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Endo/Repro > Benign and Malignant Conditions of the Vulva and Vagina > Flashcards

Benign and Malignant Conditions of the Vulva and Vagina Flashcards

1
Q

How can ambiguous genitalia present?

A
  • Clitormegly
  • Clitoral agenesis
  • Bifid clitoris
  • Midline fusion of the labioscrotal folds
  • Cloaca (no definite separation between the vagina and bladder
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2
Q

What is required for ambiguous genitalia?

A
  • Careful examination

- PE, US, hormonal studies, karyotyping

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3
Q

What is the result of an infant with suboptimal development of penile or scrotal structures?

A
  • Infant is assigned female
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4
Q

What is female pseudohermaphroditism?

A
  • Masculinization in utero of the female fetus
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5
Q

What causes female pseudohermaphroditism?

A
  • Endogenous hormonal milieu (congenital adrenal hyperplasia, ingestion of exogenous hormones, androgen secreting tumors of the mothers adrenals or ovaries)
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6
Q

What is seen in female pseudohermaphroditism?

A
  • Clitoromegaly
  • Hypospadiac urethral meatus
  • Malpositioned vaginal orifice
  • Internal genital organ development is normal
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7
Q

What is male pseudohermaphorditism?

A
  • Results from mosaicism and can occur with varying degrees of virtualization and mullerian development
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8
Q

What causes androgen insensitivity?

A
  • Genetic deficiency in androgen receptors
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9
Q

What is the karyotype of androgen insensitivity?

A
  • 46 XY

- Most commonly an x-linked recessive disorder

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10
Q

What is the clinical presentation of an infant with androgen insensitivity?

A
  • External female phenotypic development
  • Testes are undescended
  • Müllerian inhibiting substance is produced by the 46xy resulting in a lack of müllerian duct development (no uterus or fallopian tubes)
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11
Q

What is true hermaphroditisim?

A
  • Rare
  • Affected child has both male and female development externally and internally (combined ovotestes or separate gonads)
  • Extent of masculinization depends on amount of functioning testicular tissue
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12
Q

How is labial agglutination treated?

A
  • Estrogen cream is massaged on to separate the labia majora
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13
Q

What is Fox-Fordyce disease?

A
  • Severe pruritic raised yellow retention cysts in the axilla, labia majora, and minor resulting from keratin plugged inflammation of apocrine glands
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14
Q

What are epidermal inclusion cysts?

A
  • Located beneath the epidermis and are mobile, nontender, spherical, and slow growing
  • Most common of genital cysts
  • Develop when the hair follicle becomes obstructed; deeper portion swells to accommodate the desquamated cells
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15
Q

What are vulvar varicosities?

A
  • Can enlarge and become painful in pregnancy

- Have characteristic blue color

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16
Q

What are urethral caruncles?

A
  • Appear as a small fleshy red outgrowth at the distal edge of the urethra
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17
Q

What causes urethral caruncles in children?

A
  • Spontaneous prolapse of the urethral epithelium
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18
Q

What causes urethral caruncles in postmenopausal women?

A
  • Secondary to contraction of the hypoestrogenic vaginal epithelium resulting in everting of the urethral epithelium
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19
Q

What is vulvar vestibulitis?

A
  • Rare condition in which one or more of the minor vestibular glands becomes infected
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20
Q

What is seen with vulvar vestibulitis?

A
  • Lesions are 1-4 mm erythematous dots that are extremely tender
  • Characterized by severe introital dyspareunia and occasionally vulvar pain
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21
Q

How is vulvar vestibulitis treates?

A
  • Can try topical estrogens/hydrocortisone

- Surgical therapy may be required

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22
Q

What is a sebaceous cyst?

A
  • Caused by inflammatory blockage of the sebaceous gland duct
  • Small, smooth, nodular masses usually on inner surface of labia minora and majora
  • Contain a cheesy sebaceous material
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23
Q

What are fibromas?

A
  • Most common benign solid tumor of the vulva

- Slow growing, most range from 1-10 cm

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24
Q

What is a lipoma?

A
  • Slow growing tumors composed of adipose cells
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25
Q

What is a hidradenoma?

A
  • Rare lesion arising from sweat gland of the vulva
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26
Q

What is a syringoma?

A
  • Eccrine gland tumor
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27
Q

What is a neurofibroma?

A
  • From Von Recklinghausen’s disease
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28
Q

What is an angioma?

A
  • Appear as multiple 2-3mm red lesions usually in fourth or fifth decade
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29
Q

What is a vulvar hematoma?

A
  • Loculated collection of blood that collect following trauma (bike injury, birth trauma, or sexual assault)
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30
Q

What may be warranted with a vulvar hematoma?

