartholin cyst

Answer 3

Blockage of the duct by inflammation or trauma → accumulation of secretions from gland → cyst formation

Question 4

Clinical features of Bartholin cyst

Answer 4

Often asymptomatic but can cause mild dyspareunia

Question 5

Epidemiology of Lichen sclerosus

Answer 5

1. Most commonly affects (postmenopausal) women

2. Mean age of onset: 52 years; less commonly affects prepubertal girls (age 7–8 years)

Question 6

Etiology of Lichen sclerosus

Answer 6

1. Unknown

2. Factors such as genetic predisposition, autoimmunity, hormonal changes are thought to play a role.

Question 7

Clinical features of lichen sclerosus

Answer 7

Early disease:

1. Papules and plaques that are white, polygonal, well-demarcated, and potentially surrounded by a red inflammatory halo
2. Dominant symptom: severe pruritus, possibly pain/soreness

Advanced disease
1. lichenification, skin thinning/fragility, and erosive scarring

Question 8

Complications of lichen sclerosus

Answer 8

1. Benign condition

2. Increased risk of squamous cell carcinomas, e.g., vulvar carcinoma

Question 9

Definition of lichen simplex chronicus

Answer 9

Secondary skin lesions as a result of chronic scratching

Question 10

Clinical features of lichen simplex chronicus

Answer 10

1. Lichenified plaques and excoriations

2. Lesions occur on any part of the body that is scratchable, including anogenital areas (e.g., vulva, scrotum, anus)

Question 11

Histopathology of lichen simplex chronicus

Answer 11

Hyperplasia and hyperkeratosis of squamous epithelium

Question 12

Prognosis of lichen simplex chronicus

Answer 12

Benign condition (risk of squamous cell carcinoma not increased)

Question 13

Definition of vulvar intraepithelial neoplasia (VIN)

Answer 13

Precancerous lesion caused by dysplasia of squamous cells

Question 14

Classification of valvular intraepithelial neoplasia

Answer 14

1. VIN, usual type (most common)
   - Associated with HPV
   - Commonly multifocal
2. VIN, differentiated type
   - Associated with lichen sclerosis and other dermatoses
   - Commonly unifocal
3. VIN, unclassified type

Question 15

Prognosis of valvular intraepithelial neoplasia

Answer 15

May progress to vulvar carcinoma despite treatment

Question 16

Paget disease of the vulva

Answer 16

1. Adenocarcinoma; carcinoma in situ
2. Low risk (< 15%) of underlying invasive Paget disease/invasive adenocarcinoma (unlike Paget disease of the breast which is always associated with underlying carcinoma)

Question 17

Clinical features of Paget disease of the vulva

Answer 17

1. Eczematoid lesions

2. Local pruritus