Benign Gyne Lesions Flashcards
gray-white tumors, difcult to distnguish them from
fbroma
ADENOFIBROMA/ CYSTADENOFIBROMA
Histologically, two principal components:
1. Solid masses or nests of uniform epithelial cells
(similar to uroepithelium)
2. Surrounding fbrous stroma
Brenner tumor
Grossly: heavy, solid, well encapsulated, and grayish white;
majority are edematous
Cut secton: homogeneous white or yellowish white solid tssue
with a trabeculated or whorled appearance similar to myomas
Fibroma
The surface of an afected ovary is ofen irregular, puckered, and
scarred and replaces the normal ovarian tssue
Most are asymptomatc
Pelvic pain, dyspareunia, infertlity
ENDOMETRIOMA
Grossly: walls are a shiny, smooth, opaque white color
Cut secton: thick sebaceous fuid pours, ofen with tangled
masses of hair and frm areas of cartlage and teeth Sebaceous
material is a thick fuid at body temperature but solidifes when it
cools in room air
Dermoid Cyst
Grossly: maybe voluminous, multple gray- bluish tnged thin
walled locules (HONEYCOMB APPEARANCE) containing straw
colored or hemorrhagic fuid
Theca Lutein Cyst
Grossly: smooth surface with areas of purplish red to brown hemorrhages
Cut Secton: the convoluted lining is yellowish orange, and the center contains an organizing blood clot
Corpus Luteum Cyst
Translucent, thin-walled dome on ovarian cortex
Filled with a watery , clear to straw - colored fuid
Lining: closely packed layer of round, plump granulosa cells, with
the spindle-shaped cells of the Theca interna deeper in the stroma
Follicular cyst
Grossly: globular enlargement of the uterus, with prominent
trabeculae and multple foci of hemorrhages
Adenomyosis
- grows by direct extension and grossly appears like a “SPAGHETTI” TUMOR - only 25% extend beyond the broad ligament
Intravenous Leiomyomatosis
- benign small nodules over the surface of the pelvis and abdominal peritoneum
Leiomyomatosis Peritonealis
Diagnosis: Enlarged, frm, irregular uterus on palpaton Mobility of the pelvic mass as part of the uterus
RED/ CARNEOUS DEGENERATION
Myoma (LEIOMYOMA UTERI
)
Grossly: the surface is homogenous with loss of the whorled
patern Histologically: the cellular detail is lost as the smooth muscle cells
are replaced by fbrous CT
HYALINE degeneration
Globular and mildly tender uterus Diagnosis:
o confrmed by ultrasound and release of dark brown
blood from the cervical os upon probing with a narrow
metal dilator
HEMATOMETRA
Ultrasound: Well-defned, uniformly hyperechoic mass that is
less than 2cm in diameter, within the endometrial cavity
ENDOMETRIAL POLYP
What population is primarily affected by urethral caruncles?
Postmenopausal and premenarchal females
What causes urethral caruncles to develop?
Decreased estrogen leading to ectropion of the posterior urethral wall
What histological features are seen in urethral caruncles?
Transitional and stratified squamous epithelium with loose connective tissue and large dilated veins
What symptoms are associated with urethral caruncles?
Dysuria, frequency, urgency, and point tenderness
How are small asymptomatic urethral caruncles managed?
No treatment is necessary
Where do Bartholin glands open into?
Vulvar vestibule at 5 and 7 o’clock positions
What is the estimated lifetime risk of Bartholin duct cysts?
Approximately 2%
How are non-inflamed Bartholin duct cysts treated?
They do not require treatment unless causing discomfort
What type of epithelium lines Skene duct cysts?
Non-specific epithelium, typically cuboidal
What is the most common benign vulvar lesion?
Epidermal cyst (epidermoid cyst)
What are common characteristics of epidermal cysts?
Firm, nontender, slow-growing, located in hair-bearing areas
What is the second most common malignancy arising in the vulva?
Melanoma
What is the typical age for vulvar melanoma diagnosis?
Around 68 years
What percentage of malignant melanomas arise from a preexisting nevus?
0.5
What are ABCD characteristics of malignant melanoma?
Asymmetry, Border irregularity, Color variegation, Diameter >6mm
What type of hemangioma is commonly identified during childhood?
