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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > 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.

Commonest cause of vulval swelling

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17
Q

What is the function of the bartholins gland?

A

There are 2 Bartholian’s glands situated on either side of the posterior fourchette. The duct from each gland drains into lower vaagina between hymenal remenants and the fourchette.

Secrete thin, lubricating mucus during sexual excitation

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18
Q

Symptoms of bartholian’s abscess

A

PAIN

Swelling

Dyspareunia

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19
Q

Signs of bartholin’s abscess

A

Unilateral fluctuant vulval swelling

Abscess erythematous and exquisitely tender on palpation

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20
Q

What can cause vulval ulcers?

A
  • Syphillis
  • HSV
  • Carcinoma
  • Chancroid
  • Lymphogranuloma venerum
  • Granuloma inguinale
  • TB
  • Behcet’s syndrome
  • Crohn’s Disease
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21
Q

What is the following?

A

Bartholin’s Abscess - infected bartholins cyst

22
Q

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

A
  • If asymptomatic - no intervention
  • Symptomatic - incision, drainage and marsupialisation (inner cyst wall sututed to skin to create new opening)
  • Consider Antibiotics - broad spectrum
23
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

24
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

More commonly anaerobes

25
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
26
Q

What features of a lump may suggest malignancy?

A
  • Irregular
  • Nodular
  • Persistently Indurated
  • Hard
  • Fixed
27
Q

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

A

Herpetic is painful

28
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.

29
Q

What urological problem might occur with a genital haematoma?

A

Urinary retention

30
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
31
Q

What is vaginal intraepithelial neoplasia?

A

Pre-malignant phase of vulval cancer

32
Q

What are causes of VIN?

A
  • HPV - esp 16
  • Smoking
  • Previous malignancy
  • Immunosuppression
33
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
34
Q

Risk factors for vulval cancer

A
  • Age (mostly >65 years)
  • Vulval skin conditions (3-5% risk of vulval cancer) eg lichen sclerosis, lichen planus
  • VIN (assoc. HPV)
  • Smoking
  • Genital herpes
  • Immunosupression
35
Q

How would you investigate someone presenting with features of VIN?

A
  • Punch biopsy
  • Examine cervix, anal canal, natal cleft and breasts
36
Q

How would you manage someone with VIN?

A
  • Surveillance
  • Surgery
  • Topical treatments - Imiquimod, photodynamic therapy
  • Laser ablation
37
Q

What proportion of vulval cancers are squamous cell carcinomas?

A

90%

38
Q

What are the main types of vulval cancers?

A
  • SCC
  • BCC
  • Melanoma
  • Bartholin’s Gland carcinoma
39
Q

How does vulval cancer present?

A
  • Lump
  • Indurated ulcer
  • Vulval pain
  • Vulval bleeding
40
Q

What age group does vulval cancer most commonly affect?

A

>60

41
Q

What is stage 1 vulva carcinoma?

A

Tumour < 2cm, confined to vulva

42
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

43
Q

What is stage III vulval cancer?

A

Tumour of any size with local spread and unilateral nodes (inguino-femoral)

44
Q

Which lymph nodes does vulval cancer usually spread to?

A

Inguinal lymph nodes

45
Q

What is stage IV vulval cancer?

A

Distant/advanced local disease with pelvic lymph nodes

46
Q

How would you manage someone with vulval cancer?

A
  • Surgery - wide local excision, vulvectomy, Unilateral/Bilateral/groin node dissection
  • Pelvic Radiotherapy
  • Chemotherapy
47
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
48
Q

How common is vulval cancer?

A

GP will see one once verey 7 years

Relatively rare - only 1200 cases/year in the UK

49
Q

What key symptoms would prompt referral for vulval cancer?

A
  • Pruritis
  • Unexplained vaginal lump
  • Unexplained vulval bleeding/ulceration
50
Q

Spread of vulcal cancer

A
  • Inguinal nodes
  • Iliac nodes
51
Q

Prognosis of vulval cancer

A
  1. 90%
  2. 77%
  3. 50%
  4. 18%

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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