Benign and Malignant Condition of the Vulva and Vagina Flashcards
ambigious geneitalia can present with? (5 things)
cliteromegaly
clitoral agenesis
bifid clitoris
midline fusion of the labiascrotal folds
cloaca
what is the cause of clitoral agensis
failure of the genital tubercle to form
what is a cloaca
no definite seperatino between the vagina and bladder
in general with suboptimal development of penile or scrotal structure the infant is usually assigned a _ gender
female
what is female pseudohermapahroditism
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
most obvious abnormality in female psuedohemaphorditsm ?
clitoromegaly, hypospadic urethra meatus, malpositioned vaginal orifice
what is male pseudohermaphorditism
mocaism that can give various degrees of virulization and mullerian development
comme example of male psuedohermaphordisim
androgen insensitivity syndrome
what is androgen insensitivity
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
what is true hermaphoditism
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
what is labial agglutination, how is it treated?
this is when the labia sticks together, we can take estrogen cream and manual manipulation to seperate the labia majora
what is fox-fordyce disease
itchy raised yellow cysts in the axilla (armpit) and labia majora and minora that result from keratin plugged inflammation of apocrine glands
what are inclusion cysts
cysts that are beneth the epidermis that are mobile and non tender and slow growing
most times dont need treatment
what is an epidermal inclusion cyst
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
what are vuvlar varicosities
enlarged veins that can enlarge and become painful in pregnancy they are typically blue in color
(tortous veins)
_ and _ on the vulva need to be distinguished from melanomas
lentigos (freckles) and nevi (moles)
what are urethral caruncles?
small fleshy, super red warty outgrowths from the distal edge of the urethra
urethral caruncles are caused by what in children?
are caused by what in adults?
caused by spontenous prolapse of the urethral epithelium
contraction of the hypoestrogenic vaginal epithelium which everts the urethral epithelium
what is vulvar vestibulitis
infection of the minor vestibular glands that are super tender out of porprtion to the pressure applied
symptoms of vulvar vestibulities
extremely tender
erythematous dots
pain with sec
vulvar pain
how to treat vulvar vestibulitis
topical estrogens, maybe surgery if required
what is a sebaccous cyst of the vulva
blockage of the sebaceous gland ducts that are usually on the inner surface of the labi minora/majora with a cheese sebacous material
what is a fibroma of the vulva
most common benign solid tumor of the vulva (slow growing, can become HUGE)
what is a lipoma of the vulva
this is a slow growing tumor composed of adipose cells
what is a hidradenoma of the vulva
lesion arising from the sweat gland of the vulva
what is a syringoma
eccrine gland tumor
what is a neurofibroma on the vulva
a lesion that is from von recklinghausens disease
what is an angioma, who is it most common in ?
multiple red lesions on the vulva that is seen in the 4th and 5th decade of life
what are some traumatic lesions of the vulva
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
what is atrophic vaginitis, what causes it, how do we treat
a dermatological condition
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
what is lichen simplex chronicus of the vulva
squamous cell hyperplasia that causes local thickening of the epithelium from prolonged scratching
it is super itchy
what are the symptoms of lichen simplex chronicus
itchy, white or reddish leathery raised surface
biopsy of lichen simplex chronicus shows?
elongated rete ridges and hyperkeratosis of the keratin layer
treatment of lichen simplex chronicus
steroid ointments and antipuritic agents
what is lichen sclerosis of the vulva
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)
what are the symptoms of lichen sclerosis
intense itchiness, white inelactic skin that is like crinkled tissue paper
biopsy of lichen sclerosis shows
thinning of the epidermis
loss of rete ridges and inflammatory cells in the basement membrane
treatment of lichen sclerosis
high does steroid clobetasol
the most striking feature of lichen sclerosis on histology is?
hyaline zone from edema and defeneration of collagen and elastic fibers of the dermis
what is lichen planus of the vulva, what syndrome can it present with? how do we treat?
