Pathoma: Vulva

Question 1

What is included in the vulva?

Answer 1

The skin of the female genitals external to the hymen

Question 2

Which are posterior, Bartholin’s glands or Skein’s glands?

Answer 2

Bartholin’s glands

(Think: if a woman is in the lithotomy position, then the Skein’s are on the ceiling and the Bartholin’s are on the bottom.)

Question 3

Describe Bartholin’s cysts.

Answer 3

Bartholin’s cysts can be caused by infection, inflammation, or any kind of blockage. They are generally posterior, unilateral and occur in reproductive-age women. Most often, they are painful.

Question 4

True or false: condyloma often transition to carcinoma.

Answer 4

False.

Question 5

True or false: condylomas are not associated with koilocytic change.

Answer 5

False.

Question 6

Histologically, lichen sclerosis presents with _______________.

Answer 6

thinning of the epidermis and fibrosis of the dermis

Question 7

Lichen sclerosis is mostly ____________.

Answer 7

benign

Question 8

What is lichen simplex chronicus?

Answer 8

Thickened, hyperplastic vulvar skin due to chronic irritation

Question 9

There are two paths to vulvar carcinoma: ________________.

Answer 9

• HPV-associated: perimenopausal women; dysplastic VIN

* non-HPV associated: older women; chronic lichen sclerosis

Question 10

How does extramammary Paget’s disease present?

Answer 10

Pruritic, ulcerated, erythematous vulvar lesions

Question 11

How can you distinguish extramammary Paget’s disease from melanoma of the vulva?

Answer 11

Usually, staining is required:
• Melanoma: S-100 +, keratin -, PAS -
• Extramammary Paget’s disease: S-100 -, keratin +, PAS+

Question 12

What does PAS stain for?

Answer 12

Mucus (hence, only epithelium would stain positive for PAS)

Question 13

What is a “high-yield” distinction between mammary and extramammary Paget’s disease?

Answer 13

Mammary Paget’s often signifies a cancer deep within the breast, while extramammary Paget’s does not usually signify underlying cancer.