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FALL 2013 Patho Exam 1 > Vulvar Disorders > Flashcards

Vulvar Disorders Flashcards

1
Q

Infectious/Inflammatory Vulvar Disorders

A

Bartholinitis, (Bartholin cyst) and Non-neoplastic epithelial disorders (Lichen Sclerosis and Squamous cell hyperpasia)

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2
Q

Vulvar Tumors

A

Benign exophytic lesions including condyloma acuminatum, and vulvar cancers includng VIN, Squamous Neoplastic lesions, glandular neoplastic lesions, and malignant melanoma

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3
Q

adenitis

A

acute inflammation of gland (like in bartholinitis)

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4
Q

function of bartholin gland

A

provide moisture for vaginal vestibule

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5
Q

location of bartholin glands

A

located at 4 and 8 o clock on L and R side of vagina

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6
Q

infection of bartholin gland can result in 1 of 2 things:

A

adenitis (acute inflammation of the gland) or abscess (infected cyst, usually 1-8 cm)

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7
Q

remnants of male embryonic structures that are in the differential diagnosis of bartholin cyst

A

mesonephric cyst of the vagina and canal of nuck (hydrocele-fluid filled sac in scrotum- residua of wolffian duct that can form in vaginal vault or can go to perineum and come out looking like bartholin cyst

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8
Q

bacterial organisms responsible for bartholin cyst

A

e. coli, staph, strep, sexually transmitted pathogens -usually polymicrobial cause

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9
Q

non bacterial causes of bartholin cyst

A

obstruction of duct by inflammatory process or trauma

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10
Q

chronic bartholinitis

A

small cyst, slightly tender, but usually asymptomatic

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11
Q

DDx of bartholin cyst

A

mesopnephric cyst of the vagina, canal of nuck (hydrocele), epithelial inclusion cyst

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12
Q

manifestations of bartholin cyst

A

can by asymptomatic if small cyst, painful if large cyst or abscess, or cause local discomfort

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13
Q

tx options of bartholin cyst

A

I and D (high recurrence, do with another procedure), abx for complicated infection, excision, or marsupilization or word catheter

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14
Q

abx prescribed for bartholin cyst

A

cefixime if strep or e. coli, and clindamycin if staph

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15
Q

cystadentitis without abscess tx

A

abx and hot sitz bath 3x a day at home

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16
Q

asymptomatic cyst tx

A

none needed if less than 40. if over 40, need tx with biopsy to r/o carcinoma

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17
Q

opaque white, plaque like mucosal thickening on female genitals that produces itching and scaling

A

leukoplakia

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18
Q

what percents have paget’s patients have underlying adenocarcinoma?

A

15%

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19
Q

White plaques on female genitals might be d/t any of the following non-neoplastic epithelial disorders:

A

leukoplakia, psoriasis, lichen sclerosus, lichen simplex chronicus

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20
Q

rete pegs

A

inward projections of the epidermis into the dermis

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21
Q

Smooth white plaques or papules in vulvar region in post menopausal women complaining of dyspareunia and itching. Labia are atrophied and stiff. Vaginal orifice is constricted. Dx?

A

Lichen sclerosus

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22
Q

Lichen sclerosus characterized by

A

atrophy

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23
Q

histopathology of lichen sclerosus

A

Epidermis changes- Hydropic degeneration of basal cells, thinning of epidermis, superficial hyperkeratosis, disappearance of rete pegs. Dermis- dermal fibrosis. Scant perivascular mononuclear infiltrate

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24
Q

Scant mononuclear infiltrate in lichen sclerosus refers to what?

A

chronic inflammatory condition involving monocytes, macrophages, lymphocytes, PMS, neutrophils

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25
Q

the primary skin disease of vulva in post menopausal women

A

lichen sclerosus

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26
Q

Can lichen sclerosus become malignant?

A

Yes. It is an epithelial disorder that can become SCC. FOLLOW CLOSELY!

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27
Q

Pathogenesis of lichen sclerosus

A

autoimmune disorder- activated T cells, presence of other autoimmune diseases

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28
Q

You are seeing a postmenopausal women with symptoms that sound like lichen sclerosus. What other autoimmune disorders do you ask her about in history?

