Disorders of Vulva, Vagina, PID Flashcards
What are the types of Non-Neoplastic Epithelial Disorders?
- Lichen Simplex Chronicus (Squamous Cell Hyperplasia)
- Lichen Sclerosus et Atrophicus
- Lichen Planus
- Leukoplakia
Lichen Simplex Chronicus
- Age?
- Cause?
- Visual
- Any age-usually young
- Caused by scratching of chronic itch
- thickening of epidermis, hyperkeratosis (may have dermal fibrosis)
Lichen Sclerosus et Atrophicus
- Age?
- Visual?
- Post menopausal age
- white plaques of confluent white patches
- epidermal atrophy
- dense collagenous dermal fibrosis
- Called Balanitis Xerotica Obliterans in males
- Occasionally progresses fo Squamous Cell Carcinoma
Lichen Simplex Chronicus
Lichen Sclerosus et Atrophicus
Which NNED has an hourglass appearance?
Lichen Sclerosus et Atrophicus
Lichen Planus characteristics?
- inflammatory lesion
- raised purplish plaques and patches
- labia minora shows reddening and there is an area of erosion with red denudation of mucosa
- Tx with topicla steroids
Acute (allergic) Contact Dermatits affects which vaginal regions?
BOTH labia majora and labia minora
Which inflammatory vulval disease causes pruritis, soreness, and pain??
Allergic Dermatitis
Allergic Dermatitis causes?
- Topical applications like deodorants, creams, ointments (usually used for the treatment of vulval irritation and soreness)
- Soap, detergents in shower gels and bubble baths, detergents used in washing underwear, cosmetics, perfumes…
- rubber and latex chemicals used in contraceptives and nail varnish
- local anesthetics and creams/ topical steroids often given as treatment
What are some other skin inflmmatory conditions?
- Psoriasis
- suborrheic dermatitis
- drug rashes of various types
- blistering diseases (eosinophil, neutrophil, lymphocyte)
Viruses responsible for Vulval infections?
HPV and Herpes Vulvitis
- Thickening of labia minora skin and mucosa (Flat Condyloma)
- Multiple protuberant warts (Condyloma Acuminata)
HPV 6 and 11
Strong link to intraepithelial neoplastic change in the vulva
HPV 16 and 18
Form initially painless blisters which subsquently break down to form a painful, sore, eroded area?
Herpes Vulvitis
Funals Vulval Infections
Candida and Dermatophytic fungi
causes vulvovaginitis, copious vaginal discharge and vulval reddening and soreness, SEEN IN DIABETICS
Candida Albicans
Causes superficial inflammation and soreness
Dermatophytic fungi
Non-Viral Causes of Vulval infection
Klebsiella, Chlamydia,Haemophilus, Treponema
Granuloma inguinale
Klebsiella
Ulcerating Nodules on the vulva with donovan bodies
Lymphogranuloma venerum
Chlamydia
Ulcerating vulval papules and enlarged inguinal lymph nodes
Chancroid
Haemophilus
ulcerating vulval tender papules and ulcerating nodeuls with tender enlargement of the inguinal lymph nodes
Syphillus
Treponema Pallidum
Small painless indurated vulval or vaginal papules in the first stage and multiple moist, warty, vulvovaginal and perineal lesions (condylomata lata) in the second stage
Squamous Cell Carcinoma
- Benign or Malignant?
- Prognosis?
- De novo or Intraepithelial formation
- Malignant, usually occurs in elderly women
- Poor Px- Extensive invasion to other pelvic organs and lymph node metastases
- Good Px- Localized and well differentiated
- Mostly arise de Novo, but HPV 16, 18, 31 develop VIN
What does VIN mean?
What age group does it effect?
Predisposing factors?
Vulval Intraepithelial neoplasia
Effects young women
Predisposition in smokers
Which virus is strongly associated with vulval carcinomas arising in VIN
HPV 16
What evidence would be present in HPV warty change?
effected adjacent epithelium
Squamous cell Carcinoma variant?
Age Group?
Verrocous Carcinoma
Very old women
Describe Verrocous Carcinoma?
Large warty cauliflower like growth that slowly invades local tissues
Almost never metastasizes
D/D: Condyloma Accuminata
Virus responsible for Condyloma Acuminata?
HPV 6/11
Common source of derivation for benign cysts on Vulva
Skin or Bartholin’s glands
Name some other neoplastic Lesions of the Vulva?
Benign intradermal nevus
Compound Nevus
Malignant Melanoma
Papillary Hiradenoma
Pagets Disease
Where is Pagets Disease derived from?
skin appendages carcinoma
but no associated underlying malignancy
Pagets diseas of Vulva associated with what other location?
20-30% associated with Breast Paget Dz
Vulva is most common extra mammary site.
What is vaginal adenosis?
Remnant of columar endocervical tissue
red granular areas that have columnar mucinous epithelium
Seen in 35-90% of women exposed to DES (diethylstilbestrol) in utero –> increases RISK of CCC
BUT rarely progress to Clear Cell CA
What is Gartner duct cyst?
relatively common
cyst in lateral wall of vagina
remnants of wolffian duct
What is endometriosis vagina?
mullerian derived lesion
simulates malignancy
What is Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
Red polypoid mass that may protrude from vaginal orifice
1st clincal sign is spotting/bleeding
Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
Histology?
Age?
Prognosis?
Rhabdomyoblasts with cross striation
Girls < 6 yo
Px= good with surgery and chemotherapy
Diagnostic hallmark of Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)?
CROSS STRIATION of Rhabdomyoblasts
-tadpole, strap, and spider cells-
Arrows show a rhabdoid cell (rhabdomyoblasts) with increased eosinophilic cytoplasm that is classic for sarcoma botryoides.
The lesion in the absence of rhabdoid cells, may be confused with benign inflammatory polyp
Verrocous Carcinoma
Sarcoma Botryoides
What is PID and whcih pathogens and most commonly involved?
PID is an ascending genital infection
N. gonnorhea, C. trachomatis, streptococci, staphylococci, clostridia, E. Coli
What are the STAGES of PID?
- Vulvovaginitis and cervicitis
- Acute endometritis
- Acute suppurative salpingitis
- Salpingo-oopheritis
- Pyosalpinx and tubo-ovarian abscess
Clinical presentation of PID
- Lower abdominal pain
- Vaginal discharge (if Chlamydia infection)
- Fever and chills
- Nausea and vomiting
- Dyspareunia
- Abnormal vaginal bleeding
- Infertility: Important preventable cause
- Cervical motion tenderness
PID Complications?
Chronic salpingitis and hydrosalpinx
Scarring and tubal obstruction:
Infertility, Ectopic (tubal) pregnancy, Chronic Abdominal Pain
Pelvic peritonitis
Perihepatitis and peritoneal fibrous adhesions
(Fitz-Hugh-Curtis syndrome)
Fitz-Hugh-Curtis Syndrome
- Contrast enhancement along surface of the liver
- Perihepatic abscess associated
- Pericholecystic fluid associated with transient hepatic perfusion abnormality
- Focal liver-encapsulated fluid collection
- Gallbladder wall thickening
- Soft-tissue bands in abundant ascites
- Heterogeneous adnexal mass
- Moderate chronic ascites
Diagnostic Hallmark of Vaginal Adenosis progression to Clear Cell Carcinoma
Hobnail cells
