Lesions of the Vulva Flashcards
What kind of conditions usually affect the vulva and why?
because the vulva is largely made up of skin
- most inflammatory skin conditions
- eczema, psoriasis, contact dermatitis - skin infections and skin tumours
What lesions are peculiar to the vulva?
- Bartholin gland cyst
- Non neoplastic epithelial disorders
- Neoplasms
What are the non neoplastic epithelial disorders of the vulva?
- Lichen sclerosus
2. Lichen simplex chronicus
What are the neoplasms of the vulva?
- Benign: Condyloma acuminatum
- Premalignant: Vulval intraepithelial neoplasia (VIN)
- Malignant: SCC, Extramammary Paget’s disease
Describe the Bartholins gland cyst?
- common
- occur at all ages
- Cysts can become large up to 5cm
- Cysts are painful and cause discomfort
What is the cause of a Bartholin’s gland cyst?
Result from obstruction of Bartholin duct usually by an infection
- Sometimes an abscess can complicate the cyst
Describe the histology of a Bartholin’s gland cyst?
lined by either transitional epithelium of normal duct or by squamous metaplasia
What is Lichen Sclerosus?
chronic atrophic inflammation of the vulva
What is the epidemiology of Lichen Sclerosus?
- Occurs in all age groups
- more common in menopause
What is the pathogenesis of LS?
unclear
- could be autoimmune
Describe Lichen Sclerosus?
- Slowly developing, insidious and progressive
- LS is not a precancerous lesion
Describe the pathology of LS?
- atrophy, fibrosis and scarring of the vulva
2. Labia are atrophic and introitus (vaginal opening) is narrow
What are the 4 cardinal microscopic features of LS?
- Epidermal atrophy (thinning)
- Hydropic degeneration (oedema) of basal cells
- Replacement of dermis by a dense collagenous fibrous tissue
- A bandlike lymphocytic infiltrate
What is Lichen Simplex Chronicus?
a chronic dermatitis caused by rubbing and scratching to relieve pruritus from any cause
- it is not a precancer lesion
Describe the microscopic morphology of LSC?
- hyperplasia of squamous epithelium (Acanthosis)
- hyperkeratosis - increased thickness of the outer layer of skin
- variable dermal inflammation
What are the possible causes of pruritus?
- infectious e.g. candida, pubic lice
2. non infectious e.g. chemical irritants
What is Condyloma Acuminatum?
- Benign tumour caused by Human papilloma virus (HPV)
- Low risk HPV 6 and 11
- aka genital warts
Describe the macroscopic morphology of Condyloma acuminatum?
Single or multiple pedunculated, papillary excrescences/projections
- There is no dysplasia
Name malignant neoplasms?
- squamous cell carcinoma - 85%
- Basal cell carcinoma
- Melanomas
- Adenocarcinoma
- Other primary skin tumours
Squamous cell carcinoma of the vulva is divided into what 2 groups?
Group 1: Associated with high risk HPV
Group 2: Arises on background of normal skin, squamous hyperplasia or lichen sclerosus
What are the 2 groups of SCC of the vulva divided in terms of?
- Aetiology
- Pathogenesis
- Clinical presentation
SCC associated with high risk HPV is preceeded by?
classic precancerous lesion
- vulval intraepithelial neoplasm (VIN)
What is the clinical presentation of VIN?
white or pigmented plaques on vulva
- frequently multicentric
What is the epidemiology of SCC and VIN?
frequently seen in young patients with the advent of HIV/AIDS
How is VIN classified?
VIN I, II, III (mild moderate and full thickness dysplasia)
- Invasion through basement membrane denotes invasive cancer
Describe SCC on background of normal skin, squamous hyperplasia or lichen sclerosus?
- Aetiology is unclear
- No association with HPV
- Associated with P53 mutations
- Seen in elderly women
- Rare type of vulval cancer compared to the HPV related one
