Vulvar Disorders/Dysplasia/CA Flashcards
vulvular dystrophies are characterized by what two key features?
pruritus and white lesions of the vulva
t or f: vulvuar lesions must be biopsied to rule out malignancy
TRUE
t or f: an increased risk of vulvar carcinoma is associated with lichen plans and lichen sclerosus.
TRUE
t or f: paget disease of the vulva is frequently associated with cancers
TRUE (these pts are at increased risk of cancer)
t or f: recurrence of paget disease of the vulva is fairly uncommon
FALSE (its actually very common and requires yearly screening)
pruritic, erythematous, eczematoid lesions of the vulva are indicator of what?
paget of the vulva
t or f: paget of the vulva is more common in women in their 20s to 30s
FALSE; post menopausal women (white)
paget of the vulva is associated with which two carcinomas?
adenocarcinoma of the GI tract or breast
how is the diagnosis of paget of the vulva made?
direct bx which reveals paget’s cells
what is the treatment of a solitary paget lesion without malignancy?
wide excision to subq fat
what three exams/tests need to be performed annually in pts with paget disease?
breast exam, screening for GI disease, and cytology of cervix and vulva
this vulvar disorder is a hypertrophic dystrophy caused by chronic irritation resulting in raised, white, thickened lesions
lichen simplex chornicus
what are the two main complaints (in terms of symptoms) associated with lichen simplex chronicus?
itching and scratching
These are fine white lacy lesions commonly associated with lichen planus
Wickham striae (often found on the papules).
microscopic examination of lichen simplex chornicus will reveal which two things?
acanthosis and hyperkeratosis
this vulvar dystrophy is characterized by a paper like appearance of the vulva on both sides and epidermal contractures
lichen sclerosis
what does microscopic examination of lichen sclerosis reveal?
epithelial thinning with a layer of homogenization below and inflammatory cells
what are some commons signs that help reveal lichen planus?
purple (shiny purple lesions), polygonal, planar pruritic
how is the diagnosis of lichen planus made?
3 to 5 mm punch biopsy
what is the medical management of lichen planus? (pharma)
steroid creams (testosterone, clobetasol/temovate); oral steroid in severe cases; remember you can also use uv light for continued scratching
which vulvar dystrophy is characterized by red plaques covered by silver scales?
psoriasis
what is the pharma treatment for psoriasis of the vulva?
steroid creams and vitamin d
t or f: vestibulitis is associated w/insertional dyspareunia and post coital pain
TRUE
what does the colposcopic examination of the lesion of vestibulitis reveal?
acetic acid turns the affected area white, BUT these lesions are NOT dysplastic
t or f: TCA application is a treatment option for vestibulitis
true; vestibulectomy is a drastic option
vestibulitis diagnosis can be made how?
cotton tipped applicator application produces pain
vestibular glands (bartholin) are located where in the vestibule?
at 5 and 7 o’clock
t or f: bartholin gland cysts tend to be bilateral
FALSE - unilateral
t or f: bartholin gland cysts can rupture on their own w/in a few days of development
TRUE
what are the bartholin glands analogous to in the male?
Cowper’s gland
what is the function of the bartholin glands?
to secret thick, alkaline fluid during coitus
t or f: bartholin gland cysts often produce severe unilateral pain
FALSE; often not painful
t or f: a normal bartholin gland is not palpated
TRUE
what is the MCC of bartholin gland abscess?
infection causing main duct draining the gland to become occluded
what is the mainstay of treatment for bartholin gland abscess?
i&d followed by marsupialization
what is the alternative to marsupialization when treating bartholin gland abscess?
placement of ward catheter
what is the most common vulvar cyst?
sebaceous cyst (epidermoid)
is an epidermoid cyst more common on the labia minora or majora?
majora; (remember, this is where the hair - cysts form when the pilosebaceous ducts become occluded)
t o f: most epidermoid cysts do NOT require treatment
TRUE
hidradenitis suppurativa is commonly found where?
in intertriginous areas of the body
t or f: women are more likely to develop hidradenitis suppurativa than men
true
this condition is a chronic infection of the apocrine glands
hidradenitis suppurativa - as the infection grows over time, scaring and pits can form
how is the diagnosis of hidradenitis suppurativa made?
biopsy
what is the treatment of hidradenitis suppurativa?
topic steroid creams and oral antibiotics
what is the most common complaint in vulvar cancer?
itching and burning of the vulva (with raised white lesions)
what are the two high and low risk strains of HPV we vaccinate against with Guardasil?
6 11 (low) 16 18 (high)
lower numbered strains of HPV are typically responsible for what pathology? higher strains?
condylomas/vulvar warts; dysplasia and CA
t or f: vulvar cancer risk factors include HPV (16, 18, 31, 33)
TRUE
what are the precancerous lesions of the vulva called?
VIN (vulvar untraepithelia neoplasia)
t or f: a hx of vulvar skin dz is a risk factor for VIN
TRUE
what are the two mainstay procedures for diagnosis of VIN?
colposcopy and biopsy
at what staging level of VIN is it considered carcinoma-in-situ?
VIN III
in general, the bigger the VIN lesion what are the treatment options?
small lesions can get wide local excision while larger lesions require lasers and vulvectomy
t or f: vulvar intraepithelial lesions are just as likely as cervical intraepithelial lesions to become high grade or cancers
FALSE - LESS LIKELY
what is the most common type of vulvar CA?
squamous cell (90%)
post menopausal or premenopausal women more at risk for vulvar CA?
post
how is the diagnosis of vulvar CA made?
bx
what is the MCC of vulvar dysplasia>
labia majora
what is the difference between the condyloma acuminata and lata?
acuminata is associated with HPV (pearly, and plaque-like or cauliflower appearance); lata associated with secondary syphilis (non-painful, raised, grayish-white lesions)
what type of vaginal CA is associated with in utero DES exposure?
clear cell adenocarcinoma
what is the general treatment and staging of vulvar cancer?
as the stage increases in number, the more invasive the cancer; as the cancer becomes more invasive you have to surgically removes more involved organs
vaginal CA présents typically in which age group?
post menopausal women
what is the most common type of vaginal CA (cell type)?
squamous cell carcinoma
t or f: having VIN and/or CIN is a risk factor for vaginal CA
TRUE
as the stage increases with vaginal CA how does the tx change?
with an increase in stage you move away from surgery and move towards radiation only
how is vulvar CA staged?
surgical
how is vaginal CA staged?
clinical
