Vulvar Pathology

Question 1

Most important prognostic factor

Answer 1

Regional lymph node involvement

Question 2

5 year survival with negative nodes

Answer 2

96%

Question 3

5 year survival with 2 positive nodes

Answer 3

80%

Question 4

5 year survival with 3/> nodes

Answer 4

12%

Question 5

Stage 1A

Answer 5

• <2cm
• stromal invasion 1mm

Question 6

Stage 1B

Answer 6

• > 2cm
• > 1mm invasion

Question 7

Stage 2

Answer 7

Tumor of any size with spread to vagina, Anusara or urethra

Question 8

Stage 3A1

Answer 8

One lymph node >/= 5mm

Question 9

Stage 3A2

Answer 9

= 2 nodes <5mm in size

Question 10

Stage3B1

Answer 10

> 2 nodes size >/=5mm

Question 11

Stage 3B2

Answer 11

3 or more nodes, size <5mm

Question 12

Stage 3C

Answer 12

Extracapsular spread plus nodes

Question 13

Stage 4A1

Answer 13

Invades upper urethra +/- vaginal/bladder/rectal mucosa or pelvic bone

Question 14

Stage 4A2

Answer 14

Fixed or ulcerated inguinal femoral node

Question 15

Stage 4B

Answer 15

Any distant mets

Question 16

What is lichen sclerosus

Answer 16

A benign, chronic, progressive dermatological condition characterized by marked inflammation, epithelial thinning, itching and pain.

Question 17

What is the most common location of LS

Answer 17

Anogenital 85-98%

Can develop on any skin surface and also oral mucosa

Question 18

What age group is affected in women for VLS

Answer 18

Prepubertal and postmenopausal

More commonly postmenopausal

Question 19

What are the main factors that contribute to VLS

Answer 19

• genetic
• hormonal: hypoestrogenic states
• autoimmune

Question 20

What autoimmune diseases ate associated with LS (5)

Answer 20

• vitiligo
• alopecia Areata
• thyroid disease
• pernicious anaemia
• diabetes mellitus

Question 21

What is the hallmark symptom of LS

Answer 21

Vulvar itching
Worse at nights and disturbs sleep

Other symptoms
- pain
- anal discomfort
- dyspareunia
- dysuria

Question 22

What are the examination features of LS

Answer 22

-White atrophied papules that coalesce into plaques
- follicular plugging
- fissuring at posterior fourchette
- fused labia and buried clitoris
- narrowed introitus

Question 23

What is the first line treatment for LS

Answer 23

High potency corticosteroids

Clobetasol propionate
- daily x 1/12
- alt daily x 1/12
- twice weekly x 1/12

Review after 2-3mnths

Question 24

What is second line therapy

Answer 24

Tacrolimus

Must do biopsy prior to treatment

Question 25

What is the lifetime risk of developing Squamous cell carcinoma with LS

Answer 25

<5%

Question 26

What is the predisposing factor for differentiated VIN

Answer 26

Lichen sclerosus

Question 27

What is the incidence of vulvar cancer

Answer 27

3.7: 100,000

Question 28

What is the common age group of vulvar ca

Answer 28

> 65yrs

Question 29

What are predisposing factors for vulvar ca

Answer 29

• lichen sclerosus 4%
• high risk hpv