Vulval/vaginal lump Flashcards
What are the causes of a vulval/vaginal lump
Bartholin’s gland cyst or abascess
Vaginal cyst
vulval cancer
Infection: herpes simplex, syphilis, HPV, molluscum
Labial abscess
Sebaceous/epidermoid cyst
Skin tag
What is a Bartholin cyst
Common, benign lesion of the vulva, representing a dilatation of the duct of Bartholin’s glands
What is the difference between a cyst and abscess
Cyst = collection of fluid within a sac
Abscess = collection of pus resulting from infection
What is the cause of Bartholin Cyst/abscess
If the Bartholin’s duct is obstructed, a cyst forms which contains sterile muscus
Mucus becomes colonised and therefore infected, an abscess will form.
The most common causative organisms are staphylococcus, streptococcus and E. Coli. Gonococci can also rarely cause an abscess.
What is the epidemiology of Bartholin cyst
Affects 1 in 50 women
Higher risk in sexually active women aged 20-30
STIs are a risk factor
Uncommon in children/after menopause
What are the signs and symptoms of Bartholin cysts
Tender unilateral swelling, unable to sit or walk
- lower part of the vestibule
Dyspareunia and vague pelvic pain
Surrounding labial oedema, palpable lymph nodes
Systemically unwell e.g. fever
Urinary irritation
What is the management for Bartholin cyst
Conservative: analgesia, warm soak/compress
Medical: swab for MC&S and Abx
Surgical:
- Incision and drainage under LA or GA
- Balloon (Word) catheter insertion: LA, left to drain for 2 weeks with Abx
- Marsupialisation
- Bartholin’s gland removal
Describe marsupialisation
Minor surgical procedure used to treat Bartholin cysts, where the cyst is cut and drained. The edge of the cyst are sutured to the surrounding tissue, forming a small pouch, which allows fluid to drain freely
Describe vaginal cysts
Congenital cysts
Smooth white appearance, may be as large as a golf ball
When in the vagina it is often mistaken as a prolapse
Describe vaginal adenosis
Columnar epithelium found in the squamous epithelium of the vagina
Commonly occurs in women whose mothers receive diethylstilboestrol (DES) in pregnancy
- Women with DES exposure in utero are screened annually by colposcopy
Usually resolves spontaneously but has a small risk of turning malignant - clear cell carcinoma of the vagina
Define VIN
Vulvar intraepithelial neoplasia (VIN) = presence of atypical cells in the vulval epithelium
What are the types of VIN
Usual type
- Warty, basaloid, mixed
- Common in women aged 35-55
- RF: HPV (esp. HPV-16) | cervical intraepithelial neoplasia CIN | smoking | chronic immunosuppression
- Multifocal: Appearance varies widely: red, white, pigmented, plaques, papules, patches, erosions, nodules, warty, hyperkeratosis
Differentiated type
- Associated with lichen sclerosis
- Seen in older women
- Unifocal: ulcer or plaque
- Associated with keratinising squamous cell carcinomas of the vulva
- Risk of progression to cancer is higher than usual type VIN
What is the management for VIN
Local surgical excision to relieve symptoms
Supportive: emollients, mild topical steroid
What are the most common carcinomas of the vulva and what are the risk factors
95% of vulval malignancies are squamous cell carcinomas, the rest are melanomas, basal cells carcinomas, adenocarcinomas, and a variety of others
RF: lichen sclerosis | immunosuppression | smoking | Paget’s disease of the vulva
What are the signs and symptoms of vulval carcinoma
Presentation: pruritus, bleeding, discharge, mass found
Examination: ulcer or mass (most commonly labia majora, clitoris) | tender and/or hard inguinal lymphadenopathy
