27: Vulvar/vaginal neoplasm Flashcards Preview

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Flashcards in 27: Vulvar/vaginal neoplasm Deck (19)

VIN is ?
Histologic grades include ?

a premalignant disease confined to the vulvar epithelium. VIN I, II, and III based on depth of epithelial involvement
-often asymptomatic but can present with vulvar pruritus and irritation unresponsive to treatment with antifungals or steroids


VIN risk factors

HPV 16 and 18, cigarette smoking, immunodeficiency, and immunosuppression.


VIN diagnosis and treatment

diagnose with vulvar biopsy
-treat with wide local excision, simple or skinning vulvectomy, or laser vaporization of tissue with close colposcopic follow-up
-conservative tx with topical 5-FU or imiquimod


Extra Mammary Paget disease (EMPD)

a preinvasive intraepithelial neoplasia of the vulva; rare but is associated with adenocarcinoma 20% of the time


EMPD appearance
how to diagnose and treat?

-chronic inflammatory changes; pruritic, velvety red in appearance and can eventually scar into white plaques
-biopsy to diagnose
- wide local excision; there is a high recurrence rate and close f/u is important.
-almost always fatal if spread to LNs


is vulvar carcinoma common?
how to stage
risk factors

less than 5% of gyne cancers
-staged surgically
-risk factors: HPV, HIV, and history of cervical cancer


vulvar cancer presentation
how to diagnose?
90% of vulvar carcinoma is this histological type

vulvar itching, pain, and bleeding, and the diagnosis is made by vulvar biopsy.
SCC (squamous cell carcinoma)


treatment of vulvar cancer

radical local excision (stage I) or radical vulvectomy (stages II, III, IV), and regional (inguino-femoral) lymphadenectomy; pelvic exenteration or preoperative chemoradiation may also be used for advanced disease.


Five-year survival rates for vulvar cancer are excellent for ?, but drops to 15% for ?

two or fewer positive nodes
three or more positive node


VAIN lesions presentation
how to pick up?

often asymptomatic but may present with vaginal discharge or postcoital spotting. They can also be picked up on cervical cytology (persistently abnormal paps but no cervical neoplasia)


is VAIN more or less common than CIN or VIN?
where are lesions and how to diagnose?

VAIN is much less common than CIN or VIN.
-Most lesions are multifocal and located in the vaginal apex.
-Diagnosis is made by colposcopically directed vaginal biopsy (with acetic acid and Lugol's solution)


At least 50% to 90% of patients with VAIN have what coexistent neoplasm ?

intraepithelial lesion or invasive lesion of the cervix or vulva.


common therapies for VAIN

Local excision, laser ablation/vaporization, and topical 5-FU
-require close follow-up with colposcopy to rule out recurrence


Prior to treating VAIN, patients should undergo ? to assess for ?

chest imaging, cystoscopy, proctosigmoidoscopy, and IVP to assess for the extent disease.


Small stage I malignancies of the upper vagina can be treated with ?; all other lesions are treated with ? for an overall 5-year survival rate between ?

-surgical excision
-internal and external radiation therapy
-45% and 55%.


Preinvasive neoplastic disease of the vulva is divided into two categories

-squamous (vulvar intraepithelial neoplasia; VIN)
-nonsquamous intraepithelial neoplasias (Paget disease, melanoma in situ)


other types of vulvar cancers besides SCC include ?

malignant melanoma (6%), Bartholin's adenocarcinoma (4%), basal cell carcinoma (2%), and soft tissue sarcomas (1%)


vaginal cancer types

squamous cell carcinoma (SCC) (85%); adenocarcinoma (6%), sarcomas, and melanomas (rare) In the 1970s, clear cell adenocarcinoma was found to be associated with in utero exposure of diethylstilbestrol (DES).


vaginal cancer presentation

Many patients (20%) with are asymptomatic.
-most common symptoms: pruritus, postmenopausal vaginal bleeding, postcoital spotting, and/or watery, blood-tinged discharge