Vulvar Pathology Flashcards by Storm Wolf

Bartholin gland cysts - pathology

blockage of ducts - polymicrobial(N. gonorrhea most common)

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Bartholin gland cysts - treatment

incision to drain, Word catheter to create new tract or marsupialization

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Skin pattern 4 P’s of Lichen planus

planar, pruritic, purple, papular

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Lichen planus - pathology

inflammatory disorder of the skin/mucosa, unknown cause (AI?)

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Lichen planus - diagnose

clinical and/or Biopsy

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Lichen planus - treatment

topical corticosteriods, no cure, often clears in ~ 1 year

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White reticulated skin pattern of Lichen Planus

Wickham’s striae

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Lichen planus - histology

band of inflammatory cells pushed up against dermal/epidermal junction

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Lichen sclerosis (LS&Atropy) - pathology

skin becomes white and tense (atrophic) and inflexible, white parchment like areas, cause: AI?

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Lichen sclerosis - age group

elderly and post menopausal females, but any age possible

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Lichen sclerosis - prognosis

not precancerous but 1-4% assd w/ increased SCC risk

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Lichen sclerosis - histology

dermal sclerosis - band of hyalinization(pink homogenized stroma) below dermal/epidermal jxn, sometimes chronic inflammation below stroma

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Lichen simplex chronicus - pathology

squamous hyperplasia and acanthosis, hyperkeratosis

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Lichen simplex chronicus - S/S

itchy, leukoplakia (white patches, slightly elevated)

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Lichen simplex chronicus - histology

no cytologic atypia, thickened keratin layer

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Condyloma Acuminatum - pathology

venereal warts, often multiple, verrucous(papillar), occasionally flat: warty type(cauliflower) and coalescing papules (Bowenoid papulosis)

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Condyloma Acuminatum - prognosis

frequently regress, but may relapse years later

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Condyloma Acuminatum - treatment

cryo, chemical, laser, or excisional

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Condyloma Acuminatum - HPV assn

90% - HPV 6,11 (low risk)

10% - HPV 16, 18, 33 (high risk)

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Condyloma Acuminatum - histology

koilocytic change (raisinoid nucleus) - low grade
nuclear enlargement (DNA integration) - high grade

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Vulvar Intraepithelial neoplasm (VIN) - describe

VIN 1-3 - premalignant neoplasm - multistep progression from dysplasia to invasive SCC

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VIN - HPV assn

VIN 1(mild) - all types (90% 6,11) -  Condyloma acuminatum
VIN 2 (moderate) - 16, 18 (high risk) - 
VIN 3 (severe) - 16, 18 (30%),  VIN classic (warty, basaloid)
                   absent 70% VIN simplex (keratinizing)

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VIN - tests

Must biopsy!! look for tumor cells that go past BM into dermis

VIN classifications are also based on:

thickness of squamous epithelium effected

If VIN is all the way through dermis with enlarged nuclei

carcinoma - in - situ

Invasive SCC of the Vulva - 2 pattern types

60% SCC - warty, bowenoid type (HPV) 40% SCC - keratinizing type not HPV, elderly women - precursor lesion is VIN

SCC of vulva - spread pattern

Local invasion with lymphovascular spread to inguinal - pelvic-iliac-periaortic Mets to lungs, liver, other organs

SCC of vulva - treatment

vulvectomy and lymphadenectomy

SCC of Vulva - prognosis

``` depends on stage Low T ( 80% @5 year High T (tumor invades sidewall, M+ - < 10% @5 year ```

SCC of Vulva - S/S

exophytic mass and/or endophytic ulcer in labia majora/minora. (hard indurated lesion) Usually solitary. 10% multifocal w/ condyloma

SCC of vulva - histology

squamous pearls (characteristic of malignant SCC), in into dermis = invasive

Accessory breast tissue of vulva - pathology

from milk line - physiologic - expands during pregnancy rarely - can become adenocarcinoma

Papillary hidradenoma - pathology, histology, prognosis

sharply circumscribed nodule with normal overlying skin - benign tumor of apocrine glands - double layer of cells columnar and myoepithelial - sometimes ulcerates

Extramammary Paget disese - pathology

Malignant (in situ)pruritic, red, crusted sharply demarcated area on labia majora of older women - NO underlying carcinoma mass(unlike Pagets of breast)

Extramammary Paget disease - histology

- tumor cells from primitive germinal cells of mammary like gland ducts in the vulvar skin - large pale malignant cells in epidermis, don't usually invade(also seen in malignant melanoma - must stain)

Extramammary Paget disease - tests

Cytoplasmic mucopolysaccharide: PAS +, Mucin | CEA +, EMA + on IHC stain, (S100/melanin-A negative)

Extramamammary Paget disease - treatment

wide local excision - difficult, may recur | look for synchronous tumors

Malignant melanoma of the vulva - prognosis

poor - usually nodular type

Malignant melanoma of the vulva - tests

S-100 and Melanin-A positive

Melanosis of vulva

Pigmented lesions of the vulva - benign area of increased pigmentation - must biopsy - look like melanoma

Vaginal adenosis - path

glandular epithelium of the embryologic vagina is replaced by squamous epithelium normally, if residual glandular tissue remains = adenosis in ~ 40 % of menstruating women

What is significance of DES (diethylstilbestrol)?

1940-70s - given to women with miscarriages caused vaginal adenosis in their daughters could lead to clear cell carcinoma of the vagina Also increased risk of developing CIN/VIN(& breast ca) -males - cryptochism and hypospadius

Main risk factor for clear cell carcinoma of vagina

mother who received DES

Vaginal neoplasms - general

80% metastatic usually SCC (due to HPV) | rare melanoma

Embryonal rhabdomyosarcoma - s/s

polypoid(grapelike) mass/vaginal bleeding arises in lamina propria of vaginal wall girls < 5 years old

Embryonal rhabdomyosarcoma - prognosis

surgical cure if < 3cm (localized) | grows by local invasion w/ spread to nodes

Gartner duct cyst - path

simple cyst w/ monolayer of benign cuboidal epithelium on lateral(not 4 or 8 oclock(bartholin)) vaginal wall (Wolffian remnant)

Gartner duct cyst - treatment

excisional biopsy

Location of herpes infection

vulva, vagina, cervix - ulcers

Location of Molluscum contagiosum infxn

vulva - molluscum lesions

location of HPV infection

vulva, vagina cervix - warts, intraepithelial neoplasia, invasive carcinoma

Location of Chlamydia trachomatis infection

cervix, uterus, fallopian tubes - follicular cervicitis, endometriosis, salpingo-oophoritis (PID)

Location of Neisseria gonorrhoeae infection

vulva, vagina, cervix, uterus, fallopian tubes - skene gland adenitis, vaginitis(kids), acute cervicitis, acute endometriis and salpingitis

Location of Candida trichomonas infection

vulva, vagina, cervix - vulvovaginitis, cervicovaginitis

Location of gardenella infection

vagina, cervix