Vulva, vagina, cervix Flashcards
vulvitis
reactive inflammation d/t irritation (urine, soap, detergent) or allergic rxn (perfume, soap, clothing dye)
erythematous weeping and crusting papules and plaques
candida vulvovaginitis
very common, d/t yeast fungus
risk factor: DM, pregnancy, abx, immunocompromised states
causes pruritic rash, dyspareunia, thick discharge
genital herpes
HSV usually type 2
dormant w reactivation d/t stress, trauma, UV radiation
can be transmitted in latent or active phase
causes papules -> painful vesicles -> ulcers
histo: intranuclear inclusions and giant cells
*systemic herpes in immunocompromised (AIDS, neonates)
Bartholin cyst
usually d/t obstruction of duct following infection
lined by transitional or squamous metaplastic epithelium
tx: excise or marsupialise (open permanently)
epidermal inclusion cyst
similar to cyst in other hair-bearing skin
lined by keratinized squamous epithelium - can smell bad if keratin rots
lichen sclerosus etiology and gross appearance
aka chronic atrophic vulvitis
inflammatory dz of unknown cause, sometimes a/w AI dz
m/c post-menopause
skin is atrophic, pale gray, scarring, pruritic
*not pre-malignant, but inc risk carcinoma
lichen sclerosus histo
epidermis: hyperkeratosis, atrophic w loss of rete pegs, hydropic degeneration of basal cells
dermis: dense collagenous infiltrate, perivascular T cell infiltrate
squamous cell hyperplasia
aka hyperplastic dystrophy or lichen simplex chronicus
result of rubbing/scratching
presents as leukoplakia
not premalignant
squamous cell hyperplasia histo
acanthosis (epidermal thickening) and hyperkeratosis
stratum granulosum thickened, inc basal and suprabasal mitoses, NO cellular atypia
dermal inflammatory infiltrate
HPV vulvar disease - types
condylomata acuminata
classic vulvar intraepithelial neoplasia (VIN) - precursor to…
squamous cell carcinoma: basaloid and warty types
condylomata acuminata
sexually transmitted “venereal warts”
d/t HPV 6, 11
verrucous proliferation of stratified squamous epithelium - acanthosis w hyperkeratosis, parakeratosis, koilocytic atypia (raisinoid nuclei w perinuclear vacuoles)
*not pre-malignant, may regress
classic vulvar intraepithelial neoplasia
precursor to poorly differentiated basaloid and warty squamous cell carcinomas
90% a/w HPV 16, 18
in middle-aged females, smokes
multifocal erythematous plaque with scaling
classic VIN histo
acanthosis, hyperkeratosis, parakeratosis
nuclear atypia, mitoses, lack of maturation from base extending superficially
3 grades; VIN 3 = squamous carc in situ
differentiated VIN
aka VIN simplex
tP53 mutations
histo: basal cell atypia and superficial differentiation
precursor to well-differentiated keratinizing squamous cell carcinoma
keratinizing squamous cell carcinoma
common in 80s, esp w lichen sclerosus or squamous cell hyperplasia
dev from diff VIN
*good prognosis if caught early (less than 2cm lesion = 90% 5 yr survival), but LN involvement = less than 10%