A

DM, thyroid dz (esp hypo), vitiligo, pernicious anemia

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29
Q

acanthrosis

A

thickening epidermis

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30
Q

histological changes in lichen simplex chronicus

A

Acanthrosis, hyperkeratosis, expansion of stratum granulosum.

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31
Q

how to differentiate lichen sclerosus vs. lichen simplex chronicus

A

biopsy

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32
Q

Can lichen simplex chronicus be malignant?

A

No increase predisposition to cancer

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33
Q

Benign vulvar lesions that are exophytic (raised)

A

condyloma latum, condyloma acumnatum, fibroepithelial polyp

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34
Q

Looks like “cauliflower” lesion on vulva

A

condyloma acuminatum

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35
Q

how to differentiate between condyloma latum and condyloma acuminatum?

A

BIOPSY! but often can tell from appearance. condyloma latum- raised w/ FLAT top. acuminatum- cauliflower appearance. imp. to distinguish because tx is different

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36
Q

90% of all warts caused by…

A

HPV 6, 11

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37
Q

cause of condyloma acumnatum

A

sexually transmitted via HPV 6, 11

38
Q

histopahtologic changes in condyloma acuminatum

A

“tree like” cores of stroma covered by squamous epithelium, and koilocytic atypia- halo around nuclei

39
Q

koilocytic atypia

A

viral cytopathic change that causes halo around nuclei- found in condyloma acuminatum

40
Q

if you see koilocytic atypic on path report of patient with condyloma acuminatum, should you take it seriously?

A

Yes, F/U frequently with patient becuase these cells tend to be dysplastic and found in potentially pre-CA lesions

41
Q

verrucous gross appearing raised lesion on vulva that looks wart-like. may resemble cauliflower, or tree-like

A

condyloma acuminatum

42
Q

condyloma acuminatum may involve what areas

A

vulvar, perineal, perianal, and vaginal regions

43
Q

is condyloma acuminatum precancerous?

A

Not typically

44
Q

4th most common site of gynecologic neoplasia

A

vulva

45
Q

most common vulvar carcinoma

A

squamous vulvar carcinoma

46
Q

What infections are associated with squamous cell changes of vulva, vagina, and cervix possibly causing carcinoma?

A

HPV 16 and 18 infections

47
Q

risk factors/associations with vulvar carcinomas

A

smoking, coffee intake, females 30-90

48
Q

list the types of vulvar carcinomas from most frequent to least

A

squamous (90%), malignant melanoma (5%), sarcoma, basal cell, adenocarcinoma, paget’s disease, and 4% are undifferentiated

49
Q

precursor of vulvar squamous cell carcinoma

A

VIN

50
Q

2 types of VIN

A

Usual and differentiated

51
Q

categories of usual and differentiated VIN

A

VIN, USUAL TYPE: Warty type, basaloid type, and mixed type. VIN, DIFFERENTIATED TYPE: Simplex type

52
Q

Out of the 2 VIN’S, which is a high grade squamous lesion?

A

VIN, differentiated type (simplex)- progresses to cancer. More aggressive. (although both types can progress to SCC)

53
Q

90% of basaloid and warty type VIN lesions are positive for

A

HPV 16, 18, 31

54
Q

Vin, usual type lesions are often multifocal and multicentric occurring in these areas:

A

interlabial folds, posterior fourchette, and perineum

55
Q

10-30% of people who have VIN, usual type lesions also have what lesions?

A

vaginal or cervical HPV related lesions

56
Q

histological characteristics of VIN, basaloid type

A

atypical immature parabasal type cells, hyperchromatic nuclei, increased mitosis, flat smooth surface, and thickened epithelium

57
Q

histological characteristics of VIN, warty type

A

abnormal maturation of cells from basal cell on outward, increased mitosis in these layers (including basal layer), condylomatous appearance and spiking surface

58
Q

VIN differentiated or usual more common?

