Benign and Malignant Conditions of the Vagina and Vulva (Moulton) Flashcards
Clitoromegaly, Clitoral agenesis, Bifid clitoris, Midline fusion of the labiascrotal folds, and Cloaca are all presentations of?
They are congenital anomalies of the?
1) Ambiguous genitalia
2) Vulva
Clitoral agenesis results secondary to failure of the ____ to form.
Genital tubercle
No definite separation between the vagina & bladder results in?
Cloaca
What is caused by masculinization in utero of the female fetus?
Female pseudohermaphroditism
Congenital Adrenal hyperplasia, Ingestion of exogenous hormones, and Androgen secreting tumors of the mothers adrenal or ovaries all can lead to?
Female pseudohermaphroditism
The most obvious abnormalities of female pseudohermaphroditism are __1__, __2__, and __3__.
1) Clitoromegaly
2) Hypospadiac urethra meatus
3) Malpositioned vaginal orifice
____ insensitivity, which may be seen in ambiguous genitalia, is caused by a genetic deficiency in ____ receptors
Androgen
1) What karyotype is seen in ambiguous genitalia with androgen insensitivity?
Ambiguous genitalia is most commonly an X-linked __2__ disorder.
1) 46 XY
2) Recessive
With ambiguous genitalia , __1__ inhibiting substance is produced by the 46xy which results in lack of __1__ duct development.
2) This results in what structures to be absent?
1) Mullerian
2) Uterus or fallopian tubes
What structural and benign neoplastic condition of the vulva is treated with estrogen cream and massage to separate the labia majora?
Labial agglutination
1) What structural and benign neoplastic condition of the vulva causes severe pruritic raised yellow retention cyst in the axilla, labia majora and minora?
It results from __2__ plugged inflammation of __3__ glands.
1) Fox-Fordyce disease
2) Keratin
3) Apocrine
__1__ are the most common type of genital cyst.
They develop when the __2__ become obstructed.
1) Epidermal inclusion cysts
2) Hair follicles
What can enlarge and become painful in pregnancy and have characteristic blue color?
Vulvar varicosities
__1__ appear as a small fleshy red outgrowth at the distal edge of the urethra.
In children they are caused by the spontaneous prolapse of the __2__.
In post menopausal women it is secondary to contraction of the hypoestrogenic __3__ epithelium resulting in everting of the __4__ epithelium.
1) Urethral caruncles
2) Urethral epithelium
3) Vaginal
4) Urethral
__1__ is a rare condition in which one or more of the minor vestibular glands becomes infected resulting in 1 - 4mm erythematous dots that are extremely tender.
They are characterized by severe __2__ and occasionally vulvar pain.
It may be treated with topical __3__ and __3__ or surgical therapy may be required.
1) Vulvar vesitbulitis (Vestibular adenitis)
2) Dyspareunia
3) Estrogens/hydrocortisone
What are small, smooth, nodular masses usually on inner surface of labia minora and majora due to inflammatory blockage of its ducts?
How can the material that they contain be described?
1) Sebaceous cyst
2) Cheesy sebaceous material
What are the most common benign solid tumors of the vulva? They are slow growing, most range from 1-10 cm.
Fibromas
What are slow growing tumors composed of adipose cells?
Lipoma
What are rare lesions arising from sweat gland of the vulva?
Hidradenoma
Syringoma is a(n) ____ gland tumor.
Eccrine
What tumor can occur due to Von Recklinghausen’s disease?
Neurofibroma
What tumor appear as multiple 2-3 mm red lesions usually in fourth & fifth decade?
Angioma
What are loculated collections of blood that collect following trauma such as bike injuries (straddle injury), birth trauma or sexual assault?
Vulvar hematomas
An exam that reveals atrophy of the external genitalia and loss of vaginal rugae is diagnostic of __1__.
It is due to loss of __2__, which may occur due to menopause or surgery.
Treatment involves __3__.
1) Atrophic vaginitis
2) Estrogen
3) Topical estrogen (may use oral to prevent recurrence)
Local thickening of epithelium that reveals white, leathery, raised surface is diagnostic of?
What does it results from?
1) Lichen simplex chronicus (Squamous cell hyperplasia)
2) Chronic itching of the area
What does biopsy of Lichen simplex chronicus reveal?
1) Elongated rete ridges
2) Hyperkeratosis of keratin layer
__1__ reveals thin, white, inelastic skin with a crinkled tissue paper appearance that causes pruritus, dyspareunia, and burning pain.
It is frequently found on the vulva of __2__women.
