BENIGN GYNECOLOGIC LESIONS (TB) Flashcards
What is another term for the vulva?
Pudenda
What structures are included in the vulva?
Mons pubis. clitoris. urinary meatus. labia majora and minora. vestibule (hymen. vaginal opening. urethral opening. Bartholin and Skene’s glands)
What is the most common benign solid tumor of the vulva?
Fibroma
Where is fibroma most commonly found in the vulva?
Labia majora
Does fibroma have a potential for malignancy?
Yes
What does a fibroma look like on cut section?
Smooth surface. gray-white tissue. firm consistency (more firm than rubbery lipoma)
What is the treatment for fibroma?
Excision biopsy
What is the second most common benign vulvar mesenchymal tumor?
Lipoma
Where do lipomas most commonly arise in the vulva?
Periclitorally or within the labia majora
How does lipoma differ from fibroma in consistency?
Lipoma is softer and usually larger than fibroma
What is the histologic appearance of lipoma?
Homogeneous with areas of connective tissue and mature adipose cells
What is the treatment for large lipomas?
Excision biopsy
What is another term for a nevus?
Mole
What cells form a nevus?
Localized nest or cluster of melanocytes
What is the ABCD rule in evaluating moles?
Asymmetry. Border irregularity.Color variegation. Diameter >6mm
What is the recommended biopsy method for a suspicious nevus?
3-dimensional excisional biopsy with 5-10mm margins including underlying dermis
What is the most common small vulvar cyst?
Epidermal inclusion cyst
How does an epidermal inclusion cyst appear on inspection?
Firm. smooth-surfaced. white. yellow. pink or skin-colored papule or nodule (0.5-2 cm)
What is found inside an epidermal inclusion cyst when incised?
White. caseous material like thick cheese
What is the treatment for an inflamed epidermal inclusion cyst?
Local heat application. incision and drainage. excision if recurrent infection occurs
What is the most common cause of primary irritant contact dermatitis?
Non-immunologic irritants like excessive cleansing. soaps. fabric softeners or incontinence
How long does it take for allergic contact dermatitis to manifest?
36-48 hours (Type IV hypersensitivity reaction)
What is a common allergen causing vulvar allergic contact dermatitis?
Latex (e.g. condoms. gloves)
What is the treatment for contact dermatitis?
Remove irritants. keep skin clean and dry. apply topical steroids. zinc oxide for incontinence-related dermatitis
What common misconception exists about using perfume on the vagina?
Perfume does not improve vaginal odor; it can disturb normal flora and cause bacterial vaginosis.
What is the classic sign of psoriasis on scraping?
Silver scales and pinpoint bleeding (Auspitz sign)
What is the initial treatment for vulvar psoriasis?
1% hydrocortisone cream
Does psoriasis involve the vagina?
No
What is a key symptom of lichen planus in the vulva?
Soreness. burning. itching and dyspareunia
What is the treatment for vulvar lichen planus?
Potent topical steroids (clobetasol BID). steroid suppositories or systemic estrogen replacement in postmenopausal women
What surgical procedure may be needed for severe lichen planus?
Surgery to separate vaginal adhesions or uncover a buried clitoris
Why are postmenopausal women with lichen planus monitored regularly?
Increased risk for vulvar squamous cell carcinoma (SCCA)
What is lichen sclerosus?
A condition characterized by epithelial thinning. inflammation and distinctive histological changes in the dermis.
What is the etiology of lichen sclerosus?
Unknown. but associated with hypoestrogenism.
What are the symptoms of lichen sclerosus?
Pruritus and vulvar discomfort.
What is the appearance of lichen sclerosus lesions?
White atrophic papules that coalesce into porcelain-white plaques.
What areas are affected by lichen sclerosus?
Lesions are always limited by the labia majora.
What are the three stages of lichen sclerosus?
Early (inflammation). Middle (erosion. blisters and purpura). Late (atrophic and tumor).
What is hidradenitis suppurativa?
A chronic. refractory infection of the skin and subcutaneous tissue containing apocrine glands.
Who is most commonly affected by hidradenitis suppurativa?
98% of cases occur in reproductive-age women and most regress after menopause.
Where does hidradenitis suppurativa commonly occur?
Intertriginous areas such as the mons pubis. genital folds and buttocks.
What is a key feature of hidradenitis suppurativa lesions?
Painful deep scars. pits and foul-smelling discharge.
What is the current etiological theory of hidradenitis suppurativa?
Inflammation beginning in the hair follicles. also called “acne inversa.”
How can shaving contribute to hidradenitis suppurativa?
Shaving can cause irritation and trigger the condition.
