Vulva Flashcards
What structures are included int he vulva and what cells are they comprised of?
Anatomically includes the skin and mucosa of the female genitalia external to the hymen (labia majora and minora, mons pubis and vestibule. Lined by squamous epithelium
What is a Bartholin gland and what does its dysfunction cause? How does it arise and present?
It produces a mucus like fluid that drains via ducts into the lower vestibule. Cystic dilation of the Bartholin gland which arises due to inflammation and obsruction of gland. Usually occurs in women of reproductive age. Presents as a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal
What is a Condyloma and what causes two things can cause it? How is it transmitted and what is seen on histology? Can it progress to carcinoma?
It is a large warty neoplasm of vulvar skin. Most commonly due to HPV types 6 or 11. Secondary syphilis (condyloma latum) is a les common cause. Both are sexually transmitted. Histologically, HPV associated condylomas are characterized by koilocytes. Rarely progresses to carcinoma (6 and 11 are low-risk HPV types.
A 57 year old ballet dancer presents to your office complaining of a lesion on her vagina. Upon inspection, you observe she has a white patch that feels like parchment. What does she have? What are the characteristics of this lesion? Etiology? Cancer risk?
This is lichen sclerosis characterized by thinning of the epidermis and fibrosis (sclerosis) of the dermis. Presents as a white patch (leukopakia) with partchment-like vulvar skin. Most commonly seen in menopausal women; possible autoimmune etiology. Benign, but associated with slightly increased risk for squamous cell carcinoma.
A 57 year old ballet dancer presents to your office complaining of a lesion on her vagina. Upon inspection, you observe she has a white patch that feels like a thick leathery vulvar skin. She also complains that she is always itching and scratching in the area. What does she have? What are the characteristics of this lesion? Etiology? Cancer risk?
This is lichen simplex chronicus which is characterized by hyperplasia of the vulvar squamous epithelium. Presents as a white patch (leukopakia) with thick vulvar skin. Benign with no increased risk for squamous cell carcinoma.
What are the ddx for leukoplakia in the vulvar region? How would you confirm if it is cancerous? What cell types would be involved in the arisal of a cancer and what are some possible etiologies?
Lichen sclerosis, lichen simplex chronicus and vulvar carcinoma. Do a biopsy. Relatively rare Carcinoma arising from squamous epithelium lining the vulva. Etiology may be HPV related or non HPV related.
Which subtypes are implicated in HPV related vulvar carcinoma? What are the risk factors? Where does the carcinoma arise from and what 4 characteristics does it have?
HPV 16 and 18. Risk factors include multiple partners and early first age of intercourse. Arises from vulvar intraepithelial neoplasia (VIN), a dysplastic precursor lesion characterized by koilocytic change, disordered cellular maturation, nuclear atypia and increased mitotic change.
What is a cause of non HPV related vulvar carcinoma? How does it present and which population does it target?
Arises from long standing lichen sclerosis. Chronic inflammation and irritation eventually lead to carcinoma. Generally seen in elderly women (average 70 years of age).
A woman presents to your clinic complaining of an itchy and red ulcer on her vulva. You take a biopsy and the lab reports that the slide is PAS+, keratin+ and S100-. What is this indicative of? What cells is it characterized by? Where else would it present? Is this associated with underlying carcinoma?
This is extramammary Paget disease which is characterized by malignant epithelial cells in the EPIDERMIS of the vulva. Represents carcinoma insitu with no underlying carcinoma unlike Paget disease of the nipple.
PAS+, Keratin +, S100- are which cells?
Extramammary Paget disease
PAS-, Keratin -, S100+ are which cells?
Melanoma