1) Lichen sclerosis
2) Menopausal
4% of treated women & 10% of untreated women with lichen sclerosis can develop ____ of the vulva.
Squamous cells cancer
What does biopsy of Lichen sclerosis reveal?
1) Thin epithelium
2) Loss of rete ridges
3) Inflammatory cells lining basement membrane
Lichen simplex chronicus presents with marked hyperkeratosis and parakeratosis with a prominent ____ layer.
Granular
The most striking feature of lichen sclerosis is the presence of a ____ zone in the superficial dermis. This is the result of edema and degeneration of the collagen and elastic fibers of the dermis.
Hyaline
Purplish, polygonal papules that may appear in an erosive form causing vulvar burning and severe dyspareunia is diagnostic of?
Lichen planus
Autoimmune blistering disease involving the vulvovaginal conjunctival areas is characteristic of?
Pemphigus
What syndrome classically involves ulcerations in the genital, oral areas with uveitis?
Bechet’s syndrome
What is primarily a GI disorder but vulvar ulcerations can occur due to fistulations?
Chron’s
What ulcers can develop when chronic pressure is applied or secondary to tissue being moist secondary to urinary incontinence?
Decubitus ulcers
1) After birth, what bulging membrane-like structure may be noticed in the vaginal opening which can block the egress of mucus?
If it is not detected until after menarche, it can appear as a __2__ structure which entraps __3__.
1) Imperforate hymen
2) Thin dark bluish
3) Menstrual flow
What type of vaginal septum is most commonly found in the upper and middle thirds of the vagina and often a small sinus tract or perforation will be present which allows the egress of menstrual flow?
Transverse vaginal septum
What type of vaginal septum creates a double vagina and can attach to the lateral wall thus creating a blind vaginal pouch?
Midline longitudinal vaginal septum
Which vaginal septum are usually associated with various duplication anomalies of the uterine fundus?
Midline longitudinal vaginal septum
Vaginal agenesis is the most extreme vaginal anomaly with total absence of the vagina except for the most distal portion that is derived from?
Urogenital sinus
Rokintansky-Kuster-Hauser Syndrome (Mullerian agenesis) presents if __1__ is absent but __2__ are spared.
1) Uterus
2) Fallopian tubes
____ of the vaginal wall consists of islands of columnar cells in normal squamous epithelium and are seen in women who have been exposed to DES in utero.
Adenosis
____ arise from the remnant of the Wolffian duct (mesonephros).
They vary in size from 1-5 cm and are found in the ____ of the vagina
1) Gartner’s duct cyst
2) Lateral walls
What small 0.3 - 3.0 cm sac like projections in the anterior vagina along the posterior urethra that can cause recurrent UTI, dysuria, and occasionally urinary leaking?
Urethral diverticula
What cysts are located in the posterior or lateral wall in the lower third of the vagina and are frequently associated with gynecologic surgery or lacerations from childbirth?
They result from infolding of the?
1) Inclusion cyst
2) Vaginal epithelium
Endometriosis is caused by implants seen in the vagina and they change in appearance with the?
Menstrual cycle
What asymptomatic cyst usually presents as an unilateral swelling and is the most common vulvovaginal tumor?
Bartholin’s cyst
What painful inflammatory mass arises from blockage and accumulation of purulent material?
Bartholin’s gland abscess
What is characterized by leaving in for 4-6 weeks which promotes an epithelialized tract for drainage of glandular secretions?
What is characterized by creating a new ductal opening by everting the cyst wall onto the epithelial surface where it is sutured with interrupted absorbable sutures?
Both of these treatments are used for?
1) Word catheterization
2) Marsupialization
3) Bartholin’s gland abscess
What structural change is characterized by anterior vaginal prolapse?
What structural change is characterized by posterior vaginal prolapse?
1) Cystocele
2) Rectocele
Rectovaginal, urethrovaginal, and vesicovaginal ____ can result from radiation, obstetric injuries, complications of surgery.
Fistulas
The most common cause of vaginal trauma is?
Sexual assault
After menopause the vaginal __1__ flatten out and the vaginal __2__becomes thin, pale, & inelastic.
3) What happens to the vaginal pH?
1) Rugations
2) Epithelium
3) Rises
The most common malignant tumors of the vulva are?
Squamous Cell Carcinomas
Squamous Cell Carcinomas occur mainly in what population of women?
The most frequently reported symptom of vulvar cancer is long history of?
1) Postmenopausal
2) Chronic vulvar pruritis
Vulvar intraepithelial (VIN) I-III are designated based upon the?
Which is aka as squamous cell carcinoma in situ has been linked to vulvar cancer?
