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ENRP II > Benign and Malignant Condition of the Vulva and Vagina > Flashcards

Benign and Malignant Condition of the Vulva and Vagina Flashcards

1
Q

ambigious geneitalia can present with? (5 things)

A

cliteromegaly
clitoral agenesis
bifid clitoris
midline fusion of the labiascrotal folds
cloaca

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2
Q

what is the cause of clitoral agensis

A

failure of the genital tubercle to form

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3
Q

what is a cloaca

A

no definite seperatino between the vagina and bladder

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4
Q

in general with suboptimal development of penile or scrotal structure the infant is usually assigned a _ gender

A

female

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5
Q

what is female pseudohermapahroditism

A

masculinization in utero of a female fetus caused by CAD, exogenous hormones, androgen secreting tumors

internal genital organs is normal

CAD: 21 hydroylase def, increased testosterone

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6
Q

most obvious abnormality in female psuedohemaphorditsm ?

A

clitoromegaly, hypospadic urethra meatus, malpositioned vaginal orifice

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7
Q

what is male pseudohermaphorditism

A

mocaism that can give various degrees of virulization and mullerian development

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8
Q

comme example of male psuedohermaphordisim

A

androgen insensitivity syndrome

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9
Q

what is androgen insensitivity

A

a genetic deficiency in androgen receptors

46XY

results in an external female development

X linked recessive

testes in abdomen

male levels of testosterone, absent uterus

ambigious genetalia is due to the partial androgen insensivity

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10
Q

what is true hermaphoditism

A

a rare disorder that gives both male and female development externally and internally with either combined ovotests or seperate gonads

the degreee of masculinization depends on the amount of functioning testincular tissue producing testosterone

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11
Q

what is labial agglutination, how is it treated?

A

this is when the labia sticks together, we can take estrogen cream and manual manipulation to seperate the labia majora

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12
Q

what is fox-fordyce disease

A

itchy raised yellow cysts in the axilla (armpit) and labia majora and minora that result from keratin plugged inflammation of apocrine glands

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13
Q

what are inclusion cysts

A

cysts that are beneth the epidermis that are mobile and non tender and slow growing

most times dont need treatment

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14
Q

what is an epidermal inclusion cyst

A

the most common type of genital cyst that develops when the hair follicles become obstructed and the deeper portion of the follicle swells to acommodate the desquamated cells

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15
Q

what are vuvlar varicosities

A

enlarged veins that can enlarge and become painful in pregnancy they are typically blue in color

(tortous veins)

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16
Q

_ and _ on the vulva need to be distinguished from melanomas

A

lentigos (freckles) and nevi (moles)

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17
Q

what are urethral caruncles?

A

small fleshy, super red warty outgrowths from the distal edge of the urethra

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18
Q

urethral caruncles are caused by what in children?

are caused by what in adults?

A

caused by spontenous prolapse of the urethral epithelium

contraction of the hypoestrogenic vaginal epithelium which everts the urethral epithelium

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19
Q

what is vulvar vestibulitis

A

infection of the minor vestibular glands that are super tender out of porprtion to the pressure applied

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20
Q

symptoms of vulvar vestibulities

A

extremely tender
erythematous dots
pain with sec
vulvar pain

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21
Q

how to treat vulvar vestibulitis

A

topical estrogens, maybe surgery if required

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22
Q

what is a sebaccous cyst of the vulva

A

blockage of the sebaceous gland ducts that are usually on the inner surface of the labi minora/majora with a cheese sebacous material

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23
Q

what is a fibroma of the vulva

A

most common benign solid tumor of the vulva (slow growing, can become HUGE)

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24
Q

what is a lipoma of the vulva

A

this is a slow growing tumor composed of adipose cells

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25
Q

what is a hidradenoma of the vulva

A

lesion arising from the sweat gland of the vulva

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26
Q

what is a syringoma

A

eccrine gland tumor

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27
Q

what is a neurofibroma on the vulva

A

a lesion that is from von recklinghausens disease

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28
Q

what is an angioma, who is it most common in ?

A

multiple red lesions on the vulva that is seen in the 4th and 5th decade of life

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29
Q

what are some traumatic lesions of the vulva

A

vulvar hematoma: following trauma a collection of blood - fall off bike/straddle injury- observe closely

female genital circumcision- common in african and eastern asia- increases risk for infection, change in sexual function and vaginal delivery

obestetric related trauma- lacerations or episotomies

episiotomy- cut in the opening of the vagina to help during childbirth

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30
Q

what is atrophic vaginitis, what causes it, how do we treat

a dermatological condition

A

the minora regresses and majora shrinks, loss of vaginal ruggae, vaginal introitus constricts

from a loss of estrogen

topical estrogen ( oral estrogen if concered about reoccurence)

menopause- loss of estrogen

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31
Q

what is lichen simplex chronicus of the vulva

A

squamous cell hyperplasia that causes local thickening of the epithelium from prolonged scratching

it is super itchy

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32
Q

what are the symptoms of lichen simplex chronicus

A

itchy, white or reddish leathery raised surface

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33
Q

biopsy of lichen simplex chronicus shows?

