Weibliche Geschlechtsorgane - Vulva Flashcards by Tim Soylu

Vulvitis-

What is the most common reason for vulvitis?

A reactive inflammation in response to (in Erwiderung auf)
an exogenous stimulus. This can be an irritant (Reizmittel-Chem)
or an allergen

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Vulvitis-

What pathological secondary symptom exacerbates (verschlimmert) the primary condition?

Puritis (itching) causes scratching which results in trauma. This often exacerbates the primary condition

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Vulvitis-
How does Contact irritant eczymatous dermatitis (Toxisches Kontaktekzem) becomes manifest in vulvitis? What is the visible pathology?

Pathology:
Contact irritant eczymatous dermatitis (Toxisches Kontaktekzem)
manifests as well-defined erythematous weeping (nässend) and crusting papules (Knötchen, Papel)
- nass, rot, verkrustete Knötchen

Reasons:
Reaction to urine, soaps, detergents, antiseptics, deodorants or alcohol

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Vulvitis-

Was ist diese “Irritant contact dermatitis”?

In der Medizin beschreibt das toxische Kontaktekzem (Syn. toxische Kontaktdermatitis, irritatives Kontaktekzem - für die chronische Form auch kumulativ subtoxisches Kontaktekzem)[1] eine direkte Schädigung der Haut infolge einer äußeren Ursache. Sie äußert sich typischerweise in akuten oder chronischen ekzematösen Veränderungen, die durch den direkten und intensiven Kontakt der Haut mit einer Substanz, die potentiell toxisch wirken kann, entstehen. Betroffen sind daher die Hautpartien, die unmittelbar mit der Substanz in Berührung kommen, meistens Hände und Unterarme.

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Vulvitis-
Vulvitis also may be caused by infections, which are often sexually transmitted. Count the most important infectious agents in North America!

HPV (human papillomavirus)
the causative agent of condyloma acuminatum
vulvar intraepithelial neoplasia (VIN)
HSV-1/2
N. Gonorrhoeae
Treponema pallidum
Candida

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Vulvitis-
What is an important complication of vulvitis/ what can happen with the vagina because of a vulvitis?
What are the symptoms?

An important complication of vulvitis is obstruction of the excretory ducts of Bartholin glands!
This blockage may result in painful dilation of the glands - Bartholin cyst -
and abscess formation

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Vulvitis -

wozu dienen die Bartholinische Drüse?

Sie dient der produktion eines mukösen Sekrets, welche den Scheidenvorhof befeuchtet

Die Bartholinische Drüse oder Glandula vestibularis major ist eine paarige, etwa erbsengroße Drüse des weiblichen Genitale. Sie gehört zu den akzessorischen Geschlechtsdrüsen der Frau und entspricht der Bulbourethraldrüse des Mannes.

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Non-Neoplastic Epithelial Disorders

What are both of the most frequent observed non-neoplastic epithelial disorders at the vulvar mucosa?

Lichen sclerosus and lichen simplex chronicus

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Lichen Sclerosus

What kind of ilness is Lichten Sclerosus?

An autoimmune disease! With activated T-cells in the subepithelial inflammatory infilrate

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Lichen Sclerosus

What parts of the vagina are affected?

Labia, clitoris, or Klotorisvorhaut (foreskin of the clitoris), or
the perianal area

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Lichen sclerosus

What happens with the mucosa (pathology)?

Lichen sclerosus is characterized by
- thinning of the epidermis,
- disappearance of rete pegs (physiologische epitheliale
wellenartige Ausbreitung ins Gewebe -rosa welle)
- hydropic degeneration of the basal cell
(Hydropic degeneration is a condition in
which excessive amounts of water accumulate/ansammeln in
dysfunctional cells. In general, hydropic degeneration is
reversible, provided the inciting/anstacheln cause is resolved)
- dermal fibrosis
- a scant (ungenügend) perivascular, mononuclear inflammatory
cell infiltrate

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Lichen Sclerosus

How appears Lichen Sclerosus in macroscopy view?

