Vulva - Pathoma

Question 1

What portion of the female reproductive tract does the vulva represent?

Answer 1

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.

Question 2

What type of epithelium lines the vulva?

Answer 2

Squamous epithelium

Question 3

What causes a cystic dilation of the Bartholin Gland?

Answer 3

arises due to inflammation and obstruction of the gland

Question 4

What population of women commonly get Bartholin Cysts? Why?

Answer 4

usually occurs in women of reproductive age => because they are often related to infection and STDs

Question 5

Are Bartholin Cysts usually unilateral or bilateral?

Answer 5

unilateral

Question 6

What is the major complication of Bartholin Cysts?

Answer 6

abscess

Question 7

What is the typical presentation of a Bartholin Cyst?

Answer 7

Unilateral, painful cystic lesion located in the vestibule adjacent to the vaginal canal

Question 8

What is a Condyloma?

Answer 8

Warty neoplasm of vulvar skin (squamous epithelium), often large

Question 9

What are Condylomas most commonly due to?

Answer 9

HPV types 6 or 11

Question 10

Do Condylomas progress to cancer?

Answer 10

Rarely progress to carcinoma

Question 11

How do HPV infections generally manifest histologically?

Answer 11

Koilocytic change => nucleus looks like a raisin

Question 12

How do you know whether HPV is high risk or low risk?

Answer 12

Based on DNA sequence (HPV = DNA virus)

Low risk: 6 and 11

High risk: 16, 18, 31, and 33

Question 13

What do you call a thinning of the epidermis and fibrosis of the dermis that causes leukoplakia with parchment-like vulvar skin?

Answer 13

Lichen sclerosis

Question 14

Which population of women most commonly get Lichen sclerosis?

Answer 14

Post-menopausal women

Question 15

Is Lichen sclerosis benign or malignant?

Answer 15

Benign, but associated with a slightly increased risk of squamous cell carcinoma

Question 16

What do you call a thickening/hyperplasia of vulvar squamous epithelium that causes leukoplakia with thick, leathery vulvar skin?

Answer 16

Lichen simplex chronicus

Question 17

What causes Lichen simplex chronicus?

Answer 17

Chronic irritation and scratching

Question 18

Is Lichen simplex chronicus benign or malignant?

Answer 18

Benign, no increased risk for squamous cell carcinoma

Question 19

What do you call a cancer that arises within the vulva due to proliferation of squamous epithelium lining?

Answer 19

Vulvar carcinoma (type of squamous cell carcinoma)

Question 20

How common is Vulvar carcinoma?

Answer 20

Relatively rare => accounts for only a small percentage of female genital cancers

Question 21

How does Vulvar carcinoma present?

Answer 21

Leukoplakia

Question 22

How do you distinguish carcinoma from the other causes of leukoplakia?

Answer 22

Biopsy

Question 23

What are the two pathways in which Vulvar carcinoma can form?

Answer 23

HPV related (16/18=> vulvar intraepithelial neoplasia)

OR

non-HPV related (longstanding lichen sclerosis)

Question 24

What populations of women develop HPV-related Vulvar carcinoma and non-HPV related Vulvar carcinoma?

Answer 24

HPV-related: 40s-50s

non-HPV related: elderly women >70

Question 25

What do you call malignant epithelial cells in the epidermis of the vulva that present as erythematous, pruritic (itchy), and ulcerated skin?

Answer 25

Extramammary Paget Disease

Question 26

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?

Answer 26

Carcinoma vs. Melanoma

Paget cells (carcinoma): PAS+, keratin+, and S100-

Melanoma: PAS-, keratin-, and S100+