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OB/GYN > Vulvar & Vaginal disease & neoplasia (from Dr. K's book) > Flashcards

Vulvar & Vaginal disease & neoplasia (from Dr. K's book) Flashcards

1
Q

what is lichen sclerosus

A

lymphocytic infiltration of upper dermis & epidermal basal layer. Familial, immune disorder.

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2
Q

sx’s of lichen sclerosus

A

vulvar pruritis, thin, whitish epithelium (“onion skin” or “cigarette paper”), may have areas of cracked skin, c/=> dyspareunia

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3
Q

how to dx lichen sclerosis

A

bx, histo’c dx

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4
Q

what are the histo’c findings of lichen sclerosis

A

“hyalinized” or “glassy” appearing dermis

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5
Q

tx of lichen sclerosis. What kind of f/u needed?

A 
corticosteroid cream (clobetasol)
f/u with re-bx b/c tx-resistant form is ass'd w/SCC
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6
Q

prognosis of lichen sclerosis

A

unlikely to completely resolve. May need intermittent tx indefinitely

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7
Q

what is lichen simplex chronicus?

A

“an itch that rashes” 2/2 irritant dermatitis. Scratching => epidermal thickening, inflam

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8
Q

tx of lichen simplex chronicus

A

benadryl, hydroxyzine hydrochloride (anti-itch). Remove irritant. Topical steroid. If relief does not occur in 3 mos, bx.

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9
Q

what is lichen planus?

A

desquamation of vulva

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10
Q

sx’s of lichen planus

A

vulvar burning, pruritis, insertional dyspareunia, profuse discharge containing lots of inflam cells but few bacteria

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11
Q

tx for lichen planus

A

topical steroid, maybe intravaginal hydrocortisone douche

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12
Q

etiology of vulvar psoriasis

A

AD inheritance (component of a generalized dermatologic disorder)

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13
Q

when is vulvar psoriasis likely to occur

A

during menarche, pregnancy, menopause

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14
Q

tx of vulvar psoriasis

A

derm consult

corticosteroids (topical or intralesional injection)

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15
Q

2 categories of vulvar dermatitis

A

eczema, seborrheic dermatitis

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16
Q

2 categories of eczema

A

exogenous & endogenous

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17
Q

what is exogenous eczema:

A

irritant or allergic contact dermatitis

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18
Q

what is endogenous eczema:

A

atopic dermatitis

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19
Q

tx of vulvar dermatitis

A

remove irritant, perineal hygeine, aluminum acetate solution + air-dry
betamethasone valerate (penetrates skin well)
antipruritic agents to help with nighttime scratching

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20
Q

vulvar vestibulitis

A

acute & chronic inflam of vestibular glands (near hymenal ring)

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21
Q

sx’s of vestibulitis

A

new-onset insertional dyspareunia, usually progressive worsening over 3-4 mos, pain w/tampon insertion or bathing

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22
Q

tx of vestibulitis

A

variable, individualized. Topical lidocaine, cortisone ointment, abstinence, surgical excision of vestibular glands, low dose TCA, calcium citrate to remove urine oxalic acid crystals

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23
Q

how is vulvar intraepithelial neoplasia classified

A

VIN 1, 2, 3.
VIN1 = mild dysplasia
VIN 2 = moderate dysplasia
VIN 3 = severe dysplasia, carcinoma in situ

24
Q

cause of VIN 1

A

HPV, or reactive atypia. Usually not neoplastic. (ISSVD got rid of this term since its not precancerous)

25
Q

what is “VIN, usual type”

A

ISSVD grouping of both VIN 2 and 3. Is true neoplasia, high likelihood of progressing to cancer

26
Q

what causes VIN, usual type?

A

HPV

27
Q

what % of women w/VIN 3 or VAIN 3 will also have CIN?

A

60

28
Q

sx’s of VIN

A

vulvar pruritis, irritation, raised mass lesions

29
Q

what are the 3 subtypes of VIN usual type

A

warty
basaloid
mixed

30
Q

tx of VIN usual type

A

wide local excision or laser ablation

31
Q

what is VIN differentiated type

A

a hyperkeratotic, warty papule, or ulcer most often seen in older women. Not HPV-related. Ass’d w/SCC or lichen sclerosus. Progresses rapidly to invasive cancer

32
Q

tx of VIN differentiated type

A

excision

33
Q

what is Paget disease of vulva

A

“fiery red background mottled w/whitish hyperkeratotic areas”

34
Q

pts w/Paget disease have increased risk of what?

A

underlying internal malignancy (esp breast and lung)

35
Q

tx of Paget dis

A

wide local excision or vulvectomy

36
Q

what is most common vulvar carcinoma

A

squamous cell carcinoma (90%0, then melanoma. Adenoca is not common.

37
Q

what age does vulvar ca occur?

A

postmenopausal, mostly 70-80, some (about 20%) dx’d younger than 50.
Esp smokers

38
Q

sx of vulvar ca

A

pruritis, may notice an ulcerative exophytic lesion

39
Q

nat hist of vulvar ca

A

remains localized for a long time

then spreads to LNs

40
Q

how is vulvar ca staged?

A

surgically. Remove the tumor, assess regional LN involvement

41
Q

tx of vulvar ca

A

surgery - trying to do less radical procedures

42
Q

what is an irritated pigmented vulvar lesion concerning for, and what to do about it?

A

melanoma, bx it

43
Q

vaginal neoplasias usually occur 2/2 what?

A

local spread of cervical or vaginal cancers

44
Q

what is a gartner duct cyst?

A

a vaginal cyst that forms from vestigial remnants of wolffian or mesonephric duct

45
Q

what is an inclusion cyst?

A

a cyst on post lower vagina 2/2 imperfect approximation of childbirth lacs or episiotomy

46
Q

what is VAIN

A

vaginal intraepithelial neoplasia

47
Q

VAIN classifications

A

VAIN 1 = involves basal epith layers
VAIN 2 = involves up to 2/3 of vaginal epith
VAIN 3 = involves most of vag epith (CIS)

48
Q

where is VAIN most commonly found?

A

upper 1/3 of vagina, due to its ass’n w/cervical ca spread

49
Q

mgt of VAIN I and II =

A

monitor, usually no tx needed. Topical ES for atrophy.

50
Q

mgt of VAIN III =

A

laser ablation or local excision, or 5-FU cream

51
Q

what % of pts who undergo hysterectomy for CIN III will dvp VAIN III?

A

1-2%

52
Q

sx’s of VAIN III

A

ulcerated, hyperkeratotic lesion but asx’c

53
Q

VAIN III can progress to what?

A

invasive vaginal carcinoma

54
Q

what is the most common type of vaginal cancer?

A

squamous cell

55
Q

what are the 2nd and 3rd most common vaginal cancers?

A

adenoca, melanoma

56
Q

how is vaginal cancer staged?

A

clinical, by degree of invasion to adjacent structures (same as cervical ca.)

57
Q

tx for SCC of vagina

A

radiation, surgery for some. Pelvic exenteration & radical vulvectomy if lower vaginal lesions and vulvar involvement.

OB/GYN (29 decks)

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