A
  • Close observation and occasional surgical exploration
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31
Q

What is female genital circumscision?

A
  • More common in Africa and Eastern Asia countries

- Degree of anatomic change has an effect on infection risk, sexual function and vaginal delivery

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32
Q

What causes atrophic vaginitis?

A
  • Menopause

- Surgical removal of uterus and ovaries

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33
Q

What will exam reveal for someone with atrophic vaginitis?

A
  • Minora regresses and majora shrinks
  • Loss of vaginal rugae
  • Vaginal introitus constriction
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34
Q

What is the treatment for atrophic vaginitis?

A
  • Topical estrogen

- May consider oral estrogen to prevent recurrence

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35
Q

What is lichen simplex chronicus?

A
  • Local thickening of epithelium that results from a prolonged itch-scratch cycle
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36
Q

What is a symptoms of lichen simplex chronicus?

A
  • Pruritus
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37
Q

What does exam reveal for lichen simplex chronicus?

A
  • Reveals white or reddish, thickened, leathary, raised surface
  • Looks similar to psoriasis
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38
Q

What does biopsy reveal for lichen simplex chronicus?

A
  • Elongated rete ridges

- Hyperkeratosis of the keratin layer

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39
Q

What is the treatment for lichen simplex chronicus?

A
  • Moderate strength steroid ointments with antipruritic agents
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40
Q

What is lichen sclerosis?

A
  • Most frequently found on vulva of menopausal women

- Can cause genital structural abnormalities

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41
Q

What are some symptoms of lichen sclerosis?

A
  • Intense pruritus
  • Dyspareunia
  • Burning pain
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42
Q

What does examination reveal for lichen sclerosis?

A
  • Thin, white, inelastic skin with crinkled tissue paper appearance
  • “Onion skin, cigarette paper, parchment like”
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43
Q

What does biopsy reveal for lichen sclerosis?

A
  • Thin epithelium

- Loss of rete ridges and inflammatory cells lining the basement membrane

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44
Q

What is the treatment for lichen sclerosis?

A
  • Clobetasol 0.05%
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45
Q

What could some women with lichen sclerosis develop?

A
  • Squamous cell carcinoma of the vulva
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46
Q

What is seen on exam for lichen planus?

A
  • Purplish, polygonal papules that may appear in an erosive form
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47
Q

What is vulvar-vaginal-gingival syndrome?

A
  • When lichen planus involves the vagina, vulva, and mouth
48
Q

What are the symptoms of lichen planus?

A
  • Vulvar burning

- Severe insertional dyspareunia

49
Q

What is the treatment for lichen planus?

A
  • Topical and systemic steroids
50
Q

What is psoriasis?

A
  • Autosomal dominant inherited disorder

- On the vulva generally appears velvety but may lack the silver scaly patches found on flexor surfaces

51
Q

What does eczema look like?

A
  • More erythematous presentation
52
Q

What is pemphigus?

A
  • Autoimmune blistering disease involving the vulvovaginal and conjunctival areas
53
Q

What is Behcet’s syndrome?

A
  • Classically involves ulcerations in the genital, oral areas with uveitis
54
Q

What is crohn disease?

A
  • Primarily a GI disorder but vulvar ulcerations can occur due to fistulization
55
Q

What are apthous ulcers?

A
  • Superficial and painful

- More commonly found in mouth

56
Q

What are decubitus ulcers?

A
  • Can develop when chronic pressure is applied or secondary to tissue being moist secondary to urinary incontinence
57
Q

What is acanthosis nigrcans?

A
  • Most commonly found in the intertriginous area, vulva, axilla, or nape of neck
  • Appears as a demarcated, brown pigmented thickened area in the superficial layers of the skin
58
Q

What is acanthosis nigricans most commonly associated with?

A
  • Insulin resistance and obesity but can be linked to other benign conditions and malignancy
59
Q

What is contact dermatitis?

A
  • Careful history may identify the specific irritant
  • PE may reveal erythema, edema, excoriation, or ulceration
  • May need biopsy
60
Q

What is an imperforate hymen?

A
  • After birth, a bulging, membrane-like structure may be noticed in the vaginal opening, can block the egress of mucus
  • If not detected until after menarche, imperforate hymen can appear as a think dark bluish structure which entraps menstrual flow
61
Q

What is a transverse vaginal septum?

A
  • Most commonly found in the upper and middle thirds of the vagina often a small sinus tract or perforation will be present which allows the egress of menstrual flow
  • May only become apparent when intercourse is impeded
62
Q

What is a midline longitudinal vaginal septum?

A
  • Creates a double vagina, a longitudinal septum can attach to the lateral wall thus creating a blind vaginal pouch
  • These are usually associated with various duplication anomalies of the uterine fundus
63
Q

What is vaginal agenesis?

