Vulval Pathology

Question 1

What is a Bartholin’s Cyst?

Answer 1

Fluid filled sac in one of the Bartholin’s glands of the Vagina secondary to build up of mucous and hence blockage

Question 2

What are the Bartholin’s Glands?

Answer 2

Glands situated posterior to the Labia Majora, that secrete mucous to lubricate the vagina

Question 3

Give three risk factors for Bartholin’s Cysts

Answer 3

Nulliparous and Child Bearing Age
Sexually Active
History of Vulval Surgery

Question 4

How do Bartholin’s Cysts present?

Answer 4

If small it may be asymptomatic

Large: Vulvar Pain (worse on sitting or walking), Superficial Dysparenuria

Rupture causes sudden relief

Question 5

How does a Bartholin’s Cyst appear OE?

Answer 5

Fluctuant, Fluid Filled and Non Tender

Question 6

Name a complication of Bartholin’s Cysts

Answer 6

Bartholin’s Abscess

Question 7

How do Bartholin’s Abscesses present?

Answer 7

Sudden onset pain

Difficulty urinating

Question 8

How does a Bartholin’s Abscess appear OE?

Answer 8

Hard, Tender, Surrounding erythema and cellulitis

Question 9

How are Bartholin’s Cysts investigated?

Answer 9

Generally Clinical
STI swabs
If over 40, biopsy to exclude Vulval Carcinoma

Question 10

How are Small Bartholin’s Cysts managed?

Answer 10

Warm baths may stimulate spontaneous rupture

Question 11

Describe three management techniques of larger Bartholin’s Cysts

Answer 11

Word Catheter (left in for 4-6 weeks, done under LA)

Marsupialisation (vertical incision made and wall inverted)

Silver Nitrate Cautery

Question 12

What is Lichen Sclerosus?

Answer 12

Chronic Inflammatory Disease of Anogenital Region in Women

Bimodal age distribution of Pre Pubescent and Post Menopausal

Question 13

Describe the aetiology of Lichen Sclerosus

Answer 13

Patients have a high titre of antibodies to ECM Protein 1, therefore thought to be autoimmune

Risk Factors - Genetics, Other autoimmune diseases

Question 14

Describe the microscopic appearance of Lichen Sclerosus

Answer 14

Atrophied Squamous Cell layer

Chronic Inflammatory cells beneath

Question 15

Name four presentations of Lichen Sclerosus

Answer 15

White atrophic patches on skin
Itching
Fissuring/Erosions causing pain
Dyspareunia

Question 16

Give three differentials for Lichen Sclerosus

Answer 16

Vulval Cancer
Vitiligo
Lichen Simplex

Question 17

How is Lichen Sclerosus managed?

Answer 17

Topical Steroids such as Clobetasol Propionate

Once nightly for 4/52, then alternate nights for 4/52, then twice weekly for 4/52

Followed up due to SCC risk

Question 18

Describe the typical histology of Vulval Cancer

Answer 18

Normally SCC

Normally located on Labia Majora

Question 19

Vulval Carcinomas are normally SCC, give two risk factors

Answer 19

Lichen Sclerosus

HPV

Question 20

Describe the two types of VIN

Answer 20

Usual - HPV

Differentiated - Non HPV (other chronic inflammatory conditions)

Question 21

How is VIN managed?

Answer 21

Wide Local Excision

Or

Imiquimod

Question 22

What is VIN?

Answer 22

Vulval Intraepithelial Neoplasia (ie Carcinoma in Situ)

Question 23

How does Vulval Cancer present?

Answer 23

Vulval Lump
Bleeding
Pruritus/Pain

Question 24

Describe the staging of Vulval Carcinoma

Answer 24

I - Confined to Vulva (A= less than 2cm, B= greater than 2cm)
II - extension to perineal structures but not nodes
III - extension to nodes but not perineal structures
IV - Invades other regional/distal structures

Question 25

When should a Woman be under 2ww for Vulval Cancer

Answer 25

Unexplained Vaginal Lump

Unexplained Vaginal Bleeding/Ulceration

Question 26

How is Vulval Cancer managed?

Answer 26

Surgery, Chemotherapy and Radiotherapy to varying degrees dependent on stage