Vulva

Question 1

Bartholin Gland Cyst Presentation

Answer 1

Obstruction/infection causes unilateral, painful cystic lesion at lower vestibule adjacent to vaginal canal

Question 2

Condyloma

Answer 2

Warty neoplasm from HPV 6 or 11, low risk of cancer

Question 3

Lichen Sclerosis vs. Lichen Simplex Chronicus (feel, similar presentation, cancer risk)

Answer 3

Sclerosis is thinning of epidermis and fibrosis of dermis, so feels like thin parchment
Simplex is hyperplasia so feels like thickening
Both have leukoplakia
Sclerosis has slight increase in risk for squamos cell carcinoma

Question 4

Vulvar Carcinoma (presentation, 2 etiologies)

Answer 4

Presents as leukoplakia so need bx
Can be HPV related (16 and 18 lead to VIN then carcinoma. Younger, like 40 to 50) or non-HPV (long standing lichen sclerosis, older, postmenopausal like 70s)

Question 5

Extramammary Paget Disease (what it is and presentation)

Answer 5

Malignant epithelial cells in epidermis of vulva, presents as erythamatous/pruritic/ulcerated vulvar skin

Question 6

Important Differentiation for Paget Disease and 3 Stains For It

Answer 6

Paget: keratin+ (epithelial), S100-, PAS+ (mucous, only epithelials make)
Melanoma: keratin-, S100+ (melanoma), PAS-

Question 7

Important Difference with Mammary and Extramammary Paget Disease

Answer 7

Mammary usually means there’s some other underlying breast cancer
Vulva Paget usually isolated