Vulvar & Vaginal disease & neoplasia (from Dr. K's book) Flashcards
what is lichen sclerosus
lymphocytic infiltration of upper dermis & epidermal basal layer. Familial, immune disorder.
sx’s of lichen sclerosus
vulvar pruritis, thin, whitish epithelium (“onion skin” or “cigarette paper”), may have areas of cracked skin, c/=> dyspareunia
how to dx lichen sclerosis
bx, histo’c dx
what are the histo’c findings of lichen sclerosis
“hyalinized” or “glassy” appearing dermis
tx of lichen sclerosis. What kind of f/u needed?
corticosteroid cream (clobetasol) f/u with re-bx b/c tx-resistant form is ass'd w/SCC
prognosis of lichen sclerosis
unlikely to completely resolve. May need intermittent tx indefinitely
what is lichen simplex chronicus?
“an itch that rashes” 2/2 irritant dermatitis. Scratching => epidermal thickening, inflam
tx of lichen simplex chronicus
benadryl, hydroxyzine hydrochloride (anti-itch). Remove irritant. Topical steroid. If relief does not occur in 3 mos, bx.
what is lichen planus?
desquamation of vulva
sx’s of lichen planus
vulvar burning, pruritis, insertional dyspareunia, profuse discharge containing lots of inflam cells but few bacteria
tx for lichen planus
topical steroid, maybe intravaginal hydrocortisone douche
etiology of vulvar psoriasis
AD inheritance (component of a generalized dermatologic disorder)
when is vulvar psoriasis likely to occur
during menarche, pregnancy, menopause
tx of vulvar psoriasis
derm consult
corticosteroids (topical or intralesional injection)
2 categories of vulvar dermatitis
eczema, seborrheic dermatitis
2 categories of eczema
exogenous & endogenous
what is exogenous eczema:
irritant or allergic contact dermatitis
what is endogenous eczema:
atopic dermatitis
tx of vulvar dermatitis
remove irritant, perineal hygeine, aluminum acetate solution + air-dry
betamethasone valerate (penetrates skin well)
antipruritic agents to help with nighttime scratching
vulvar vestibulitis
acute & chronic inflam of vestibular glands (near hymenal ring)
sx’s of vestibulitis
new-onset insertional dyspareunia, usually progressive worsening over 3-4 mos, pain w/tampon insertion or bathing
tx of vestibulitis
variable, individualized. Topical lidocaine, cortisone ointment, abstinence, surgical excision of vestibular glands, low dose TCA, calcium citrate to remove urine oxalic acid crystals
how is vulvar intraepithelial neoplasia classified
VIN 1, 2, 3.
VIN1 = mild dysplasia
VIN 2 = moderate dysplasia
VIN 3 = severe dysplasia, carcinoma in situ
cause of VIN 1
HPV, or reactive atypia. Usually not neoplastic. (ISSVD got rid of this term since its not precancerous)
what is “VIN, usual type”
ISSVD grouping of both VIN 2 and 3. Is true neoplasia, high likelihood of progressing to cancer
what causes VIN, usual type?
HPV
what % of women w/VIN 3 or VAIN 3 will also have CIN?
60
sx’s of VIN
vulvar pruritis, irritation, raised mass lesions
what are the 3 subtypes of VIN usual type
warty
basaloid
mixed
tx of VIN usual type
wide local excision or laser ablation
what is VIN differentiated type
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
tx of VIN differentiated type
excision
what is Paget disease of vulva
“fiery red background mottled w/whitish hyperkeratotic areas”
pts w/Paget disease have increased risk of what?
underlying internal malignancy (esp breast and lung)
tx of Paget dis
wide local excision or vulvectomy
what is most common vulvar carcinoma
squamous cell carcinoma (90%0, then melanoma. Adenoca is not common.
what age does vulvar ca occur?
postmenopausal, mostly 70-80, some (about 20%) dx’d younger than 50.
Esp smokers
sx of vulvar ca
pruritis, may notice an ulcerative exophytic lesion
nat hist of vulvar ca
remains localized for a long time
then spreads to LNs
how is vulvar ca staged?
surgically. Remove the tumor, assess regional LN involvement
tx of vulvar ca
surgery - trying to do less radical procedures
what is an irritated pigmented vulvar lesion concerning for, and what to do about it?
melanoma, bx it
vaginal neoplasias usually occur 2/2 what?
local spread of cervical or vaginal cancers
what is a gartner duct cyst?
a vaginal cyst that forms from vestigial remnants of wolffian or mesonephric duct
what is an inclusion cyst?
a cyst on post lower vagina 2/2 imperfect approximation of childbirth lacs or episiotomy
what is VAIN
vaginal intraepithelial neoplasia
VAIN classifications
VAIN 1 = involves basal epith layers
VAIN 2 = involves up to 2/3 of vaginal epith
VAIN 3 = involves most of vag epith (CIS)
where is VAIN most commonly found?
upper 1/3 of vagina, due to its ass’n w/cervical ca spread
mgt of VAIN I and II =
monitor, usually no tx needed. Topical ES for atrophy.
mgt of VAIN III =
laser ablation or local excision, or 5-FU cream
what % of pts who undergo hysterectomy for CIN III will dvp VAIN III?
1-2%
sx’s of VAIN III
ulcerated, hyperkeratotic lesion but asx’c
VAIN III can progress to what?
invasive vaginal carcinoma
what is the most common type of vaginal cancer?
squamous cell
what are the 2nd and 3rd most common vaginal cancers?
adenoca, melanoma
how is vaginal cancer staged?
clinical, by degree of invasion to adjacent structures (same as cervical ca.)
tx for SCC of vagina
radiation, surgery for some. Pelvic exenteration & radical vulvectomy if lower vaginal lesions and vulvar involvement.
