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Reproductive Medicine > Vulva - Benign and malignant disease > Flashcards

Vulva - Benign and malignant disease Flashcards

1
Q

What is pruritis vulvae?

A

Vaginal itching

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2
Q

What are causes of pruitis vulvae?

A
  • General pruritis
  • Skin disease - psoriasis, lichen planus
  • Infection - thrush
  • Allergy to detergents, fabric dyes
  • Infestation
  • Vulval dystrophy - lichen sclerosis, leukoplakia, carcinoma
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3
Q

Does post-menopausal atrophy cause vaginal itch?

A

No

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4
Q

What can exacerbate vaginal itching?

A
  • Obesity
  • Incontinence
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5
Q

What is lichen sclerosis?

A

Thought to be an autoimmune condition which leads to elastic tissue turning to collagen

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6
Q

What are features of vulval lichen sclerosus?

A
  • Red, purpuric rash
  • White, flat, shiny plaques
  • Intensely itchy
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7
Q

What is the following?

A

Vulval lichen sclerosus

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8
Q

How would you manage lichen sclerosus?

A
  • Clobetasol propionate - daily for 28 days, then alternate days for 4 weeks
  • May need immunotherapy - tacrolimus
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9
Q

What is the following?

A

Vulval leukplakia - white vulval patches due to skin thickening and hypertrophy

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10
Q

Is vulval leukoplakia a pre-malignant conditon?

A

Yes - need to be biopsied if found

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11
Q

What would you treat someone with vulval leukoplakia with?

A
  • Topical steroids
  • Psoralens
  • Phototherapy
  • Methotrexate/ciclosporin
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12
Q

What are causes of vulval lumps?

A
  • Local varicose veins
  • Boils
  • Sebaceous cysts
  • Keratocanthoma
  • Viral warts
  • Primary chancre/Conylomata lata
  • Molluscum contagiosum
  • Bartholin’s Cyst/abscess
  • Uterine prolapse/polyp
  • Inguinal hernia
  • Varicocele
  • Carcinoma
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13
Q

What can cause vulval warts?

A

HPV

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14
Q

What strains of HPV cause vulval warts?

A

6 and 11

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15
Q

How are viral warts treated?

A
  • Podophyllotoxin cream
  • Cryotherapy
  • Excision
  • Laser therapy
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16
Q

What is a Bartholin’s Cyst?

A

A tense cyst which forms due to blockage of the bartholin’s gland ducts. If this becomes infected, it can lead to an abscess forming

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17
Q

What is the function of the bartholins gland?

A

Secrete thin, lubricating mucus during sexual excitation

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18
Q

What can cause vulval ulcers?

A
  • Syphillis
  • HSV
  • Carcinoma
  • Chancroid
  • Lymphogranuloma venerum
  • Granuloma inguinale
  • TB
  • Behcet’s syndrome
  • Crohn’s Disease
19
Q

What is the following?

A

Bartholin’s Abscess - infected bartholins cyst

20
Q

How would you manage a bartholin’s cyst/Abscess?

A
  • If asymptomatic - no intervention
  • Symptomatic - incision, drainage and marsupialisation
  • Consider Antibiotics - broad spectrum
21
Q

What is marsupialisation?

A

Cyst wall eversion (after incision of the cyst) then suturing the edges of the cyst open so that there is a continuous surface from inside to outside ensuring the cyst remains open and can drain freely

22
Q

What organisms are commonly implicated in bartholin’s abscess?

A
  • Aerobic - N Gonorrhoea, S Aureus, C Trachomatis, E Coli
  • Anaerobic - B Fragilis and C Perfringens
23
Q

What should you look for when assessing a lump?

A

SPACE SET

  • Size
  • Position
  • Attachments
  • Consistency
  • Edge
  • Site
  • Evidence of inflammation - (Rubor, Tumor, Calor Dolor)
  • Tethered
24
Q

What features of a lump may suggest malignancy?

A
  • Irregular
  • Nodular
  • Persistently Indurated
  • Hard
  • Fixed
25
Q

What is the difference between herpetic and syphillitic vulval ulceration in terms of pain?

A

Herpetic is painful

26
Q

What is the following (in a puerperal woman)?

A

Puerperal genital haematoma

The picture demonstrates a haematoma arising in an episiotomy. A Haematoma will generally be associated with significant pain and swelling. It is usually secondary to failure to achieve haemostasis especially at the apex of a tear.

27
Q

What urological problem might occur with a genital haematoma?

A

Urinary retention

28
Q

How would you manage a genital haematoma?

A
  • ABC
  • Prompt examination + Estimate blood loss, monitor ongoing loss - FBC, Coag screen, Group and Save
  • Analgesia.
  • Catheterisation - may be indicated
  • Incision and drainage
29
Q

What is vaginal intraepithelial neoplasia?

A

Pre-malignant phase of vulval cancer

30
Q

What are causes of VIN?

A
  • HPV - esp 16
  • Smoking
  • Previous malignancy
  • Immunosuppression
31
Q

What are features of VIN?

A
  • Raised papular or plaques lesions
  • Erosions, nodules, warty
  • Keratotic roughened appearance
  • Sharp border
  • Differentiated VIN tends to be unifocal ulcer or plaque
  • Discoloration - Red, White, Brown/pigmented
32
Q

How would you investigate someone presenting with features of VIN?

A
  • Punch biopsy
  • Examine cervix, anal canal, natal cleft and breasts
33
Q

How would you manage someone with VIN?

A
  • Surveillance
  • Surgery
  • Topical treatments - Imiquimod, photodynamic therapy
  • Laser ablation
34
Q

What proportion of vulval cancers are squamous cell carcinomas?

A

90%

35
Q

What are the main types of vulval cancers?

A
  • SCC
  • BCC
  • Melanoma
  • Bartholin’s Gland carcinoma
36
Q

How does vulval cancer present?

A
  • Lump
  • Indurated ulcer
  • Vulval pain
  • Vulval bleeding
37
Q

What age group does vulval cancer most commonly affect?

A

>60

38
Q

What is stage 1 vulva carcinoma?

A

Tumour < 2cm

39
Q

What is stage 2 vulval carcinoma?

A

>2cm and invdating the lower one-third urethra/vagina or lower one third of anus with negative nodes

40
Q

What is stage III vulval cancer?

A

Tumour of any size with local spread and unilateral nodes

41
Q

Which lymph nodes does vulval cancer usually spread to?

A

Inguinal lymph nodes

42
Q

What is stage IV vulval cancer?

A

Distant/advanced local disease with pelvic lymph nodes

43
Q

How would you manage someone with vulval cancer?

A
  • Surgery - wide local excision, vulvectomy, Unilateral/Bilateral/groin node dissection
  • Pelvic Radiotherapy
  • Chemotherapy
44
Q

What are causes of vulvar bleeding?

A
  • Infection— STDs
  • Benign lesions — sebaceous (epidermal) cysts, condylomata, and angiokeratoma
  • Malignant and premalignant lesions
  • Vulvar cancer and VIN
  • Vulvar trauma - forceful sexual activity/assault or accidents

Reproductive Medicine (43 decks)

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