Benign and Malignant conditions of the Vulva and Vagina Flashcards
Female Pseduohermaphroditism
- masculinization in utero of the female terus
- CAH, exogenous H’s, androgen secreting tumors
- clitormegaly, hypospadic urethra meatus, malpositioned vaginal orifice
Male Pseudohermaphroditism
- results from mosaicism
- virtualization and mullerian development
- AIS (testicular feminization)
Androgen Insensitivity
- def in androgen Rs
- 46,XY
- external female phenotypic development
- testes are undescended
- mullerian inhibiting substance- absent uterus
True hermaphroditism
- rare
- male and female development externally and internally
labial agglutination
- tx by estrogen cream
- separate labia majora
fox-fordyce disease
- pruritic raised yellow retention cyst in axilla and labi majora/minora
- from keratin-plugged infl of apocrine glands
inclusion cyst
- most dont require tx
- mobile, nontender, spherical, slow growing
- epidermal= most common type of genital yst
- hair follicles are obstructed
vulvar varicosities
- enlarge, painful in pregnancy
- blue color
lentigo and nevi
- lentigo (freckles)
- nevi (moles)
- need to distinguish from melanomas!!!
Urethral caruncles
- small fleshy red outgrowth at distal edge of urethra
- children and post menopausal women
Vulvar vestibulitis
- minor vestibular glands become infected
- extremely tender!!! erythematous dots
- severe introital dyspareunia
sebaceous cyst
infl blockage of sebaceous gland ducts
-cheesy sebaceous material
fibromas
-most common benign solid tumors of vulva!!!
traumatic lesions of vulva
- vulvar hematoma- straddle injury, birth trauma
- female genital circumcision
- obstetric related trauma
Atrophic vaginitis
- due to loss of estrogen- menopause, surgical
- atrophy external genitalia- minora regresses, majora shrinks, loss of vaginal rugae
- tx- topical estrogen
Lichen Simplex Chronicus (Squamous Cell Hyperplasia)
- local thickening of epit- from prolonged itch!!
- pruritus!!
- white/reddish, thickened, leathery, raised surface
- bx- elongated rete ridges, hyperkeratosis
- tx- steroid
Lichen Sclerosis
- on vulva of menopausal women
- can develop SCC of vulva
- pruritus!!
- thin, white, parchment like
- bx- thin epit, loss of rete ridges, infl cells
- tx- steroid
Lichen Planus
- purplish, polygonal papules
- vulvar-vaginal-gingival syndrome
- vulvar burning, severe insertional dyspareunia
- tx- steroids
psoriasis
- AD
- appears velvety
Aphthous ulcers
- superficial, painful
- common in mouth
Decubitus ulcer
-from chronic pressure, moist due to urinary incontinence
Contact dermatitis
- specific irritant!!
- erythema, edema, ulceration
Vagina- congenital anomalies
- imperforate hymen
- transverse or midline longitudinal septum
vaginal agenesis
-RKHS (mullerian agenesis)
adenosis
- columnar cells in normal squamous epit-
- DES!!
gartner’s duct cyst
- remnant of wolffian duct
- lateral walls of vagina
- most are asx
Urethral diverticula
- projections in ant vagina along post urethra
- can cause TI, dysuria
inclusion cyst
- infolding of vaginal epit
- post or lateral wall of vagina
- childbirth
Bartholin’s cyst
- most common vulvovaginal tumor!!!
- asx
- bx- rule out bartholin’s carcinoma
Bartholin’s gland abscess
- blockage and accum of purulent material
- word catheterization
- marsupialization
ulvar neoplasms
- most are SCC!!!
- postmenopausal women
- hx of chronic vulvapriritis
- VIN (SCC in situ)
preinvasive cancer of vulva
- VIN (SCC in situ)
- VIN usual-type- HPV, smoking, immunocompromised!!
- differentiated type IVN- not assoc with HPV pr smoking!!!- assoc with LS
VIN- sx, tx
-pruritus!!
-bx!
tx- superficial surgical excision
Paget’s disease of vulva
- postmenopausal
- also in nipple areas of breast
- itching, tenderness!!
- white plaque lesions
- large pale Paget’s cells
- local superficial excision
Squamous cell vulvar carcinoma
- postmenopausal, 70-80 yo
- vulvar lump
- pruritic, raised, ulcerated, pigmented
- bx!!!
- direct extension, lymphatic, hematogenous
Rare vulvar carcinomas
- malignant melanoma
- verrucous carcinoma
- bartholin’s gland carcinoma
- basal cell carcinoma
malignant melanoma
- 2nd most common vulvar cancer
- postmenopausal
Verrucous carcinoma
- variant of SCC
- cauliflower-like- can be confused with condyloma!!
- *Radiation is contraindicated- may induce anaplastic transformation!!!
Vaginal Intraepit Neoplasia (VAIN)
- HPV!!!
- most have prior/coexistent neoplasia of cervix or vulva
- asx!
- colposcopic directed vaginal bx!!!
carcinoma of vagina
- 60 yo
- SCC- most common
- sx- abnormal vaginal discharge/bleeding, hematuria
- ulcerative, exophytic growth
- dx- punch bx
- tx- radiation or chemoradiation
normal microecology of vagina
- vagina- non keratinized stratified squamous epit
- lactic acid and H2O2- lactobacilli- pH is 3.8-4.2
factors that alter the protective microflora
- abx
- douching
- intercourse
- foreign body
vaginal discharge- investigation
- nitrazine paper- pH
- microscope
Bacterial vaginosis
- most common cause of vaginitis
- Gardnerella
- malodorous fishy amine odor
- clue cells!!
- KOH-positive whiff test- amine-like odor
- vaginal pH> 4.5
- tx- metronidazole
- not a STI
Vulvovaginal candidiasis
- Candida
- risk factors- inc estrogen levels, DM, abx, steroid use
- vulvar pruritus, burning
- cottage cheese like discharge
- budding yeast- KOH wet prep
- pH < 4.5
Trichomoniasis
- 50% asx
- dyspareunia
- green-yellow frothy vaginal discharge
- wet mount- trichomonads, pH> 4.5
- strawberry cervix!!!
- tx- metronidazole
- STI!!!