1) Depth of epithelial involvement
2) VIN III
VIN type III is subdivided into two groups, the VIN usual type is associated with?
What preventative measure should cause a decrease the VIN usual type?
The differentiated type VIN is more commonly associated with vulvar dermatologic conditions, such as?
1) HPV 16, smoking, and immunocompromised status
2) Gardasil vaccine
3) Lichen sclerosis
What occurs in postmenopausal white females and is characterized as well demarcated and eczematoid in appearance with fiery red background with white plaque like lesions in the vulva that can also occur in the nipple areas of the breast?
Paget’s disease
What presents in post menopausal females between 70-80 y/o with a lesion that is pruritic, raised, ulcerated, pigmented or warty in appearance usually on labia majora?
Squamous cell vulvar carcinoma
What are methods of spreading for Squamous cell vulvar carcinoma ?
1) Lymphatic embolization to regional LNs
2) Hematogenous spread to distant sites (lung, liver, bone)
While other type of vulvar carcinomas are rare, what is the second most common vulvar cancer (6% of vulvar cancer)?
Malignant melanoma
What is a variant of squamous cell carcinoma and its lesions are cauliflower-like in nature can be confused with condyloma?
What is contraindicated because it may induce anaplastic transformation?
1) Verrucous carcinoma
2) Radiation
__1__ gland carcinoma accounts for 1-2% of vulvar carcinomas and presents usually as a painless vulvar mass.
Women over the age of __2__ should have biopsy of gland to exclude malignancy.
1) Bartholin
2) 40
What rare vulvar carcinoma appear as a rolled edge ulceration and they do not metastasize?
Basal cell carcinoma
What preventative measure should decease the incidence of vaginal intraepithelial neoplasia (VAIN) and vaginal cancers in the future?
Gardasil vaccine
The most common vaginal cancer is?
Squamous cell carcinoma
What is required to confirm diagnosis of vaginal cancer?
Punch biopsy
What is the main method of treatment for primary vaginal cancer?
Radiation
When ____ 1/3 of vagina is involved the groin nodes should be included in treatment field or surgically removed.
Lower
What rare vaginal cancer are metastatic usually from the cervix, endometrium, or ovary?
Why type of this cancer is secondary to DES (diethylstilbestrol)?
1) Adenocarcinomas
2) Clear cell adenocarcinomas
What rare vaginal cancer has a mean age of 55 and usually occurs on the distal anterior wall?
Malignant melanoma
What presents in girls less than 4 as a mass of grape-like polyps protruding from the introitus?
Histologically the tumor is?
1) Sarcoma Botryoides
2) Embryonal rhabdomyosarcoma
The vagina is lined by what type of epithelium?
Nonkeratinized stratified squamous
Lactic acid & Hydrogen peroxide producing ____ predominate and result in keeping the vaginal pH at 3.8-4.2.
Lactobacilli
What are factors that can alter the protective microflora?
1) Antibiotics
2) Douching
3) Intercourse
4) Foreign body
What is the most common cause of vaginitis?
It is often polymicrobial but what is the most common organism?
1) Bacterial vaginosis
2) Gardnerella vaginalis
Bacterial vaginosis can cause a profuse __1__ discharge.
Saline wet mount reveals presence of __2__.
10% KOH-positive whiff test releases __3__ like odor.
Vaginal fluid pH is __4__.
1) Thin milky
2) Clue cells
3) Amine
4) Greater than 4.5
____ 500mg BID x 7 days is used to treat bacterial vaginosis.
Metronidazole
What is the second most common cause of vaginal infections?
The most common cause of this is?
Increased levels of what are a risk factor?
1) Vulvovaginal Candidiasis
2) Candida Albicans
3) Estrogen (high dose OCPs, pregnancy)
For Vulvovaginal Candidiasis, the 10% KOH wet prep is positive for __1__.
The vaginal pH is __2__.
1) Budding yeast
2) Less than 4.5
__1__ 150mg x 1 is used to treat Vulvovaginal Candidiasis along with vaginal application with synthetic __2__.
1) Diflucan
2) Imidazole (miconazole, terconazole)
What is caused by the flagellated protozoan T. Vaginalis?
Trichomoniasis
Symptomatic cases of trichomoniasis reveal a ____ vaginal discharge.
Green-yellow “frothy”
In the diagnosis of trichomoniasis, the saline wet mount reveals __1__.
The pH is __2__.
And the cervix is describes as __3__ appearing.
1) Motile trichomonads
2) Greater than 4.5
3) Strawberry
