Vulva - Pathoma Flashcards
What portion of the female reproductive tract does the vulva represent?
The skin and mucosa external to the hymen.
The vulva includes the opening of the vagina (sometimes called the vestibule), the labia majora (outer lips), the labia minora (inner lips), and the clitoris.
What type of epithelium lines the vulva?
Squamous epithelium
What causes a cystic dilation of the Bartholin Gland?
arises due to inflammation and obstruction of the gland
What population of women commonly get Bartholin Cysts? Why?
usually occurs in women of reproductive age => because they are often related to infection and STDs
Are Bartholin Cysts usually unilateral or bilateral?
unilateral
What is the major complication of Bartholin Cysts?
abscess
What is the typical presentation of a Bartholin Cyst?
Unilateral, painful cystic lesion located in the vestibule adjacent to the vaginal canal
What is a Condyloma?
Warty neoplasm of vulvar skin (squamous epithelium), often large
What are Condylomas most commonly due to?
HPV types 6 or 11
Do Condylomas progress to cancer?
Rarely progress to carcinoma
How do HPV infections generally manifest histologically?
Koilocytic change => nucleus looks like a raisin
How do you know whether HPV is high risk or low risk?
Based on DNA sequence (HPV = DNA virus)
Low risk: 6 and 11
High risk: 16, 18, 31, and 33
What do you call a thinning of the epidermis and fibrosis of the dermis that causes leukoplakia with parchment-like vulvar skin?
Lichen sclerosis
Which population of women most commonly get Lichen sclerosis?
Post-menopausal women
Is Lichen sclerosis benign or malignant?
Benign, but associated with a slightly increased risk of squamous cell carcinoma
What do you call a thickening/hyperplasia of vulvar squamous epithelium that causes leukoplakia with thick, leathery vulvar skin?
Lichen simplex chronicus
What causes Lichen simplex chronicus?
Chronic irritation and scratching
Is Lichen simplex chronicus benign or malignant?
Benign, no increased risk for squamous cell carcinoma
What do you call a cancer that arises within the vulva due to proliferation of squamous epithelium lining?
Vulvar carcinoma (type of squamous cell carcinoma)
How common is Vulvar carcinoma?
Relatively rare => accounts for only a small percentage of female genital cancers
How does Vulvar carcinoma present?
Leukoplakia
How do you distinguish carcinoma from the other causes of leukoplakia?
Biopsy
What are the two pathways in which Vulvar carcinoma can form?
HPV related (16/18=> vulvar intraepithelial neoplasia)
OR
non-HPV related (longstanding lichen sclerosis)
What populations of women develop HPV-related Vulvar carcinoma and non-HPV related Vulvar carcinoma?
HPV-related: 40s-50s
non-HPV related: elderly women >70
What do you call malignant epithelial cells in the epidermis of the vulva that present as erythematous, pruritic (itchy), and ulcerated skin?
Extramammary Paget Disease
What do malignant epithelial cells in the epidermis of the vulva need to be differentiated from in Extramammary Paget Disease? How do you distinguish them?
Carcinoma vs. Melanoma
Paget cells (carcinoma): PAS+, keratin+, and S100-
Melanoma: PAS-, keratin-, and S100+