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
psoriasis of the vulva and most cases is inherited in a _ _ fashion it will appear _ but may lack the silver scaly patches clinically seen
autosomal dominant
velvety
usually on flezor surfaces
eczema on the vulva has a _ presentation
erythematous
pemphigus of the vulva is an autoimmune _ disease that involves the vulvovaginal and _ areas
blistering
conjunctival areas
bechets syndrome of the vulva classically involves _ of the genital and oral areas with uveitis
ulcers
uveits- inflammtion of the uvea (middle portion) of the eye
chrons disease is primarily a _ disorder byt vulvar ulcerations can occur due to fistualizations
GI
what are apthous ulcers?
superifical painful ulcers that are more commonly found in the mouth but can be on vulva
what are decubitous ulcers of the vulva
ulcers on vulva due to chronic pressure or secondary to mositure from urinary incontience
what is acanthosis nigricans of the vulva
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
what is contact dermatitis of the vulva
physical exam is important ebcause this can be caused by any irritant it will appear bright red
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
bulging
blue
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 _ _
middle and upper thirds of the vagina
intercourse is impeded
double
blind pouch
uterine fundus
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 _ _
urogenital sinus
rokitansky kuster hauser syndrome is ?
mullerian agensis when the uterus is absent but he fallopian tubes are spared (sometimes ovaries too)
what is adenosis
when the vaginal wall consists of endocervical epithelium with columnar cells in the normal squamous epithelium
squamous metaplasia
what causes adenosis of the vagina
DES exposure in utero
what is a gartner duct cyst?
this is a remnant of the wolffian duct that is usually found on the lateral wall of the vagina and looks like a grape
what is a urethral diverticula ?
how do we treat it
what can it cause
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
what is an inclusion cyst in the vagina
infolding vaginal epithelium in the posterior or lateral wall in the lower third of the vagina
inclusion cysts in the vagina are most oftenly caused by?
gynecological surgery or lacerations
endometriosis in the vagina
ectopic endometrial tissue in the vagina that can cause very bad cyclin pain, infertility, and pain with sex
what is a batholin cyst
this is a vulvovaginal tumor that has unilateral swelling (need to biopsy it to make sure its not batholin carcinoma)
what is a bartholin gland abcess caused by?
how do we treat
it is caused by blockage and accumulation of purulent material in the bartholin gland
treat with word catheterization or marsupilization
what is word catheterization
a procedure for a batholin gland abcess where you promote formation of a new epithelized tract for glandular secretions
what is marsupialization
a procedure for a bartholin cysts that creats a new ductal opening by everting the cysts wall onto the epithelial surface
vagina sits at a _ degree angle
45
what are some structural changes to the vagina that can occur over time
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
what is the most common cause of uterine prolapse
pelvic floor trauma
like in childbirth
malignant tumors of the vulva are _
uncommon
most tumors of the vulva are _ _ _ that mainly occurs in postmenopausal women, the mean age is _ and the most reported symptom is _
squamous cell carcinomas
65
chronic vulvar puritis
vulvar intraepithelial III (VINIII) is also known as _ and have been linked to vulvar cancer
squamous cell carcinoma insitu
lesions are designated VIN I, VIN II, VIN III because upon _ of epithelial involvement
depth
Vulvar Intraepithelial neoplasia type 3 (VIN III) can be divided into what 2 types: what are each one more associated with
VIN III Usual type- associated with HPV16 and smoking, and immunocompromised
VIN III Differentiated type- associated with dermatological conditions like lichen sclerosis
how do you treat squamous carcinoma insitu of the vulva (VIN III)
they look warty in apperance
can do local superficial exicison of laser therapy
what is pagets disease of the vulva
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
biopsy of pagets disease
large pale pagets cells
20 percent of patients with vulvar pagets disease will have an underlying _
carcinoma
how do you treat pagets disease
local superifical excision
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.
