Benign and malignant condition of the vulva/ vagina Flashcards
complication with vulvar varicosities
can enlarge and become painful in pregnancy
***characteristically blue in color
what do you not treat verrucounus carcinoma with
radiation bc risk if anapestic change
cauliflower like lesions on vulva
of the structural vaginal changes that can occur over time, what is the name for anterior vaginal prolapse and posterior vaginal prolapse ? and other structural ABNL that can occur over time
-anterior: cystocele (prolapsed bladder)
-posterior: rectocele (prolapsed rectum)
-others:
uterine prolapse
fistulas (from surgery/radiatoin) : rectovaginal, urethrerovagial , vesicovaginal
most frequently reported sx of (rare) vulvar cancer
long history of chronic vulvar pruritis (lichen sclerosis)
most common benign solid tumor of the vulva
fibroma
-slow growing solid mass, usually small but can be HUGE (250 lbs)
dx and tx of VIN III
dx: careful inspection of the vulva and biopsy
tx: local superficial surgical excision (MC)
can user laser therapy if on the clitoris, labia minora, or perianal area
most common type of genital cyst
inclusion cyst
- mobile, nontender, spherical, slow growing, benign cysts below the epidermis
- form from plugged hair follicles
what is the most common cause of vaginitis
bacterial vaginosis
gardnerella vaginalis
define an inclusion cyst of the VAGINA (not vulva)
- caused by infolding of the vaginal epithelium
- at posterior or lateral wall of lower 1/3 vagina
- assoc with gyn surgery or labor lacerations
define imperforate hymen
- after birth- BULDGING membrane at vaginal opening that blocks mucus outflow
- if not dx till after menarche: appears thin, dark blue, bc entrapping mestrual flow
how to dx VAIN
- usually ASX
- must do colposcopy with directed vaginal biopsy
what structural vulvar ABNL must be distinguished from melanoma
freckles (lentigo) and moles (nevi)
what describes well demarcated and eczematous in appearance with fiery red background and white plaque like lesions
Pagets DZ of the vulva
-tx: surgical excision
how to work up vaginal discharge
hx: color, amount, odor, texture
nitrazine paper: determine pH
microscope: sample discharge and place on slide under microscope
Ddx: bacterial vaginosis, candidiasis. STI
HNM
what is lichen sclerosis and how to tx
-MC on vulba of menopausal women
-assoc with autoimmune etiology
-thinning of the epidermis and sclerotic change (thickening) of the dermis
-PE: parchment like thinning of the vulvar skin, leukoplakia
-biopsy- thin epithelium, loss of retentions ridges, HYALINE ZONE in DERMIS, inflammatory infiltrate in BM
(hyperkeratinosis seen in both lichens)
-sx: intense pruritis, dyspareunia, burning pain
-tx: clobestasol
**if UNTX can increase risk of vulvar carcinoma
RF and SX of material vaginosis
RF: new or multiple sex partners, smoking, IUD, douching
Sx: many asx, profuse thin milky discharge, malodorous fishy amine odor (esp after sex)
major complications of lichen sclerosis
loss of labia minora
shrinking of labia majora
constriction of opening
inverted/trapped clitoris
how to tx VAIN
- if lesion is in vault : surgical excision
* if multifocal: tx with laser therapy, topical 5-flurouracil, and if all fails may need vaginectomy
tx for labial agglutination
estrogen cream and massage
define sebaceous cyst (and what does it resemble)
*vulvar structural ABNL
-inflammation and blocking of sebaceous gland
-sx: small, red, smooth, nodular, mass on inner surface of labia major/minora
(similar to inclusion cyst but is only on inside surface of labia and is red)
define urethra caruncle
fleshy red growth on distal end of urthera
- children caused by spontaneous prolapse of the urethral epithelium
- post menopause due to contraction of hypoestrogenic vaginal epithelium and everting of the urtheral epithelium
what is lichen simplex chronicus and how to tx
aka “vulvar squamous cell hyperplasia”
- thickening of the epidermis secondary to chronic itching
- sx: prutitis
- PE: leukoplakia, white/red thickened skin, leathery skin, (similar to psoriasis appearance)
- biopsy: ,prominent granular layer, aconthosis, elongated rete ridges, inflammatory cells in dermis (hyperkeratinosis seen in both lichens)
- tx: steroid cream and pruritic agents
RF and Sx of trichomoniasis
RF: unprotected sex
Sx: 50% asx , dyspareunia, vulvogainal irritation, occasion dysuria, green-yellow “frothy” discharge
what is Fox-Fordyce Dz
- yellow pruritic cysts in axilla and labia majora/minora
- from keratin plugged apocrine glands
define bartholin cyst
- inflammation and blocking of bartholin gland duct
- unilateral ASX cyst at the lower vestibule adjacent to vaginal canal –> becomes painful when changes to abscess