Strawberry hemangioma
What type of angioma occurs in postmenopausal women and is <3mm in diameter?
Senile or cherry angiomas
What is the classic symptom of vulvar endometriosis?
Cyclic pain associated with menstrual periods
What are common sites for vulvar endometriosis?
Old obstetric lacerations or episiotomy sites
What is the most common gynecologic symptom in women?
Pruritus
What is the classic skin change associated with lichen sclerosis?
White, thickened skin with atrophy
What are the three types of lichen planus affecting the vulva?
Erosive, classical, and hypertrophic
What is a common histological finding in lichen planus?
Degeneration of basal cell layer with lymphocytic infiltration
What is vulvodynia?
Vulvar discomfort described as burning pain without visible findings
What are common symptoms of vulvar pain syndromes?
Burning pain, dyspareunia, dysuria, itching
What is the primary cause of vulvar candidiasis?
Infection by Candida species, especially Candida albicans
What are key risk factors for vulvar candidiasis?
Diabetes, antibiotics use, immunosuppression, high estrogen levels
What is the most common benign solid tumor of the vulva?
Fibroma
Where are vulvar lipomas most commonly located?
Periclitorally or within labia majora
What anatomical structure does the Bartholin gland drain into?
The vulvar vestibule
What are common symptoms of Bartholin gland abscess?
Pain, tenderness, swelling in the vulva
Which type of vulvar cyst is most likely to be mistaken for a cystocele?
Gartner duct cyst
What is the first-line treatment for mild vulvar psoriasis?
1% hydrocortisone cream
Which medication can be used for refractory lichen planus?
Methotrexate or oral retinoids
What is the recommended treatment for large, symptomatic hemangiomas?
Cryosurgery, sclerotherapy, or laser therapy
What histological feature distinguishes granula cell myoblastoma?
Large, round cells with indistinct borders and pink-staining cytoplasm
What histological feature is common in vulvar fibromas?
Smooth surface, distinct contour, gray-white on cut surface
What are common differential diagnoses for a pigmented vulvar lesion?
Malignant melanoma, hemangioma, endometriosis, vulvar intraepithelial neoplasia
Define a urethral diverticulum.
An epithelialized saclike projection from the posterior urethra
What is the ‘three D’s’ symptom triad associated with urethral diverticulum?
Dysuria, dyspareunia, dribbling of urine
What is the primary differential diagnosis for vulvar pruritus?
Infections, STDs, specific dermatoses, atrophy, systemic diseases
Which condition can cause a rebound pruritus after steroid therapy?
Contact dermatitis
Which imaging method has 100% sensitivity for diagnosing urethral diverticulum?
MRI
What diagnostic tests are helpful for detecting urethral diverticulum?
Voiding cystourethrography and cystourethroscopy
What are vulvar varicosities, and when do they typically regress?
Vulvar vein dilation, often regressing postpartum
How is vulvodynia diagnosed?
By excluding other treatable causes of vulvar pain
What test is used to assess pain sensitivity in vulvar pain syndrome?
Cotton swab test
What are common symptoms of Bechet disease?
Oral aphthous ulcers, genital aphthous ulcers, uveitis
Which condition may present with a painful, foul-smelling discharge?
Hiradenitis Suppurativa
What are common causes of vulvar edema?
Inflammation, lymphatic blockage, trauma, systemic disease
What is the management for vulvar hematomas larger than 10 cm?
Operative therapy to control bleeding
What is the most common cause of trauma to the lower genital tract in adults?
Coital injuries
What symptoms are typical of a vaginal laceration from coitus?
Profuse bleeding, sharp pain, persistent abdominal pain
What is the typical treatment for symptomatic vulvar varicosities?
Sclerotherapy
What are characteristic features of a pyogenic granuloma?
Small nodule, pedunculated, pinched-in base
How can a ‘forgotten’ tampon be safely removed?
Using a double-glove technique
What is the primary symptom of vulvar contact dermatitis?
Intense itching with burning or stinging sensation
What is a common misdiagnosis for vulvar psoriasis?
Cutaneous candidiasis, seborrheic dermatitis, eczema
What condition presents as erythematous, edematous patches with non-adherent scales?
Seborrheic dermatitis