Smooth
white plaques (leukoplakia)
papules that in time may extend and coalesce (vereinigen)

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Lichen Sclerosus

Lichen Sclerosus is an autoimmune skine disease which can be observed my women and men, extragenital and genital.

In case of the genital Lichen Sclerosus of women, what age groups are affacted?

Lichen sclerosus occurs in all age groups!!!

But most commonly affects postmenopausal women

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Lichen Sclerosus

Is Lichen Sclerosus dangerous?

Lichen sclerosus is benign!
However a small percentage of women 1-5% develop
Plattenepithelkarzinom=squamous cell carcinoma, of the vulva

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Lichen Simplex Chronicus

How is the mucosa affected by Lichen Simplex Chronicus?

epithelial thickening (in particularly of the stratum granulosum)
hyperkerarosis (Verhornung)
An increased mitotic acivity in the basal and suprabasal layers
can be found (but no epithelial atypia)
sometimes there is a pronounced (deutlich) leukocytic infiltration
of the dermis

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Lichen simplex chronicus

The mentionted changed of the skin is caused by what?

These changes are unspecific and a consequence of chronic irritation, often caused by pruritus related to an underlying inflammatory dermatosis.

Lichen simplex Chronicus

How does Lichen simpley chronicus appear macroskopy?

It appears as an area of leukoplakia

Lichen simplex chronicus

Does lichen simplex chronicus cause cancer? What are other connections to cancer?

Lichen simpley chronicus does not cause cancer as an isolate lesion.
But it occurs at the margin of established vulvar cancer
-> it raises the possibility of an association with neoplastic
disease

Lichen

How can you differentiate between Lichen sclerosus and Lichen simplex chronicus?

Just via biopsy and microscopic examination

they both coexist in different areas of the body in the same
person
Both lesions may take the form of leukoplakia
similary white patches can be seen in a variety of other
dermatoses

Lichten simplex chronicus

Was sind die Symptome?
Wie können sich diese verschlimmern?

Lichen Simplex Chronicus äußert sich durch einen ortsständigen, starken Juckreiz, welcher auch durch Kratzen nicht gemildert werden kann.

Es bilden sich hanfkorngroße, harte und rötlichbraun oder hautfarbene Papeln, welche zu einer flächenhaften Verdickung (Lichenifikation) der Haut führen.

Bevorzugt sind die Nackenregion, Streckseiten von Unterarmen und Unterschenkeln, Kreuzbeingegend und der Genitalbereich befallen.

Psychische Belastungen oder Stress können zur Verschlechterung oder sogar zum erneuten Auftreten der Erkrankung führen. Lichen simplex chronicus verläuft in jedem Fall chronisch.

Lcihten simplex chronicus

Wie behandelt man diese Krankheit?

Langzeittherapie:
- Kortikosteroide meist unter Okklusionsverbänden
- Antihistminika gegen den Juckreiz
- Phototherapie und PUVA-Therapie
- Der Patient kann darauf achten, betroffene Körperpartien nicht
ständig mit Kleidung zu verdecken, denn Sonnenstrahlung und
Belüftung der krankhaft veränderten Haut wirkt sich Vorteilhaft
auf die Heilung aus.

Lichten sclerosus

Wie therapiert man sie?

Hochpotentes Kortison
Calcineurinantagonisten Tacrolimus, Pimecrolimus

Eine jahrelang bestehende Atrophie (porzellanartige Weißfärbung und Schrumpfung) der Vulva ist auch mit Kortison oder Calcineurinantagonisten nicht rückgängig zu machen, wobei eine weitere Progression durch die topische Anwendung entsprechender Medikamente eventuell gestoppt, zumindest aber verlangsamt werden kann

Summary

Lichen sclerosus is characterized by atrophic epithelium usually
with dermal fibrosis
Lichen sclerosus carries a slightly increased risk for
development of squamous cell carcinoma
Lichen simplex chronicus is characterized by thickened
epithelium (hyperplasia), usually with an inflammatroy infiltrate

Biospy

Tumors- condylomas

Where is the condyloma located? How does the lesion looks like?

Condyloma is the name given to any wartx lesion of the vulva

Tumor - Condylomas 1. How common is condylomata lata? 2. How does it looks like?

