Vulva and Vagina Flashcards
What are some things that can involve the vulva?
- Many inflammatory diseases that affect skin elsewhere on the body like psoriasis, eczema, and allergic dermatitis
What does the increased moisture and secretions make the vulva more prone to?
- Superficial infections
What is a Bartholin cyst?
- Relatively common
- Occur at all ages
- Due to obstruction of the duct by an inflammatory process
- Infection can result in an abscess
How does lichen sclerosus present?
- Smooth, white plaques or macules that in time may enlarge and coalesce, producing a surface that resembles porcelain or parchment
What happens in lichen sclerosus when the entire vulva is affected?
- The labia becomes atrophic and agglutinated
- Vaginal orifice constricts
Who is most affected by lichen sclerosus?
- Postmenopausal women
What is an association of lichen sclerosus?
- Development of squamous cell carcinoma of the vulva
What is seen on histology with lichen sclerosus?
- Hyperkeratosis
- Epidermal thinning
- Basal layer degeneration
What is squamous cell hyperplasia?
- A non specified localized, well-circumscribed area of thickened skin resulting from repeated rubbing, itching, and scratching of the skin to relieve pruritus
What may hyperplastic epithelium show in squamous cell hyperplasia?
- Mitotic activity but lacks cellular atypia
Is squamous hyperplasia premalignant?
- No, but sometimes presents at the margins of vulvar cancers
What is condyloma acuminatum?
- Genital warts
- Solitary but more likely multifocal
Where is condyloma acuminatum located?
- Anywhere (perianal, perineal, vulva, vagina, cervix)
What is associated with condyloma acuminatum?
- Low risk HPV types 6 and 11
What is condyloma latum associated with?
- Secondary syphilis
How does condyloma latum present?
- Superficial lesion of the skin and mucosal surfaces
When does condyloma latum present?
- 2-10 weeks after the primary chancre
Where are condyloma latum lesions located?
- Palms or soles of feet and may be maculopapular, scaly, or pustular
- Moist areas of the skin, such as the anogenital region, inner thighs, and axillae
What is squamous neoplasia of the vulva?
- Carcinoma of the vulva is uncommon
- Most are squamous cell carcinoma
What age is most affected by squamous neoplasia of the vulva?
- Age 60 or older
What are the 2 types with distinct precursor lesions to squamous neoplasia of the vulva?
- HPV related - Classic VIN (Bowen disease)
2. Non HPV related - Differentiated VIN
What are some risks of metastasis in invasive cancers of the vulva?
- Size of primary tumor
- Depth of invasion
- Lymphatic involvement
What are glandular neoplastic lesions?
- Like the breast, the vulva contains modified apocrine sweat glands
- Presumably because of the breastlike features, the vulva may be involved by two tumors with counterparts in the breast (papillary hidradenoma and extramammary Paget disease)
How does papillary hidradenoma present?
- Sharply circumscribed nodule, most commonly on the labia majora or interlabial folds
- May be confused with carcinoma because of tendency to ulcerate
What is the histological appearance of papillary hidradenoma?
- Identical to that of intraductal papilloma of the breast and consists of papillary projections covered by two cell layers (an upper layer of columnar secretory cells and a deeper layer of flattened myoepithelial cells)
How does extramammary Paget disease present?
- Pruritic, red, crusted, maplike area, usually on the labia majora
- Distinctive intraepithelial proliferation of malignant cells
How is vulvar paget different from paget of the breast?
- Vulvar paget is typically not associated with underlying cancer and is confined to the vulvar epidermis
What is the treatment for vulvar paget disease?
- Wide local excisions
What is associated with squamous cell carcinoma of the vagina?
- High risk HPV types
Who presents with embryonal rhabdomyoscarcoma?
- Children
What is embryonal rhabdomyoscarcoma?
- Uncommon vaginal tumor composed of malignant embryonal rhabdomyoblasts
- Tumors tend to invade locally and cause death by penetration into the peritoneal cavity or by obstruction of the urinary tract
What is the treatment for embryonal rhabdomyosarcoma?
- Conservative therapy coupled with chemotherapy