What is the first-line treatment for early hidradenitis suppurativa?
Topical or oral Clindamycin for a 3-month course.
What are treatment options for hidradenitis suppurativa that fails initial therapy?
Antiandrogens. Isotretinoin. Cyclosporine.
What is the management for refractory hidradenitis suppurativa?
Wide operative excision.
What is the appearance of hidradenitis suppurativa extending to the perineum and anus?
Figure-of-8 or hourglass shape with lichenification and hypopigmentation.
What is the treatment for hidradenitis suppurativa affecting the perineum?
Avoidance of irritation. high-potency topical corticosteroids. estrogen cream and surgery for severe cases.
What is a vulvar hematoma?
A localized collection of blood in the vulvar area. usually secondary to blunt trauma.
What is a rare cause of spontaneous vulvar hematomas?
Rupture of a varicose vein during pregnancy or postpartum.
How is a non-expanding hematoma managed?
Ice packs.
What is the management for a hematoma >10 cm or rapidly expanding?
Surgical ligation of the bleeding vessel.
What is the management for chronic expanding hematomas?
Drainage and debridement.
What is the vestibule?
An almond-shaped area of the external female genitalia.
What are the borders of the vestibule?
Laterally - Hart line. Medially - External surface of the hymen. Anteriorly - Clitoral frenulum. Posteriorly - Fourchette.
What structure is usually the first to rupture during first coitus?
Hymen at the 6:00 position.
What are the glandular structures in the vestibule?
Periurethral (Skene’s) glands and Vulvovaginal (Bartholin’s) glands.
How many openings are in the vestibule?
Six (Vaginal introitus. Urethral opening. 2 Skene’s glands. 2 Bartholin’s glands).
What is a urethral caruncle?
A small. fleshy mass at the posterior portion of the urethral meatus.
What populations are most affected by urethral caruncles?
Postmenopausal and premenarchal women due to low estrogen.
What are the clinical manifestations of a urethral caruncle?
Usually asymptomatic but may cause dysuria. hematuria. urgency. tenderness or spotting.
How is a urethral caruncle diagnosed?
Biopsy under local anesthesia.
What is the treatment for an asymptomatic urethral caruncle?
No treatment required.
What is the first-line treatment for a symptomatic urethral caruncle?
Topical or oral estrogen and avoidance of irritation.
What are surgical options for refractory urethral caruncles?
Cryosurgery. laser therapy. fulguration or operative excision.
Why is a Foley catheter used postoperatively for urethral caruncle excision?
To prevent urinary retention and stenosis.
What is urethral prolapse?
Annular rosette of friable. edematous. prolapsed mucosa.
What is the typical population affected by urethral prolapse?
Predominantly premenarcheal girls due to a hypoestrogenic state.
How is urethral prolapse treated?
Hot sitz baths. topical estrogen cream and in rare cases. excision of redundant mucosa.
What are Bartholin’s glands?
The greater vestibular glands. homologous to Cowper’s glands in males.
Where do the Bartholin’s ducts open?
Distal to the hymeneal ring at the 5 and 7 o’clock positions.
What is a Bartholin duct cyst?
Cystic dilation of an obstructed Bartholin duct.
What is the most common large cyst of the vulva?
Bartholin duct cyst.
What is the lifetime risk of developing a Bartholin duct cyst?
Approximately 2%.
What is the treatment for an asymptomatic Bartholin duct cyst?
No treatment required.
What is the most common pathogen in an infected Bartholin duct cyst?
Staphylococcus aureus.
What is the treatment for an infected Bartholin duct cyst?
Incision and drainage with Clindamycin or Co-amoxiclav.
What is the management for recurrent Bartholin abscesses?
Marsupialization with antibiotics.
What is the function of Skene’s glands?
They secrete mucus and are homologous to the prostate gland.
Where do Skene’s glands open?
Along the entire inferior aspect of the urethra.
What condition can result from obstruction of Skene’s glands?
Urethral diverticulum.
How does a Skene’s duct cyst differ from a urethral diverticulum?
Compression of a Skene’s duct cyst does not produce fluid from the urethral meatus
How is a symptomatic Skene’s duct cyst managed?
Excision with careful dissection to avoid urethral injury.
What is an imperforate hymen?
A congenital condition where the hymen completely covers the vaginal opening.
How does an imperforate hymen present?
Severe hypogastric pain. cyclic pain without menstruation and a bluish bulge on the vulva.
What causes the bluish bulge in an imperforate hymen?
Accumulated menstrual blood that cannot exit.
What is the treatment for an imperforate hymen?
Hymenotomy.