75
itchy
majora
how can SCC of the vulva spread
direct extension to adjacent structures like the vagina, uretha, anus
lymphatic spread
hematogenous spread
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
type 1 (usual type)
how can you treat SCC vulvar carcinoma
vulvectomy with regional lymphedenectomy
excision of primary tumor + removal of inguinal llymph node + radiation
stage 1 SCC of the vulva rarely has positive _ nnodes and thus ipsilateral lymphadenectomy is sufficent
contralateral
if positive nodes are indentifies in SCC of the vulva post op _ is needed
radiation
what is malignant melanoma of the vulva?
second most common vulvar carcinoma that is usually on the labia minora and clitoris
must excise it all to stage
what is a verrucous carcinoma of the vulva
a variant of squamous cell carcinoma it looks like a califlower lesion and can be confused with HPV condyloma (wart)
in a verrucous carcinoma _ is rare and _ is contraindicated because it may induce anaplastic transformation
metastasis
radiation
what is a batholins gland carcinoma of the vulva
this is a painless vulvar mass without history of bartholin gland disorders (must biopsy)
treat with radical vulvectomy and bilateral lymphadenectomy
recurrence is possible
what is basal cell carcinoma of the vulva?
rolled edge ulceration in the vulva that does not metastasize
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
HPV
pap
coloscopic
in the VAIN lesion involves the vaginal vault how do you treat
surgical excision
if VAIN has multifocal lesions how do you treat
laser therapy or topical 5’ fluorouracil
may need vaginectomy
most vaginal cancers are _ _ carcinomas
squamous cell
symptoms of vaginal SCC
hematuria, abnormal vaginal discharge or bleeding
on physicial exam how does SCC of the vagina look?
ulcerative or exophytic growths
how does vaginal SCC spread
direct spread
lymphatic spread
hematogenous spread
diagnosis of vaginal SCC requires a _ biopsy
punch
how do you treat SCC of the vagina
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
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
metastatic
DES exposure
they have a good survivial rate
malignant melanomas of the vagina are usually on the distal _ wall
anterior
poor survivial rate
what are sarcoma botryoides
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
how do you treat a sarcoma botyoides?
surgical resection, chemotherapy, radiation
the vagina is lined by _ _ _ epithelium
non keratinized stratified squamous epithelium
lactobacili in the vagina produce _ and _
hydrogen peroxide and lactiv acid
normal vaginal pH is?
3.8-4.2 acidic
what can alter the vagina protective microflora
antibiotcs, douching, intercourse, foreign body
most bacteria in the vagina is _ (aerobic/anerobic)
anerobic
semen can raise the pH of the vagina to ?
7.2
how can you test the vaginal pH
with nitrazine paper
how do you sample vaginal discharge under a microscope
sample from the posterior fornix place on a slide and then view under a microscope
also look grossly ask about color, amount, texture, odor
what is the most common cause of vagnitis
bacterial vaginosis
BV is mostly caused by?
polymicrobial but gardnerella vaginalis
risk factors for BV
multiple sex partners, smoking, IUD, douching
what are the symptoms of BV
think milky discharge, malodourous fishy amine odoer especially after intercourse
how do you diagnose BV
Wet mount:
KOH whiff test:
pH:
wet mount: clue cells
KOH whiff test: amine like odor (positive)
pH: greater than 4.5
treatment of BV
metroidazole
do you have to treat someone partner if they have BV?
no because it is not a sexually transmitted infection
what is the second most common cause of vaginits?
vulvovaginal candiasis
what is the most common cause of vulvovaginal candidiasis
candidie albicans
what are the risk factors for vulvovaginal candidiasis
increased estrogen, DM, antibiotics, steroids, immunosuppresion
symptoms of vulvovaginal candidiasis
itching, burning/irritation
cottage cheese like discharge
diagnosis of vulvovaginal candidiasis
KOH wet prep:
pH:
KOH wet prep: positive for budding yeast; psuedohyphae
pH: less than 4.5
treatment of vulvovaginal candidiasis
diflucan
imidazoles (micanzole, teraconazole)
trichomoniasis is caused by?
flagellate protazona Trichomonas vaginalis
risk factors for trichomoniasis
unprotected sex
what are the symptoms of trichomoniasis
pain with sec, irritation, green/yello frothy discharge
diagnosis of trichomoniasis
saline wet mount:
ph:
Cervix:
wet mount: motile trichomonads
pH: greater than 4.5
cervix: strawberry cervix
treatment of trichomonisis
metroidazole
in a patient with trichomoniasis should their patient be tested
yes, it is an STD so they should be tested and evaluated for STIs !
