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Repro Exam I > Vulvar Pathology > Flashcards

Vulvar Pathology Flashcards

1
Q

Bartholin gland cysts - pathology

A

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

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2
Q

Bartholin gland cysts - treatment

A

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

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3
Q

Skin pattern 4 P’s of Lichen planus

A

planar, pruritic, purple, papular

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4
Q

Lichen planus - pathology

A

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

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5
Q

Lichen planus - diagnose

A

clinical and/or Biopsy

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6
Q

Lichen planus - treatment

A

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

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7
Q

White reticulated skin pattern of Lichen Planus

A

Wickham’s striae

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8
Q

Lichen planus - histology

A

band of inflammatory cells pushed up against dermal/epidermal junction

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9
Q

Lichen sclerosis (LS&Atropy) - pathology

A

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

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10
Q

Lichen sclerosis - age group

A

elderly and post menopausal females, but any age possible

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11
Q

Lichen sclerosis - prognosis

A

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

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12
Q

Lichen sclerosis - histology

A

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

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13
Q

Lichen simplex chronicus - pathology

A

squamous hyperplasia and acanthosis, hyperkeratosis

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14
Q

Lichen simplex chronicus - S/S

A

itchy, leukoplakia (white patches, slightly elevated)

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15
Q

Lichen simplex chronicus - histology

A

no cytologic atypia, thickened keratin layer

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16
Q

Condyloma Acuminatum - pathology

A

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

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17
Q

Condyloma Acuminatum - prognosis

A

frequently regress, but may relapse years later

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18
Q

Condyloma Acuminatum - treatment

A

cryo, chemical, laser, or excisional

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19
Q

Condyloma Acuminatum - HPV assn

A

90% - HPV 6,11 (low risk)

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

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20
Q

Condyloma Acuminatum - histology

A 
koilocytic change (raisinoid nucleus) - low grade
nuclear enlargement (DNA integration) - high grade
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21
Q

Vulvar Intraepithelial neoplasm (VIN) - describe

A

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

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22
Q

VIN - HPV assn

A 
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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23
Q

VIN - tests

A

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

24
Q

VIN classifications are also based on:

A

thickness of squamous epithelium effected

25
Q

If VIN is all the way through dermis with enlarged nuclei

A

carcinoma - in - situ

26
Q

Invasive SCC of the Vulva - 2 pattern types

A

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

27
Q

SCC of vulva - spread pattern

A

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

28
Q

SCC of vulva - treatment

A

vulvectomy and lymphadenectomy

29
Q

SCC of Vulva - prognosis

A 
depends on stage
 Low T ( 80% @5 year
 High T (tumor invades sidewall, M+ - < 10% @5 year
30
Q

SCC of Vulva - S/S

A

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

31
Q

SCC of vulva - histology

A

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

32
Q

Accessory breast tissue of vulva - pathology

A

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

33
Q

Papillary hidradenoma - pathology, histology, prognosis

A

sharply circumscribed nodule with normal overlying skin

  • benign tumor of apocrine glands
  • double layer of cells columnar and myoepithelial
  • sometimes ulcerates
34
Q

Extramammary Paget disese - pathology

A

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

35
Q

Extramammary Paget disease - histology

A
  • 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)
36
Q

Extramammary Paget disease - tests

A

Cytoplasmic mucopolysaccharide: PAS +, Mucin

CEA +, EMA + on IHC stain, (S100/melanin-A negative)

37
Q

Extramamammary Paget disease - treatment

A

wide local excision - difficult, may recur

look for synchronous tumors

38
Q

Malignant melanoma of the vulva - prognosis

A

poor - usually nodular type

39
Q

Malignant melanoma of the vulva - tests

A

S-100 and Melanin-A positive

40
Q

Melanosis of vulva

A

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

41
Q

Vaginal adenosis - path

A

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

42
Q

What is significance of DES (diethylstilbestrol)?

A

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

43
Q

Main risk factor for clear cell carcinoma of vagina

A

mother who received DES

44
Q

Vaginal neoplasms - general

A

80% metastatic usually SCC (due to HPV)

rare melanoma

45
Q

Embryonal rhabdomyosarcoma - s/s

A

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

46
Q

Embryonal rhabdomyosarcoma - prognosis

A

surgical cure if < 3cm (localized)

grows by local invasion w/ spread to nodes

47
Q

Gartner duct cyst - path

A

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

48
Q

Gartner duct cyst - treatment

A

excisional biopsy

49
Q

Location of herpes infection

A

vulva, vagina, cervix - ulcers

50
Q

Location of Molluscum contagiosum infxn

A

vulva - molluscum lesions

51
Q

location of HPV infection

A

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

52
Q

Location of Chlamydia trachomatis infection

A

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

53
Q

Location of Neisseria gonorrhoeae infection

A

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

54
Q

Location of Candida trichomonas infection

A

vulva, vagina, cervix - vulvovaginitis, cervicovaginitis

55
Q

Location of gardenella infection

A

vagina, cervix

Repro Exam I (7 decks)

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