A
  • Most extreme vaginal anomaly with total absence of the vagina except for the most distal portion derived from the urogenital sinus
64
Q

What is Rokitansky-Kuster-Hauser syndrome?

A
  • Mullerian agenesis

- Uterus is absent but fallopian tubes are spared

65
Q

What is adenosis?

A
  • If the vaginal wall consists of islands of columnar cells in normal squamous epithelium
  • Seen in women who have been exposed to DES in utero
66
Q

What is gartner’s duct cyst?

A
  • Arise from the remnant of the wolffian duct
  • Vary in size from 1-5 cm and are found in the lateral walls of the vagina
  • Most are asymptomatic and require no intervention
67
Q

What is a urethral diverticula?

A
  • Small 0.3 -3 cm sac like projections in the anterior vagina along the posterior urethra
  • Can cause recurrent UTI, dysuria, and occasionally urinary leaking
  • Urethral dilation or excision is treatment
68
Q

What is an inclusion cyst?

A
  • Result form infolding of the vaginal epithelium
  • Located in the posterior or lateral wall in the lower third of the vagina
  • Frequently associated with gynecologic surgery or lacerations from child birth
69
Q

What is a bartholin’s cyst?

A
  • Most common vulvovaginal tumor
  • Less than 3 cm and is usually asymptomatic
  • Usually unilateral swelling
  • Need to biopsy in women 40+ to rule out Bartholin’s carcinoma
70
Q

What is a bartholin’s gland abscess?

A
  • Results from blockage and accumulation of purulent material
  • Painful inflammatory mass arises
71
Q

What are some treatment options for bartholin’s gland abscess?

A
  1. Word catheterization: Leave in 4-6 weeks which promotes an epithelialized tract for drainage of glandular secretions
  2. Marsupialization: creates a new ductal opening by everting the cyst wall onto the epithelial surface where it is sutured with interrupted absorbable sutures
72
Q

What is a cystocele?

A
  • Anterior vaginal prolapse
73
Q

What is a rectocele?

A
  • Posterior vaginal prolapse
74
Q

What are some structural changes of the vagina?

A
  • Cystocele
  • Rectocele
  • Uterine prolapse
  • Fistulas
75
Q

What is the most common cause of vaginal trauma?

A
  • Sexual assault
76
Q

What are the most common tumors of the vulva?

A
  • Squamous cell carcinomas
77
Q

Who is most likely affected by squamous cell carcinomas of the vulva?

A
  • Postmenopausal women, age 65
78
Q

What is the most frequently reported symptom of vulvar cancer?

A
  • Long history of chronic vulvar pruritus
79
Q

What is VIN usual type?

A
  • Associated with carcinogenic HPV (type 16), smoking and immunocompromised states
  • Gardasil vaccinations should cause a decrease in this type
80
Q

What is differentiated type VIN?

A
  • No associated with HPV or smoking

- More commonly associated with vulvar dermatologic conditions like lichen sclerosus

81
Q

What is the management of VIN III?

A
  • Local superficial surgical excision is mainstay of treatment
  • Skinning vulvectomy which removes all vulvar skin is rarely required
  • Laser therapy is useful if small lesions are on clitoris, labia minora or perianal areas
82
Q

What is Paget’s disease?

A
  • Extremely rare
  • Occurs in postmenopausal white females and can occur in the nipple areas of the breast
  • 10%-20% will have underlying carcinoma (breast or colon)
83
Q

What are the clinical features of Paget’s disease?

A
  • Itching and tenderness are common

- Well demarcated and eczematoid in appearance with fiery red background with white plaques like lesions

84
Q

What is the management of Paget’s disease?

A
  • Local superficial excision with 5-10 mm margins to clear the gross lesion and to exclude underlying invasive cancer
85
Q

What are some clinical features of squamous cell vulvar carcinoma?

A
  • Typically occurring in postmenopausal females between 70-80
  • Vulvar lump
  • Lesion is pruritic, raised, uclerated, pigmented, or warty usually on labia majora
86
Q

What are the different methods of spread in squamous cell vulvar carcinoma?

A
  • Direct extension to adjacent structures
  • Lymphatic embolization to regional lymph nodes
  • Hematogenous spread to distant sites
87
Q

What is the management of squamous cell vulvar carcinoma?

A
  • Radical vulvectomy and regional lymphadenectomy

- Wide local excision of the primary tumor with inguinal lymph node dissection

88
Q

What is malignant melanoma of the vulva?

A
  • Predominately in postmenopausal white women with lesions noted on the labia minora and clitoris
  • Wide local excision is necessary for diagnosis and staging
89
Q

What is verrucous carcinoma?