1. not commonly seen today | 2. these warts are flats, moist, minimal elevated (erhebte) lesions

Tumor - Condylomas What ilness is associated with condylomata lata?

Condylomata lata occurs in secondary syphilis

Tumor - Condylomas Discribe the macroskopy of the more common condylomata acuminata - size and shape - color

- papillary and distinctly(deutlich) elevated or somewhat(etwas) flat and rugose - they are red-pink to pink-brown - They occur anywhere on the anogenital surface as a single or multiple lesion - On the vulva, they range from a few milimeters to many centimeters

Tumor - Condylomas What pathogen is assoziated with condylomata lata?

Condylomata lata is strongly associated with HPV infection HPV subtypes 6 and 11 (venerally =venerisch=Geschlechtskrankheit)

Tumor - Condylomas Condylomata lata, what are the risks of the pathogen?

HPV 6 and 11 carry low risk of malignant transformation

Tumor - Vulva - How common is a carcinoma of the vulva (percentage)? - What age is often affacted? - What is the Cancertyp (cell)?

Carcinoma of the vulva represents about 3% of all femal genital tract cancer? Occurring mostly in women older than age 60 90% of carcinomas are squamous cell carcinoma

Tumor - Condylomas What two kinds of carcinoma of the vulva can be differentiated?

There are two kinds of vulvar squamous cell carcinoma: Less common form: - high-risk HPV: HPV subtypes 16 and 18 occur in middle aged women, particularly cigarette smokers Precancerous changes in the epithelium are termed VIN (vulva intraepithelial neoplasia) -Not HPV-associated: older women, occurs preceded (vorausgehend) by many years of reactive epithelial changes, principally lichen sclerosus

Tumor - Carcinoma of the Vulva 1. How do VIN (vulva intraepithelial neoplasia) and vulvar carcinoma manifest on the vulva? Morpholgy/ Makroskopy

- They manifest as areas of leukoplakia in form of epithelial thickening and whitish (weißlich) patches - in 1/4 of the cases the lesions are pigmented owing(ausstehend) to the presence of melanin - over time, these areas are transformed into overt(offensichtlich) exophytic (growth of a tomor outwards) or ulcervative endophytic tumors

Tumor - carcinoma of the vulva 1. where do these carcinoma spread first? 2. How high is the 5% survival rate of a vulva carcinom with less than 2 cm 3. ... And those with advanced stage lesions for 10 year?

1. First metastase can be found to regional nodes, after staying on the side of orgin for a few years 2. 90% survive 5 years 3. only 20% survive 10 years

Extramammary paget disease 1. Where does paget disease occur? 2. What is affacted (which morphological structure)

1. vulva or nipple of the breast 2. Paget disease is an intraepidermal proliferation of malignant epithelial cells

Extramammary paget disease 1. What is the big difference between Paget disease of the breast and of the vulva?

1. Breast: Paget disease is always associated with an underlying Carcinoma Vulva: a majority of cases of vulva Paget disease have no underlying/zugrunde-liegend tumor. They arise from epidermal progenitor cells Just occansionally there is tumor association

Extramammary paget disease How does Paget disease looks makroscopically?

A red, scaly(schuppig), crusted plaque that mimic(nacharmen) | the appearance of an inflammatory dermatitis

Extramammary paget disease How does the Paget disease looks histologically?

Large epithelioid cells Abundant(reichlich) pale, finely granular cytoplasma Occacionally cytoplasmatic vacuoles infilrate the epidermis (Singly-einzelnd and in groups)

Summary -HPV-related vulvar squamous cell carcinoma usually are poorly differentiated lesions and sometimes are multifocal they often evolve from VIN -Non-HPV-related vulvar squamous cell carcinomas occur i older women, usually as well diferentiated and unifocal, and often are Associated with lichen sclerosus or other inflammatroy conditions

Pagets diseae - Vulvar paget: red, scaly plaque - caused by proliferation of malignant epithelial cells within the epidermis - usually there is no underlying carcinoma unlike pagget of nipple - positive staining for PAS distinguishes/unterscheiden Paget disease cells from melanoma