Benign and Malignant Conditions of the Vagina and Vulva (Moulton)

Question 1

Clitoromegaly, Clitoral agenesis, Bifid clitoris, Midline fusion of the labiascrotal folds, and Cloaca are all presentations of?

They are congenital anomalies of the?

Answer 1

1) Ambiguous genitalia

2) Vulva

Question 2

Clitoral agenesis results secondary to failure of the ____ to form.

Answer 2

Genital tubercle

Question 3

No definite separation between the vagina & bladder results in?

Answer 3

Cloaca

Question 4

What is caused by masculinization in utero of the female fetus?

Answer 4

Female pseudohermaphroditism

Question 5

Congenital Adrenal hyperplasia, Ingestion of exogenous hormones, and Androgen secreting tumors of the mothers adrenal or ovaries all can lead to?

Answer 5

Female pseudohermaphroditism

Question 6

The most obvious abnormalities of female pseudohermaphroditism are __1__, __2__, and __3__.

Answer 6

1) Clitoromegaly
2) Hypospadiac urethra meatus
3) Malpositioned vaginal orifice

Question 7

____ insensitivity, which may be seen in ambiguous genitalia, is caused by a genetic deficiency in ____ receptors

Answer 7

Androgen

Question 8

1) What karyotype is seen in ambiguous genitalia with androgen insensitivity?

Ambiguous genitalia is most commonly an X-linked __2__ disorder.

Answer 8

1) 46 XY

2) Recessive

Question 9

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?

Answer 9

1) Mullerian

2) Uterus or fallopian tubes

Question 10

What structural and benign neoplastic condition of the vulva is treated with estrogen cream and massage to separate the labia majora?

Answer 10

Labial agglutination

Question 11

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.

Answer 11

1) Fox-Fordyce disease
2) Keratin
3) Apocrine

Question 12

__1__ are the most common type of genital cyst.

They develop when the __2__ become obstructed.

Answer 12

1) Epidermal inclusion cysts

2) Hair follicles

Question 13

What can enlarge and become painful in pregnancy and have characteristic blue color?

Answer 13

Vulvar varicosities

Question 14

__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.

Answer 14

1) Urethral caruncles
2) Urethral epithelium
3) Vaginal
4) Urethral

Question 15

__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.

Answer 15

1) Vulvar vesitbulitis (Vestibular adenitis)
2) Dyspareunia
3) Estrogens/hydrocortisone

Question 16

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?

Answer 16

1) Sebaceous cyst

2) Cheesy sebaceous material

Question 17

What are the most common benign solid tumors of the vulva? They are slow growing, most range from 1-10 cm.

Answer 17

Fibromas

Question 18

What are slow growing tumors composed of adipose cells?

Answer 18

Lipoma

Question 19

What are rare lesions arising from sweat gland of the vulva?

Answer 19

Hidradenoma

Question 20

Syringoma is a(n) ____ gland tumor.

Answer 20

Eccrine

Question 21

What tumor can occur due to Von Recklinghausen’s disease?

Answer 21

Neurofibroma

Question 22

What tumor appear as multiple 2-3 mm red lesions usually in fourth & fifth decade?

Answer 22

Angioma

Question 23

What are loculated collections of blood that collect following trauma such as bike injuries (straddle injury), birth trauma or sexual assault?

Answer 23

Vulvar hematomas

Question 24

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__.

Answer 24

1) Atrophic vaginitis
2) Estrogen
3) Topical estrogen (may use oral to prevent recurrence)

Question 25

Local thickening of epithelium that reveals white, leathery, raised surface is diagnostic of?

What does it results from?

Answer 25

1) Lichen simplex chronicus (Squamous cell hyperplasia)

2) Chronic itching of the area

Question 26

What does biopsy of Lichen simplex chronicus reveal?

Answer 26

1) Elongated rete ridges

2) Hyperkeratosis of keratin layer

Question 27

__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.

Answer 27

1) Lichen sclerosis

2) Menopausal

Question 28

4% of treated women & 10% of untreated women with lichen sclerosis can develop ____ of the vulva.

Answer 28

Squamous cells cancer

Question 29

What does biopsy of Lichen sclerosis reveal?

Answer 29

1) Thin epithelium
2) Loss of rete ridges
3) Inflammatory cells lining basement membrane

Question 30

Lichen simplex chronicus presents with marked hyperkeratosis and parakeratosis with a prominent ____ layer.

Answer 30

Granular

Question 31

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.

Answer 31

Hyaline

Question 32

Purplish, polygonal papules that may appear in an erosive form causing vulvar burning and severe dyspareunia is diagnostic of?

Answer 32

Lichen planus

Question 33

Autoimmune blistering disease involving the vulvovaginal conjunctival areas is characteristic of?

Answer 33

Pemphigus

Question 34

What syndrome classically involves ulcerations in the genital, oral areas with uveitis?

Answer 34

Bechet’s syndrome

Question 35

What is primarily a GI disorder but vulvar ulcerations can occur due to fistulations?

Answer 35

Chron’s

Question 36

What ulcers can develop when chronic pressure is applied or secondary to tissue being moist secondary to urinary incontinence?

Answer 36

Decubitus ulcers

Question 37

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__.

Answer 37

1) Imperforate hymen
2) Thin dark bluish
3) Menstrual flow

Question 38

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?

Answer 38

Transverse vaginal septum

Question 39

What type of vaginal septum creates a double vagina and can attach to the lateral wall thus creating a blind vaginal pouch?

Answer 39

Midline longitudinal vaginal septum

Question 40

Which vaginal septum are usually associated with various duplication anomalies of the uterine fundus?

Answer 40

Midline longitudinal vaginal septum

Question 41

Vaginal agenesis is the most extreme vaginal anomaly with total absence of the vagina except for the most distal portion that is derived from?

Answer 41

Urogenital sinus

Question 42

Rokintansky-Kuster-Hauser Syndrome (Mullerian agenesis) presents if __1__ is absent but __2__ are spared.

Answer 42

1) Uterus

2) Fallopian tubes

Question 43

____ 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.

Answer 43

Adenosis

Question 44

____ 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

Answer 44

1) Gartner’s duct cyst

2) Lateral walls