A
  • Variant of squamous cell carcinoma
  • Mets is rare
  • Lesions are cauliflower-like in nature and can be confused with condyloma
  • Radiation is contraindicated because it may induce anaplastic transformation
90
Q

What is a bartholins gland carcinoma?

A
  • Presents usually as a painless vulvar mass without history of previous bartholin’s gland disorders
91
Q

Who usually has a bartholin’s gland carcinoma?

A
  • Women over the age of 40 should have biopsy of gland to exclude malignancy
92
Q

what is the treatment for bartholin’s gland carcinoma?

A
  • Radical vulvectomy and bilateral lymphadenectomy with postoperative radiation
93
Q

How does a basal cell carcinoma of the vulva appear? Mets??

A
  • Rolled edge ulceration

- Does not metastasize

94
Q

What is the etiology of VAIN (vaginal intraepithelial neoplasia?

A
  • Appears to be related to the HPV viruses

- 50%-90% of patients with VAIN will have coexistent or prior neoplasia or cancer of the cervix or vulva

95
Q

How is diagnosis made for VAIN?

A
  • Asymptomatic
  • Usually considered with an abnormal pap in a woman who is status post hysterectomy or has no demonstrable cervical lesion
96
Q

What is the management of VAIN?

A
  • If lesion involves the vault –> surgical excision

- Multifocal lesions –> treat with laser therapy or topical 5-fluorouracil, if unsuccessful, may require vaginectomy

97
Q

What are the symptoms of carcinoma of the vagina?

A
  • Abnormal vaginal bleeding or discharge

- Hematuria

98
Q

What is the average age of someone with carcinoma of the vagina?

A
  • 60
99
Q

What are some physical exam findings of carcinoma of the vagina?

A
  • Ulcerative

- Exophytic growth may be seen

100
Q

How is diagnosis made for carcinoma of the vagina?

A
  • Punch biopsy is required
101
Q

What are some qualities of adenocarcinoma?

A
  • Most are mets from cervix, endometrium, or ovary
  • Clear cell carcinomas secondary to DES
  • Treated with radical hysterectomy and vaginectomy or radiation
102
Q

What are some qualities of malignant melanoma?

A
  • Mean age is 55 and usually occurs on the distal anterior wall
  • Prognosis is poor
103
Q

What are some qualities of sarcoma botryoides?

A
  • Mass of grape like polyps protruding from the introitus
  • Histologically the tumor is embryonal rhabdomyosarcoma
  • Average age is 2-3
104
Q

What is the vagina lined with?

A
  • Nonkeratinized stratified squamous epithelium
105
Q

What are some factors that can alter the protective microflora of the vagina?

A
  • Antibiotics
  • Douching
  • Intercourse (semen can raise pH or vaginal transudate has pH of 7.4)
  • Foreign body
106
Q

What is the most common cause of vaginitis?

A
  • Bacterial vaginosis usually caused by Gardnerella vaginalis
107
Q

What are some risk factors for bacterial vaginosis?

A
  • New or multiple sexual partners
  • Smoking
  • IUD
  • Douching
108
Q

What are some symptoms of bacterial vaginosis?

A
  • Many are asymptomatic
  • Profuse thin milky discharge often
  • Malodorous fishy amine odor especially after intercourse
109
Q

How is diagnosis made for bacterial vaginosis?

A
  • Saline wet mount reveals presence of “clue cells”
  • 10% KOH positive whiff test, releases an amine like odor
  • Vaginal pH >4.5
110
Q

What is the most common cause of vulvovaginal candidiasis?

A
  • Candida Albicans
111
Q

What are some risk factors for vulvovaginal candidiasis?

A
  • INcrease estrogen levels (high dose OCPs, pregnancy)

- DM, antibiotic use, steroid use, and immunosuppressed patients

112
Q

What aere some symptoms of vuvlovaginal candidiasis?

A
  • Vulvar pruritus, buringin, and irritation/dyspareunia

- Often little to no discharge. If discharge is present, it is white, adherent, and clumpy

113
Q

How diagnosis made for vulvovaginal candidiasis?

A
  • 10% KOH wet prep positive for budding yeast

- Vaginal pH <4.5

114
Q

What are the risk factors for tichomoniasis?

A
  • Unprotected sexual encounters
115
Q

What are some symptoms of trichomoniasis?

A
  • 50% of cases are asymptomatic
  • Dyspareunia, vulvovaginal irritation and occasional dysuria
  • Symptomatic cases reveal a green yellow “frothy” vaginal discharge
116
Q

How is diagnosis made for trichomoniasis?

A
  • Saline wet mount reveals motile trichomonads
  • pH is >4.5
  • Strawberry cervix

Endo/Repro (31 decks)

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