A

elongated rete ridges and hyperkeratosis of the keratin layer

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34
Q

treatment of lichen simplex chronicus

A

steroid ointments and antipuritic agents

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35
Q

what is lichen sclerosis of the vulva

A

a condition typically found in post menopausal women that can cause genital structural abnormalities similar to an atrophic vagina ( loss of labia minora, shrinking of labia majora, constriction of introitus, inverted clit)

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36
Q

what are the symptoms of lichen sclerosis

A

intense itchiness, white inelactic skin that is like crinkled tissue paper

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37
Q

biopsy of lichen sclerosis shows

A

thinning of the epidermis

loss of rete ridges and inflammatory cells in the basement membrane

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38
Q

treatment of lichen sclerosis

A

high does steroid clobetasol

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39
Q

the most striking feature of lichen sclerosis on histology is?

A

hyaline zone from edema and defeneration of collagen and elastic fibers of the dermis

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40
Q

what is lichen planus of the vulva, what syndrome can it present with? how do we treat?

A

this is purplish polygonal papules in the vagina

it can present with a vulvar-vaginal-gingival syndrome : where papules are in the vulva, vagina, and mouth

there is vulvar burning and pain with intercourse

treat with steroids

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41
Q

psoriasis of the vulva and most cases is inherited in a _ _ fashion it will appear _ but may lack the silver scaly patches clinically seen

A

autosomal dominant

velvety

usually on flezor surfaces

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42
Q

eczema on the vulva has a _ presentation

A

erythematous

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43
Q

pemphigus of the vulva is an autoimmune _ disease that involves the vulvovaginal and _ areas

A

blistering

conjunctival areas

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44
Q

bechets syndrome of the vulva classically involves _ of the genital and oral areas with uveitis

A

ulcers

uveits- inflammtion of the uvea (middle portion) of the eye

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45
Q

chrons disease is primarily a _ disorder byt vulvar ulcerations can occur due to fistualizations

A

GI

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46
Q

what are apthous ulcers?

A

superifical painful ulcers that are more commonly found in the mouth but can be on vulva

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47
Q

what are decubitous ulcers of the vulva

A

ulcers on vulva due to chronic pressure or secondary to mositure from urinary incontience

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48
Q

what is acanthosis nigricans of the vulva

A

brown pigmented thickened superifical layers of skin that is due to insulin resistance and obesity

often seein in interiginous areas: vulva, axilla, nape of neck

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49
Q

what is contact dermatitis of the vulva

A

physical exam is important ebcause this can be caused by any irritant it will appear bright red

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50
Q

imperforate hymens can cause primary amenorrhea and form a _ membrane like structure that can blood mucus and blood. If not detected until after menarch, imperforate hymen can appear as a thin dark _ structure

A

bulging

blue

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51
Q

vaginal septums can be transverse or midline longitudinal, the trasnverse vaginal septum is typically found in the _ and _ _ of the vagina and allow some menstrual flow to occur. However it may only become appearent when _ is impeded. Midline longitudinal vaginal septums create a _ vagina along with a blind _. Midline septas are usually associated with various duplication anomalies of the _ _

A

middle and upper thirds of the vagina

intercourse is impeded

double

blind pouch

uterine fundus

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52
Q

vaginal agensis is the most exterme vaginal anomaly with toal absence of the vagina except for the most distal portion that is derived from the _ _

A

urogenital sinus

53
Q

rokitansky kuster hauser syndrome is ?

A

mullerian agensis when the uterus is absent but he fallopian tubes are spared (sometimes ovaries too)

54
Q

what is adenosis

A

when the vaginal wall consists of endocervical epithelium with columnar cells in the normal squamous epithelium

squamous metaplasia

55
Q

what causes adenosis of the vagina

A

DES exposure in utero

56
Q

what is a gartner duct cyst?

A

this is a remnant of the wolffian duct that is usually found on the lateral wall of the vagina and looks like a grape

57
Q

what is a urethral diverticula ?

how do we treat it

what can it cause

A

a sac like projection in the anterior vagina along the posterior uretha

can cause reccurent UTIs and urinary leakage

treat with wrethral dilation of excision

58
Q

what is an inclusion cyst in the vagina

A

infolding vaginal epithelium in the posterior or lateral wall in the lower third of the vagina

59
Q

inclusion cysts in the vagina are most oftenly caused by?

