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Hannah Endo/Repro year 2 > Benign and malignant condition of the vulva/ vagina > Flashcards

Benign and malignant condition of the vulva/ vagina Flashcards

1
Q

complication with vulvar varicosities

A

can enlarge and become painful in pregnancy

***characteristically blue in color

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2
Q

what do you not treat verrucounus carcinoma with

A

radiation bc risk if anapestic change

cauliflower like lesions on vulva

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3
Q

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

A

-anterior: cystocele (prolapsed bladder)
-posterior: rectocele (prolapsed rectum)
-others:
uterine prolapse
fistulas (from surgery/radiatoin) : rectovaginal, urethrerovagial , vesicovaginal

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4
Q

most frequently reported sx of (rare) vulvar cancer

A

long history of chronic vulvar pruritis (lichen sclerosis)

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5
Q

most common benign solid tumor of the vulva

A

fibroma

-slow growing solid mass, usually small but can be HUGE (250 lbs)

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6
Q

dx and tx of VIN III

A

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

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7
Q

most common type of genital cyst

A

inclusion cyst

  • mobile, nontender, spherical, slow growing, benign cysts below the epidermis
  • form from plugged hair follicles
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8
Q

what is the most common cause of vaginitis

A

bacterial vaginosis

gardnerella vaginalis

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9
Q

define an inclusion cyst of the VAGINA (not vulva)

A
  • caused by infolding of the vaginal epithelium
  • at posterior or lateral wall of lower 1/3 vagina
  • assoc with gyn surgery or labor lacerations
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10
Q

define imperforate hymen

A
  • 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
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11
Q

how to dx VAIN

A
  • usually ASX

- must do colposcopy with directed vaginal biopsy

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12
Q

what structural vulvar ABNL must be distinguished from melanoma

A

freckles (lentigo) and moles (nevi)

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13
Q

what describes well demarcated and eczematous in appearance with fiery red background and white plaque like lesions

A

Pagets DZ of the vulva

-tx: surgical excision

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14
Q

how to work up vaginal discharge

A

hx: color, amount, odor, texture
nitrazine paper: determine pH
microscope: sample discharge and place on slide under microscope

Ddx: bacterial vaginosis, candidiasis. STI

HNM

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15
Q

what is lichen sclerosis and how to tx

A

-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

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16
Q

RF and SX of material vaginosis

A

RF: new or multiple sex partners, smoking, IUD, douching
Sx: many asx, profuse thin milky discharge, malodorous fishy amine odor (esp after sex)

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17
Q

major complications of lichen sclerosis

A

loss of labia minora
shrinking of labia majora
constriction of opening
inverted/trapped clitoris

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18
Q

how to tx VAIN

A
  • if lesion is in vault : surgical excision

* if multifocal: tx with laser therapy, topical 5-flurouracil, and if all fails may need vaginectomy

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19
Q

tx for labial agglutination

A

estrogen cream and massage

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20
Q

define sebaceous cyst (and what does it resemble)

*vulvar structural ABNL

A

-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)

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21
Q

define urethra caruncle

A

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
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22
Q

what is lichen simplex chronicus and how to tx

A

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
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23
Q

RF and Sx of trichomoniasis

A

RF: unprotected sex
Sx: 50% asx , dyspareunia, vulvogainal irritation, occasion dysuria, green-yellow “frothy” discharge

24
Q

what is Fox-Fordyce Dz

A
  • yellow pruritic cysts in axilla and labia majora/minora

- from keratin plugged apocrine glands

25
Q

define bartholin cyst

A
  • 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)
26
Q

define vaginal septum

A
  1. transverse
    - usually upper 2/3 vagina
    - usually has small opening for menstrual flow
    - may only be noticeable with impeded intercourse
  2. longitudinal (“double vagina”)
    - can have blind end vagina
    - assoc with duplication ABNLs of the uterine fundus
27
Q

how to dx SCC of the vagina

A

punch biopsy is required to confirm dx

staging is clinical

28
Q

50-90% pts with VAIN will have coexistent or prior neoplasia or cancer of the __ and ___

A

cervix and vulva

*alll HPV related

29
Q

what causes female psuedohermaphrotism

A

-masculinaztion in utero of external genitalia by hormones ABNL
(clitoromegaly, hypospadias, malpositioned vaginal orifice)
*internal genitalia is NL female

30
Q

tx for vulvar SCC

A

radical vulvectomy and regional lymphadenectomy

-can add chemo and radiation

31
Q

Dx and Tx of trichomoniasis

A 
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

32
Q

most common cause of vaginal trauma

A

sexual assault

33
Q

most common X-linked recessive disorder

A

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
34
Q

define gartner duct cyst and tx

A
  • common
  • from remnants of the wolfian (mesonephric) duct on lateral vaginal wall
  • 1-2 cm fluid filled cysts in submucosa
  • most ASX no tx
35
Q

RF and SX of vulvovaginal candidiasis

A 
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)

36
Q

true hermaphroditism

A

have both male and female internal and external genitalia

-extent of mascuinization depends on amount of functioning testicular tissue

37
Q

what is lichen planus and tx

A

“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
38
Q

tx for SCC of the vagina

A

radiation or chemo is main tx

  • if lower 1/3 : remove groin nodes if spread
  • if upper 2/3: surgical removal of the area
39
Q

when are angiomas of the vulva seen

A

40-50s yo

2-3 mm red lesions on vulva

40
Q

rokintansky kuster Hauser syndrome

A

-mullerian duct agenesis (vaginal agenesis)
= no uterus, or upper 2/3 vagina
-fallopian tubes and distal 1/3 vagina present

41
Q

what vulvar dermatologic condition is associated with insulin resistance (DM) and obesity

A

aconthosis nigricans

-brown pigmented thickened layers of superficial skin

42
Q

second most common cause of vaginal infections

A

vulvovaginal candidiasis

candida albicans

43
Q

what results from secondary failure of the genital tubercles

A

clitoral agenesis

44
Q

what is urethral diverticula and tx

A
  • 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
45
Q

risk factor for adenosis

A

(columnar cells in upper squamous epithelium of vagina; causes red area distinct from NL pink area)
-DES exposure

46
Q

congenital anomaly of the vulva: with ambiguous genitalia ___ is required

A

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)

47
Q

define vulvar vestibilitis (vestibular adenititis)

KNOW

A
  • infection of 1+ minor vestibule glands
  • causes 1-4cm VERY TENDER erythematous dots, and dyspareunia
  • tx: estrogen cream or hydrocortisone cream
48
Q

PE sign of SCC vulvar cancer

A
  • pruritic lesions that is raised, ulcerated, pigmented, or warty in appearance
  • usually on the labia major
49
Q

what is atrophic vaginitis and how to treat it

A
  • 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
50
Q

most common symptoms of VIN III

A

pruritus

51
Q

dx and tx of bacterial vaginosis

A

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)

52
Q

cause of trichomoniasis

A

T. vaginallis

53
Q

dx and tx for vulvovaginal candidiasis

A

dx:
wet prep + for budding yeast
vaginal pH < 4.5 (normal)

tx:
diflucan
synthetic imidazoles

54
Q

symptoms of SCC of the vagina

A

abnormal discharge or bleeding, hematuria (BLOOD IN URINE)

55
Q

most common vulvovaginal tumor

A

bartholin cyst

Hannah Endo/Repro year 2 (11 decks)

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