Chapter 27 Neoplastic Disease of the Vulva and Vagina Flashcards
preinvasive neoplastic disease of the vulva is divided into 2 categories:
- squamous (vulvar intraepithelial neoplasia VIN)
- nonsquamous intraepithelial neoplasias (Paget disease, melanoma insitu)
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vin1 - mild dysplasia
vinII - moderate dysplasia
vinIII - severe dysplasia
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rise in VIN and CIN is related with human papillomavirus
80-90% of VIN lesions will have DNA fragments from HPV
60% of women with VIN have cervical neoplasia as well. additional risk factors for VIN include
cigarette smoking and an immnocompromised state
any time a pruritic area of the vulva does not respond to topical antifungal creams - particularly in the postmenopausal women, further evaluation with ___ should be undertaken
vulvar biopsy
treatment of VIN in younger patients
these treatments require thorough evaluation to rule out invasive disease prior to use
5-fluorouracil (5-fu) and imiquod (aldara) . effectiveness at 40%-75%
imiquod directions: apply thin layer to warts and rub in before bedtimes 3 times per week; wash off with soap and water 6-10ours later. max 4 months. avoid sexual contact while cream is on skin.
recurrence is 18-55%
patients should have follow up colposcopy of the entire genital tract every 6 months for 2 years and then annually
paget disease of the vulva typically presents between ages 50-80. only about 20% of patients with pagent disease will have coexistent adenocarcinoma underlying the outward changes. when this occurs, metastasis is common. whenadenocarcioma is not present, Paget disease can be treated locally without concern for metastases
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treatment for paget:
in absence of invasion, treated withi wide local excision of circumscribed lesion. even with clean margins, paget disease has high recurrence rate and may require multiple local excisions. without nodal metastases, disease is commonly cured with local excision; however, the disease is almost invariably fatal if it spreads to lymph nodes
most common type of vulvar cancer is
squamous cell carcinoma (SCC) 87% of cases. other types of vulvar cancers include malignant melanoma 6%, bartholins adenocarcinoma 4%, basal cell carcinoma <2%, and soft tissue sarcomas <1%.
vulvar lesions can appear anywhere on the vulva, most are on labia majora. spread of disease is primarily via the lymphatics to the superficial inguinal lymph nodes, with smaller degree of spread via direct extension to vagina, urethra, and anus.
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patients with vulvar cancer present with long histories of
vulvar pruritus, pain, and bleeding.
20% of vulvar cancer pts will have secondary neoplasia, usually the cervix. presence of bleeding, discharge, or clear mass is strongly suggestive of invasive carcinoma
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preinvasive disease of the vagina:
vaginal intraepithelial neoplasia (VAIN) is a premalignant lesion similar to that of the vulva and cervix. however, VAIN is much less common than either VIN or CIN.
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many patients are diagnosed due to abnormality on pap smear. suspicion of vaginal neoplasia should be raised ni patients with persistently abnormal pap smears but no cervical neoplasia detected on colposcopy or cervical biopsy.
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treatment for VAIN
local excision or laser ablation.
vin (vulvar intraepithelial lesion) is a premalignant disease confined to vulvar epithelim.
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