Vulvar and vaginal pathology Flashcards
Presentation of lichen sclerosis
Postmenopausal woman, itching
Distribution of lichen sclerosis
Peri-introital, perianal
Presentation of lichen planus
Itching, flat plaque-like papules that are red, white, or purple
Distribution of lichen planus
Vulvar skin, mucosa of lower genital tract, possible oral mucosa involvement
Presentation of lichen simplex chronicus OR squamous cell hyperplasia
Itching lesion, leathery skin thickening, erythematous skin with greyish layer of keratin
Presentation of psoriasis of vulva
Erythematous plaques usually without characteristic flaking found other locations
Distribution of psoriasis
Lateral aspect of labia majora or labio-crural folds
Presentation of condyloma accuminatum
Young, warty lesion
Histology: thin epithelium, blunted rete pegs, chronic inflammatory infiltrate
Lichen sclerosis
Histology: lymphocytic infiltrate, necrosis of basal keratinocytes
Lichen planus
Histology: thick epithelium, with hyper- and para-keratosis, collagenous dermal layer, superficial inflammatory infiltrate
Lichen simplex chronicus
Histology: Thick epithelium with hyper- and para-keratosis, collagenous dermal layer
Squamous cell hyperplasia
Histology: stratified squamous epithelium, features of HPV infection (koilocytosis, multinucleated cells, parabasal hyperplasia)
Condyloma accuminata
Treatment for most vulvar dematoses
Topical corticosteroids
Second and third line treatment for lichen planus
Cyclosporin, retinoids; complete surgical resection
Treatment for condyloma accuminata
Aldara, Condylox, Interferon alpha, excision, laser ablation, cryotherapy
Most common skin cancer diagnosis (less common on vulva)
Basal cell carcinoma
Smooth pearly papule with rolled borders
Basal cell carcinoma
Treatment for basal cell carcinoma
Local excision
Scaly plaque-like lesion, necrosis, hemorrhagic, hyperkeratotic
Squamous cell carcinoma
Treatment for squamous cell carcinoma
Wide radical excision +/- LND
Melanoma staging based on…
Depth of invasion (<1 mm is microinvasive)
Treatment for VIN
Surgical excision vs laser vaporization (can be better for multifocal as long as not VIN3 - no specimen), occasionally imiquimod
Treatment for VAIN
Surgical excision vs laser vaporization vs 5-FU cream (can cause vulvar toxicity) vs imiquimod
Proportion of GYN cancers that are vulvar / vaginal
5%
Risk factors for vulvar cancer
Similar to cervical cancer, HPV implicated in 40%, increasing age
Common histology of vulvar cancer
Squamous cell (90%)
Melanoma (5%)
Others basal cell, sarcoma, adenocarcinoma, Bartholin’s Paget’s
FIGO stages of vulvar cancer by location
I - vulva
II - adjacent structures (urethra, lower vagina, anus)
III - inguinofemoral LNs
IV - distant
Vulvar cancer invasion depth requiring groin LND
> 1 mm
Vulvar cancer treatment
Individualized, including resection, LND, radiation, chemoradiation (?)
Vulvar cancer prognostic factors
Depth of invasion (most important), lymph node status, extent of disease (stage)
Demographics for Paget’s disease
Caucasian, postmenopausal
Sharply demarcated red velvety lesion with islands of white hyperkeratosis, pruritis or pain
Paget’s disease
Histology: intraepithelial proliferation of glandular-like cells (large, clear cytoplasm, signet ring cells)
Paget’s disease
Malignancy associations with Paget’s disease
25% associated with another primary malignancy (breast, urinary tract, cervix, or rectal cancer)
15-20% have underlying adenocarcinoma
Treatment for Paget’s disease
Excision, rule out additional malignancy
Histology of Bartholin’s gland cancer
Squamous 50%
Adenocarcinoma 50%
Vaginal cancer definition
Cancer arising only from vagina, no cervical or vulvar involvement
Risk factors for vaginal cancer
HPV-related probably, DES exposure in-utero (clear cell adenocarcinoma)
Histology of vaginal cancer
Squamous 85%
Adenocarcinoma 10%
FIGO stages of vaginal cancer by location
I - vagina
II - subvaginal tissue
III - pelvic sidewall, obstructed ureter
IV - adjacent organs, distant organs
Treatment of vaginal cancer
Radiation; surgery in selected cases; maybe chemo-RT, extrapolated from cervical cancer data
