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
What is Cloaca?
No definite separation between the vagina & bladder
Masculinization in utero of the female fetus causes what
How is the internal genital organ development?
Female pseudohermaphroditism
Normal
Congenital Adrenal hyperplasia
Ingestion of exogenous hormones
Androgen secreting tumors of the mother’s adrenals/ovaries
Can lead to what?
Female pseudohermaphroditism
What are the 3 most obvious abnormalities of female pseudohermaphroditism?
1) Clitoromegaly
2) Hypospadiac urethra meatus
3) Malpositioned vaginal orifice
1) What is seen in Ambiguous Genitalia?
2) What is it caused by?
3) What is the Karyotype?
4) Genetics?
5) Testes?
Androgen Insensitivity
Genetic deficiency in Androgen receptors
46 XY
X-Linked Recessive
Undescended
1) How does Ambiguous genitalia occur?
2) What does this lead to phenotypically?
1) Mullerian inhibiting substance
2) Absent Uterus or fallopian tubes
What is the treatment for Labial agglutination?
Massage estrogen cream to separate labia majora
1) How is Fox Fordyce disease characterized as?
2) Where is it located?
3) What causes Fox-Fordyce disease?
1) Severe pruritic raised yellow retention cysts
2) In axilla and labia
4) Keratin plugged inflammation of Apocrine glands
1) What is the most common type of genital cyst?
2) What causes it?
3) How is it described as?
1) Epidermal inclusion cysts
2) Obstructed hair follicles
3) Mobile, non tender, spherical
1) What can enlarge and become painful in pregnancy?
2) What color do they turn?
1) Vulvar Varicosities
2) Blue
Urethral Caruncles
1) What are Urethral caruncles and where are they?
2) What causes them in children?
In postmenopausal women it is secondary to contraction of the hypoestrogenic __3__ epithelium resulting in everting of the __4__ epithelium.
1) Small fleshy red outgrowth at the distal edge of urethra
2) Spontaneous prolapse of Urethral epithelium
3) Vaginal
4) Urethral
1) What happens in Vulvar vestibulitis (Vestibular adenitis)
2) What is the result?
3) What are the clinical symptoms?
4) What is the treatment?
1) 1 or more minor vestibular gland becomes infected
2) Tender Erythematous dots
3) Dyspareunia (painful sexual intercourse) and valvular pain
4) Topical Estrogens/hydrocortisone or surgery
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
1) What is Atrophic Vaginitis due to?
2) What will exam findings show?
3) What are the treatment?
1) Loss of estrogen (menopause or surgery)
2) Atrophy of external genitalia and loss of vaginal rugae
3) Topical estrogen
Local thickening of epithelium that reveals white, leathery, raised surface is diagnostic of?
What does it results from?
What will Biopsy show?
1) Lichen simplex chronicus (Squamous cell hyperplasia)
2) Chronic itching of the area
3) Elongated Rete Ridges and Hyperkeratosis
__1__ reveals thin, white, inelastic skin with a crinkled tissue paper appearance that causes___2__
It is frequently found on the vulva of __3__women.
4) Biopsy will reveal what?
1) Lichen Sclerosis
2) Pruritus, Dyspareunia, and burning pain
3) Menopausal
3) LOSS of rete ridges, inflammatory cells lining Basement membrane, and Thin epithelium
4% of treated women & 10% of untreated women with lichen sclerosis can develop ____ of the vulva.
Squamous cells cancer
1) LICHEN SIMPLEX CHRONICUS presents with marked ____ and ____ with a prominent ____ layer.
2) What is the most striking feature of LICHEN SCLEROSIS
3) How does that occurs
1) Hyperkeratosis and parakeratosis with prominent Granular layer
2) Hyaline zone in superficial dermis
3) Due to edema and degeneration of collagen and elastic fibers of the dermis
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
Crohn’s Disease can present with what?
Vulvar ulceration due to fistulizations
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 (removal) 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
1) Vaginal agenesis is the most extreme vaginal anomaly with total absence of the vagina except for the most distal portion (external genitalia) that is derived from?
2) What is the associated syndrome?
3) What must be true for this syndrome?
Urogenital sinus
2) Rokinatansky-Kuster-Hauser Syndrome (Mullerian agenesis)
3) Uterus is absent but fallopian tubes are spared
1) Where is Adenosis located?
2) What type of cells?
3) Who gets it?
1) On the Vaginal wall
2) Columnar cells
3) Women exposed to DES in Utero
1) Where are (Asymptomatic) Gartner’s duct cyst located?
2) What do they arise from?
1) Lateral walls
2) Arise from Wolfian Duct (Mesonephros)
