Lecture 8: Benign and Malignant Conditions of the Vulva and Vagina Flashcards
Androgen insensitivity syndrome (46,XY) is most commonly inherited how?
X-linked recessive
Which disease is characterized by severe pruritic raised yellow retention cysts in the axilla and labia majora and minor resulting from keratin-plugged inflammation of apocrine glands?
Fox-Fordyce disease
What is the most common type of genital cyst?
Epidermal inclusion cyst = mobile, nontender, spherical, and slow growing
Sebaceous cysts of the vulva are most commonly found where and contain what?
- Inner surface of labia minora and majora
- Contain a cheesy sebaceous material
What is the most common benign solid tumor of the vulva; what are its growth characteristics?
- Fibromas
- Slow growing, most range from 1-10cm
- CAN become gigantic (250 lbs!!!!)
Which condition of the vulva is assoc. w/ 1-4mm erythematous dots that are extremely tender and is characterized by severe introital dyspareunia and occasional vulvar pain?
Vulvar vestibulitis (vestibular adenitis)
What is the treatment for labial agglutination?
Estrogen cream and massagetoseparatethelabia majora
Vuvlvar hematomas most often arise following what; how are they managed?
- Arise following trauma i.e., bike injuries (straddle injury), birth trauma or sexual assault
- Close observation and occasional surgical exploration may be warranted
Atrophic vaginitis is due to what; managed how?
- Due to loss of estrogen
- Tx w/ topical estrogen and may consider oral estrogen to prevent recurrence
Treatment for lichen simplex chronicus?
Moderate strength steroid ointments w/ anti-pruritic agents
Biopsy of lichen sclerosis will show what 2 major characteristics?
- THIN epithelium
- Loss of rete ridges and inflammatory cells lining the BM
What is seen with lichen planus and what are the sx’s?
- Purplish, polygonal papules that may appear in an erosive form
- Sx’s: vulvar burning, severe insertional dyspareunia
- Tx: topical and systemic steroids
Transverse vaginal septums are most commonly found where in the vagina and may only become apparent when?
- Upper and middle thirds of the vagina
- May only become apparent when intercourse is impeded
Mullerian agenesis characterizd by absence of the uterus but sparing of the fallopian tubes is known as what?
Rokintansky-Kuster-Hauser Syndrome
What is the most common vulvovaginal tumor?
Bartholin’s Cyst
Bartholin’s cysts are typically (uni-/bilateral); how does size dictate symptoms and when must you biopsy?
- Typically unilateral swelling
- <3cm is usually asymptomatic
- Need to biopsy in women 40+ y/o to rule out a Bartholin’s carcinoma!
What are 2 treatment options for bartholin’s gland abscess?
- Word catheterization: left in for 4-6 wks which promotes an epithelialized tract for drainage of glandular secretions
- Marsupialization: creates a new duct opening by everting the cyst wall onto the epithelial surface where it is sutured w/ interrupted absorbable sutures
What is the most frequently reported symptom of vuvlar cancer?
Long history of chronic vulvar pruritus
What is VIN III usual-type vs. differentiated-type?
- Usual-type: assoc w/ HPV (16/18), smoking, and immunocompromised states; younger (35-65 y/o)
- Differentiated-type: is NOT assoc. w/ HPV or smoking –> more commonly w/ vuvlar dermatologic conditions, such as Lichen Sclerosus; older (55-85 y/o)
Paget’s disease of the vuvla is most common in whom and what are the signs/sx’s?
- Postmenopausal white females
- Itching and tenderness are common —> well-demarcated and eczematoid in appearance w/ fiery red background w/ white plaque-like lesions
How is VIN type III managed clinically?
- Local superficial surgical excision is mainstay of tx; 5mm margins are typically adequate
- Can do skinning vulvectomy
- Laser therapy is useful for small lesions on clit, labia minora or perianal areas
What is the management for SCC of the vulva?
- Radical vulvectomy and regional lymphadenectomy
or
- Wide local excision of the 1’ tumor w/ inguinal LN dissection +/- pre-op radiation, chemo, or both
What do the lesions of verrucous carcinoma of the vuvla look like; what kind of tx is contraindicated?
- Lesions are cauliflower-like and can be confused w/ condyloma
- Radiation = contraindicated because it may induce anaplastic transformation
What is tx for Batholin’s gland carcinoma?
Radical vulvectomy and bilateral lymphadenectomy w/ post-op radiation
When is the diagnosis of vaginal intraepithelial neoplasia (VAIN) usually considered?
When an abnormal pap in a woman who is status post-hysterectomy or has no demonstrable cervical lesion
What is the main method of treatment for carcinoma of the vagina?
Radiation or chemoradiation
When collecting sample for investigation of vaginal discharge where do you take the sample from?
Sample discharge from posterior fornix and place on slide
Diagnosis of Gardnerella vaginalis as cause of vaginitis can be made with what 3 findings?
- Saline wet mount reveals presence of “clue cells”
- 10% KOH-positive whiff test
- Vaginal pH >4.5
What is treatment for Gardnerella vaginalis?
Metronidazole BID x 7 days
Sx’s and characteristics of the discharge assoc. w/ vuvlovaginal candidiasis?
- Vulvar itching, burning, irritation/dyspareunia
- Often little to no discharge, but if present is white adherent and clumpy (cottage cheese-like)
Diagnosis of vuvlovaginal candidiasis made via what 2 findings?
- 10% KOH wet prep-positive for budding yeast
- Vaginal pH <4.5
Treatment for vulvovaginal candidiasis?
- Diflucan
- Vaginal application w/ synthetic imidazoles (miconazole, terconazole, etc.)
What is the vaginal discharge like w/ symptomatic T. vaginalis?
Green-yellow “frothy” discharge
How is diagnosis of T. vaginalis made?
- Saline wet mount reveals motile trichomonads
- pH >4.5
- Strawberry cervix
What is the treatment for T. vaginalis; must also evaluate for what?
- Metronidazole
- Is an STD, so test pt for STI’s and have partners evaluated too!