A

gynecological surgery or lacerations

60
Q

endometriosis in the vagina

A

ectopic endometrial tissue in the vagina that can cause very bad cyclin pain, infertility, and pain with sex

61
Q

what is a batholin cyst

A

this is a vulvovaginal tumor that has unilateral swelling (need to biopsy it to make sure its not batholin carcinoma)

62
Q

what is a bartholin gland abcess caused by?

how do we treat

A

it is caused by blockage and accumulation of purulent material in the bartholin gland

treat with word catheterization or marsupilization

63
Q

what is word catheterization

A

a procedure for a batholin gland abcess where you promote formation of a new epithelized tract for glandular secretions

64
Q

what is marsupialization

A

a procedure for a bartholin cysts that creats a new ductal opening by everting the cysts wall onto the epithelial surface

65
Q

vagina sits at a _ degree angle

A

45

66
Q

what are some structural changes to the vagina that can occur over time

A

cystocele: anterior vaginal prolapse- can cause urinary incontience

rectocelel: posterior vaginal prolapse- can necessitate the need to put finger in vagina to get poop out

uterine prolapse: cervic or uterus imponging on vagina

fistulas: rectovaginal (pass stool through vagina), urethrovaginal, vescivovaginal

67
Q

what is the most common cause of uterine prolapse

A

pelvic floor trauma

like in childbirth

68
Q

malignant tumors of the vulva are _

A

uncommon

69
Q

most tumors of the vulva are _ _ _ that mainly occurs in postmenopausal women, the mean age is _ and the most reported symptom is _

A

squamous cell carcinomas

65

chronic vulvar puritis

70
Q

vulvar intraepithelial III (VINIII) is also known as _ and have been linked to vulvar cancer

A

squamous cell carcinoma insitu

71
Q

lesions are designated VIN I, VIN II, VIN III because upon _ of epithelial involvement

A

depth

72
Q

Vulvar Intraepithelial neoplasia type 3 (VIN III) can be divided into what 2 types: what are each one more associated with

A

VIN III Usual type- associated with HPV16 and smoking, and immunocompromised

VIN III Differentiated type- associated with dermatological conditions like lichen sclerosis

73
Q

how do you treat squamous carcinoma insitu of the vulva (VIN III)

A

they look warty in apperance

can do local superficial exicison of laser therapy

74
Q

what is pagets disease of the vulva

A

this is a rare disease that occurs in post menopausal white females that can also occur in the breast, it shows firey red background with white plaque like lesions

75
Q

biopsy of pagets disease

A

large pale pagets cells

76
Q

20 percent of patients with vulvar pagets disease will have an underlying _

A

carcinoma

77
Q

how do you treat pagets disease

A

local superifical excision

78
Q

squamous cell carcinoma accounts for most vulvar cancers they usualy present in _ year old women with a lesion that is _, raised pigmented or warty. It is usually on the labia _ (minora/majora) and needs a biopsy for diagnosis.

A

75

itchy

majora

79
Q

how can SCC of the vulva spread

A

direct extension to adjacent structures like the vagina, uretha, anus

lymphatic spread

hematogenous spread

80
Q

type 1 SCC of the vagina is the usual type and type 2 is differented VIN (this is the same as VIN III types), which one has a precurosir of VIN, condyloma association, HPV association, STD association, and cervical neoplasia risk

A

type 1 (usual type)

81
Q

how can you treat SCC vulvar carcinoma

A

vulvectomy with regional lymphedenectomy

excision of primary tumor + removal of inguinal llymph node + radiation

82
Q

stage 1 SCC of the vulva rarely has positive _ nnodes and thus ipsilateral lymphadenectomy is sufficent

A

contralateral

83
Q

if positive nodes are indentifies in SCC of the vulva post op _ is needed

A

radiation

84
Q

what is malignant melanoma of the vulva?

A

second most common vulvar carcinoma that is usually on the labia minora and clitoris

must excise it all to stage

85
Q

what is a verrucous carcinoma of the vulva

A

a variant of squamous cell carcinoma it looks like a califlower lesion and can be confused with HPV condyloma (wart)

86
Q

in a verrucous carcinoma _ is rare and _ is contraindicated because it may induce anaplastic transformation

A

metastasis

radiation

87
Q

what is a batholins gland carcinoma of the vulva

A

this is a painless vulvar mass without history of bartholin gland disorders (must biopsy)

treat with radical vulvectomy and bilateral lymphadenectomy

recurrence is possible

88
Q

what is basal cell carcinoma of the vulva?

