Vulvar/Ovarian Disease

Question 1

Lichen Simplex Chronicus (LSC)

• Eti
• S/S
• Tx

Answer 1

• Eti: Unknown; “the itch that rashes”
• S/S: Leathery skin w/ accentuated cutaneuous markings; diffuse redness, patches of hyperpigmentation
• Tx: Remove irritants, antipruritics; steroid cream; triamcinolone for hyperkeratosis

Question 2

Lichen Planus (LP)

• Eti
• S/S
• Types
• Tx

Answer 2

• Eti: disortder of cell-mediated immunity
• S/S: “5 Ps;” White lacy bands adjacent to reddish ulcerated lesions
• Types: Classic -> sharply demarcated purplish plaques on oral/genital; Erosive -> erosive, erythametous lesions extending up vaginal canal
• Tx: Cyclopsporin, Corticosteroids, retinoids

Question 3

Lichen Sclerosis (LS)

• EPI
• Eti
• S/S
• LabDx
• Tx

Answer 3

• Epi: Postmenopausal women
• Eti: Unknown
• S/S: pruritis, syapareunia, burning. “Cigarrette paper” or “Onion skin” appearance; “Figure eight” config
• LabDx: Thin, atrophic epithelium, subepi fibrosis + hyalinization, perivascular cuffing by mononuclear cells
• Tx: Clobetasol

Question 4

Vulvar Vetibulitis

Answer 4

• unknown eti
• New onset dyspareunia, inflammation of mucus glands of vestibule; vestibular tendernesss
• Tx steroids, gabapentin, amitryptyline

Question 5

Benign vulvar lesions

Answer 5

• Inclusion cyst
• Cyst of canal of nuck
• Lipoma
• Fibroma
• Hydradenoma
• Urethral Caruncle

Question 6

Paget’s Disease of Vulva

• S/S
• Tx

Answer 6

• S/S: Well-demarcated eczematoid, red-pink lesions w/ scattered islnds of hyperkeratosis
• Tx: excision or vulvectomy

Question 7

Melanoma of the Vulva

Answer 7

• ALL pigemented lesions of vulva req excision

- usually 6/7th decade

Question 8

Vulvar Carcinoma

• EPI
• S/S
• Tx

Answer 8

• EPI: Menopausal females
• S/S: Pruritis, bleeding, discharge, dysuria, red/white exophytic/ulcerative lesions in posterior 2/3 labum majus
• Tx: Radical vulvectomy w/’ bilateral nodal dissection

Question 9

PErineal/Perianal raised red irregular mass

Answer 9

Basal Cell CArcinoma

Question 10

Well differentiated squamous cell carcinoma that presents as a fungating tumor

Answer 10

Verrucous Carcinoma

Question 11

OVaruan cysts

Answer 11

Follicular: Serous filled cysts that originate in graafian follicles

Luteal Cyst: Formed due to the sealing of the corpus hemmorhagium

Question 12

When should CA-125 screening be ordered?

Answer 12

In the presence of clinical findings or US suspicious for Uterine malignancy