- common in reproductive age women (second the infections/STI)
- tx: word catheterization (drainage) or marsupilzation (permanent opening)
define vaginal septum
- transverse
- usually upper 2/3 vagina
- usually has small opening for menstrual flow
- may only be noticeable with impeded intercourse - longitudinal (“double vagina”)
- can have blind end vagina
- assoc with duplication ABNLs of the uterine fundus
how to dx SCC of the vagina
punch biopsy is required to confirm dx
staging is clinical
50-90% pts with VAIN will have coexistent or prior neoplasia or cancer of the __ and ___
cervix and vulva
*alll HPV related
what causes female psuedohermaphrotism
-masculinaztion in utero of external genitalia by hormones ABNL
(clitoromegaly, hypospadias, malpositioned vaginal orifice)
*internal genitalia is NL female
tx for vulvar SCC
radical vulvectomy and regional lymphadenectomy
-can add chemo and radiation
Dx and Tx of trichomoniasis
dx: wet mount reveals motile trichomonads pH > 4.5 strawberry cervix fishy odor possibly
tx:
metronidazole
STI therefore test patient and partner for other STIs
most common cause of vaginal trauma
sexual assault
most common X-linked recessive disorder
androgen insensitivity
- male 46XY with little external genitalia growth
- external female phenotype , internal male
- undescneded testes
- no mullein duct form therefore no uterus or fallopian tubes
define gartner duct cyst and tx
- common
- from remnants of the wolfian (mesonephric) duct on lateral vaginal wall
- 1-2 cm fluid filled cysts in submucosa
- most ASX no tx
RF and SX of vulvovaginal candidiasis
RF: high estrogen levels (OCP, preganancy) DM abx use steroid use immunosuppression
Sx: vulvar pruritis, burning, irritation, dyspareunia,
(no/little discharge, if + is cottage cheese like)
true hermaphroditism
have both male and female internal and external genitalia
-extent of mascuinization depends on amount of functioning testicular tissue
what is lichen planus and tx
“vulvar- vaginal- gingival” syndrome
- purple papules (maybe erosive) on vulva, vagina, and mouth
- sx: burning, and severe dyspareunia on insertion
- tx: steroid cream or systemic
tx for SCC of the vagina
radiation or chemo is main tx
- if lower 1/3 : remove groin nodes if spread
- if upper 2/3: surgical removal of the area
when are angiomas of the vulva seen
40-50s yo
2-3 mm red lesions on vulva
rokintansky kuster Hauser syndrome
-mullerian duct agenesis (vaginal agenesis)
= no uterus, or upper 2/3 vagina
-fallopian tubes and distal 1/3 vagina present
what vulvar dermatologic condition is associated with insulin resistance (DM) and obesity
aconthosis nigricans
-brown pigmented thickened layers of superficial skin
second most common cause of vaginal infections
vulvovaginal candidiasis
candida albicans
what results from secondary failure of the genital tubercles
clitoral agenesis
what is urethral diverticula and tx
- small sac like projections in the anterior vagina along the posterior urethra
- can cause recurrent UTIs and urinary leaking
- sx: dysuria
- tx: urethral dilation or excision
risk factor for adenosis
(columnar cells in upper squamous epithelium of vagina; causes red area distinct from NL pink area)
-DES exposure
congenital anomaly of the vulva: with ambiguous genitalia ___ is required
careful examination
-PE, u/s, hormone study, karyotyping
(exam genital, check u/s for inside genitalia, check male/female hormones levels, check genotype of male or female)
define vulvar vestibilitis (vestibular adenititis)
KNOW
- infection of 1+ minor vestibule glands
- causes 1-4cm VERY TENDER erythematous dots, and dyspareunia
- tx: estrogen cream or hydrocortisone cream
PE sign of SCC vulvar cancer
- pruritic lesions that is raised, ulcerated, pigmented, or warty in appearance
- usually on the labia major
what is atrophic vaginitis and how to treat it
- atrophy of external genitalia (loss of vaginal rugae, minor regresses and major shrinks, constriction)
- causes by loss of estrogen (menopause or surgical)
- tx: estrogen cream , maybe oral estrogen to prevent reoccurrence
most common symptoms of VIN III
pruritus
dx and tx of bacterial vaginosis
dx:
saline wet mount = “clue cells”
-KOH + positive whiff test for odor
-vaginal fluid pH > 4.5
tx:
metronidazole (not an STI therefore don’t need to tx partner)
cause of trichomoniasis
T. vaginallis
dx and tx for vulvovaginal candidiasis
dx:
wet prep + for budding yeast
vaginal pH < 4.5 (normal)
tx:
diflucan
synthetic imidazoles
symptoms of SCC of the vagina
abnormal discharge or bleeding, hematuria (BLOOD IN URINE)
most common vulvovaginal tumor
bartholin cyst