A

USUAL type. Differentiated consists of less than 5%

59
Q

3 differences between VIN differentiated usual

A

VIN differentiated- unifocal, unicentric, NOT associated wtih HPV, and has little or no atypia above the basal layers. VIN, usual- multifocal, multicentric, mostly caused by HPV 16, 18, and 31

60
Q

age group of those who get VIN, differentiated

A

post menopausal, above 60 years often

61
Q

90% of vulvar malignancies d/t

A

SCC (following VIN)

62
Q

VIN differentiated a/s what epithelial disorder?

A

lichen sclerosus

63
Q

2 types of vulvar SCC’s

A

Keratinizing, differentiated (simplex type) or Classic warty, or Bowenoid type

64
Q

Risk factors for VIN, usual type

A

reproductive age women, male partner with multiple sexual partners, multiple sexual partners, young age at first intercourse, smoking, immunodeficiency

65
Q

difference between Vulvar SCC keratining vs. classic warty type

A

keratinizing (simplex type)- not related to HPV, precursor is VIN differentiated (simplex)
Classic warty- HPV related, precursor is VIN usual type

66
Q

Lichen sclerosis progression if it becomes malignant

A

VIN differentiated to VIN II, III to VIN, keratinizing SCC

67
Q

where is atypia located in keratinizing SCC

A

in basal layer of squamous epithelium

68
Q

what vulvar disorders can undergo malignant transformation to keratinizing SCC?

A

lichen sclerosus, squamous cell hyperplasia, and differentiated VIN

69
Q

keratinizing SCC metastatic spread linked to

A

size, depth, and lymph involvement

70
Q

keratinizing SCC can metastasize to what areas?

A

inguinal, pelvic, iliac, and periaortic LN

71
Q

keratinizing SCC dissemination to

A

lungs and liver

72
Q

keratinizing SCC prognosis

A

less than 2 cm- 70% avg 5 year survival. if more than 2 cm and lymph node involvement- less than 10% 5 year survival rate

73
Q

HPV association differences between Classic warty SCC vs. its precursor VIN, Usual type

A

VIN, usual type- most are caused by HPV 16, 18, 31. Classic warty SCC a/w HPV 16, 18, 33

74
Q

age groups affected in the 2 types of vulvar SCC

A

keratinizing- older women. Bowenoid or classic warty SCC- younger women

75
Q

variant of SCC with condyloma-cauliflower appearance, but no response to HPV treatment. Grows slows, and rarely metastasizes to lymph nodes. Dx and Tx?

A

Verrucous SCC. Tx: excision with good borders (radiation results in increased invasiveness and mets)

76
Q

incidence of malignant melanoma

A

less than 5%

77
Q

incidence of vulvar malignant melanoma vs. cutaneous melanoma

A

MM occurs often in 60’s-70’s, cutaneous in 40’s

78
Q

5 year survival of vulvar MM

A

less than 32%

79
Q

prognosis of vulvar MM depends on

A

depth of invasion. If Deeper than 1 mm, 60% chance of mortality

80
Q

incidence of Vulvar BCC

A

less than 2% of vulvar cancers

81
Q

age group likely to see vulvar BCC

A

post menopause

82
Q

This type of vulvar carcinoma is not associated with HPV, is usually non metastatic, and a/w high incidence of antecedent malignancy elsewhere

A

vulvar BCC

83
Q

tx of vulvar BCC

A

excision

84
Q

vulvar glandular neoplastic lesions

A

papillary hidradenoma and extramammary paget Dz

85
Q

glandular neoplastic lesions arise from what kind of tissue?

A

ectopic breast tissue

86
Q

papillary hidradenoma appearance

A

identical in appearance to intraductal papillomas of the breast

87
Q

papillary projections from papillary hidradenoma with 2 layers of cells:

A

columnar secretory cells and myoepithelial cells (characteristic of sweat glands and sweat gland tumors)

88
Q

when does extramammary paget disease present?

A

post menopause 60-70’s in caucasians

89
Q

Patient describes vulvar lesion that is itchy, red, crusted, sharply demarcated, and appears like a map. Upon palpation, you note submucosal thickening or nodule. Located on labia majora

A

extramammary paget disease

90
Q

extramammary paget disease is confined to what areas

A

epidermis of skin, hair follicles, and sweat glands (pagets of breasts affects ducts)

FALL 2013 Patho Exam 1 (5 decks)

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