A

rolled edge ulceration in the vulva that does not metastasize

89
Q

vaginal intraepitheleal neoplasia (VAIN) is a precursor lesion in the vagina that is related to _ usually it is considered with an abnomral _ and no demonstrable pap lesion, you will need to get a _ direct vaginal biopy

A

HPV

pap

coloscopic

90
Q

in the VAIN lesion involves the vaginal vault how do you treat

A

surgical excision

91
Q

if VAIN has multifocal lesions how do you treat

A

laser therapy or topical 5’ fluorouracil

may need vaginectomy

92
Q

most vaginal cancers are _ _ carcinomas

A

squamous cell

93
Q

symptoms of vaginal SCC

A

hematuria, abnormal vaginal discharge or bleeding

94
Q

on physicial exam how does SCC of the vagina look?

A

ulcerative or exophytic growths

95
Q

how does vaginal SCC spread

A

direct spread
lymphatic spread
hematogenous spread

96
Q

diagnosis of vaginal SCC requires a _ biopsy

A

punch

97
Q

how do you treat SCC of the vagina

A

chemoradiation

if lower 1/3 is involved you need to remove the groin nodes or treat those too

if upper vagina is involved you should remove the vgina with upper vaginestomy, bilatteral lymphadenectomy, or radical hysterectomy

98
Q

adenocarcinoma of the vagina are mostly _ from the cervix, ednometrium, or ovary. Clear cell carcinomas are secondary to _ and they are treated with hysterectomy, vaginectomy or radiation

A

metastatic

DES exposure

they have a good survivial rate

99
Q

malignant melanomas of the vagina are usually on the distal _ wall

A

anterior

poor survivial rate

100
Q

what are sarcoma botryoides

A

this is a childhood vaginal tumor that is histologically a embryonal rhabdomysarcoma and presents like a grape like polyp mass protubding from the introitus

ages 2-3

101
Q

how do you treat a sarcoma botyoides?

A

surgical resection, chemotherapy, radiation

102
Q

the vagina is lined by _ _ _ epithelium

A

non keratinized stratified squamous epithelium

103
Q

lactobacili in the vagina produce _ and _

A

hydrogen peroxide and lactiv acid

104
Q

normal vaginal pH is?

A

3.8-4.2 acidic

105
Q

what can alter the vagina protective microflora

A

antibiotcs, douching, intercourse, foreign body

106
Q

most bacteria in the vagina is _ (aerobic/anerobic)

A

anerobic

107
Q

semen can raise the pH of the vagina to ?

A

7.2

108
Q

how can you test the vaginal pH

A

with nitrazine paper

109
Q

how do you sample vaginal discharge under a microscope

A

sample from the posterior fornix place on a slide and then view under a microscope

also look grossly ask about color, amount, texture, odor

110
Q

what is the most common cause of vagnitis

A

bacterial vaginosis

111
Q

BV is mostly caused by?

A

polymicrobial but gardnerella vaginalis

112
Q

risk factors for BV

A

multiple sex partners, smoking, IUD, douching

113
Q

what are the symptoms of BV

A

think milky discharge, malodourous fishy amine odoer especially after intercourse

114
Q

how do you diagnose BV

Wet mount:
KOH whiff test:
pH:

A

wet mount: clue cells
KOH whiff test: amine like odor (positive)
pH: greater than 4.5

115
Q

treatment of BV

A

metroidazole

116
Q

do you have to treat someone partner if they have BV?

A

no because it is not a sexually transmitted infection

117
Q

what is the second most common cause of vaginits?

A

vulvovaginal candiasis

118
Q

what is the most common cause of vulvovaginal candidiasis

A

candidie albicans

119
Q

what are the risk factors for vulvovaginal candidiasis

A

increased estrogen, DM, antibiotics, steroids, immunosuppresion

120
Q

symptoms of vulvovaginal candidiasis

A

itching, burning/irritation

cottage cheese like discharge

121
Q

diagnosis of vulvovaginal candidiasis

KOH wet prep:
pH:

A

KOH wet prep: positive for budding yeast; psuedohyphae
pH: less than 4.5

122
Q

treatment of vulvovaginal candidiasis

A

diflucan

imidazoles (micanzole, teraconazole)

123
Q

trichomoniasis is caused by?

A

flagellate protazona Trichomonas vaginalis

124
Q

risk factors for trichomoniasis

A

unprotected sex

125
Q

what are the symptoms of trichomoniasis

A

pain with sec, irritation, green/yello frothy discharge

126
Q

diagnosis of trichomoniasis

saline wet mount:

ph:

Cervix:

A

wet mount: motile trichomonads

pH: greater than 4.5

cervix: strawberry cervix

127
Q

treatment of trichomonisis

A

metroidazole

128
Q

in a patient with trichomoniasis should their patient be tested

A

yes, it is an STD so they should be tested and evaluated for STIs !

ENRP II (25 decks)

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