Benign and Malignant Conditions of the Vagina and Vulva (Moulton)

Question 1

Clitoromegaly, Clitoral agenesis, Bifid clitoris, Midline fusion of the labiascrotal folds, and Cloaca are all presentations of?

They are congenital anomalies of the?

Answer 1

1) Ambiguous genitalia

2) Vulva

Question 2

Clitoral agenesis results secondary to failure of the ____ to form.

Answer 2

Genital tubercle

Question 3

What is Cloaca?

Answer 3

No definite separation between the vagina & bladder

Question 4

Masculinization in utero of the female fetus causes what

How is the internal genital organ development?

Answer 4

Female pseudohermaphroditism

Normal

Question 5

Congenital Adrenal hyperplasia
Ingestion of exogenous hormones
Androgen secreting tumors of the mother’s adrenals/ovaries

Can lead to what?

Answer 5

Female pseudohermaphroditism

Question 6

What are the 3 most obvious abnormalities of female pseudohermaphroditism?

Answer 6

1) Clitoromegaly
2) Hypospadiac urethra meatus
3) Malpositioned vaginal orifice

Question 7

1) What is seen in Ambiguous Genitalia?
2) What is it caused by?
3) What is the Karyotype?
4) Genetics?
5) Testes?

Answer 7

Androgen Insensitivity

Genetic deficiency in Androgen receptors

46 XY

X-Linked Recessive

Undescended

Question 8

1) How does Ambiguous genitalia occur?

2) What does this lead to phenotypically?

Answer 8

1) Mullerian inhibiting substance

2) Absent Uterus or fallopian tubes

Question 9

What is the treatment for Labial agglutination?

Answer 9

Massage estrogen cream to separate labia majora

Question 10

1) How is Fox Fordyce disease characterized as?
2) Where is it located?
3) What causes Fox-Fordyce disease?

Answer 10

1) Severe pruritic raised yellow retention cysts
2) In axilla and labia
4) Keratin plugged inflammation of Apocrine glands

Question 11

1) What is the most common type of genital cyst?
2) What causes it?
3) How is it described as?

Answer 11

1) Epidermal inclusion cysts
2) Obstructed hair follicles
3) Mobile, non tender, spherical

Question 12

1) What can enlarge and become painful in pregnancy?

2) What color do they turn?

Answer 12

1) Vulvar Varicosities

2) Blue

Question 13

Urethral Caruncles

1) What are Urethral caruncles and where are they?
2) What causes them in children?

In postmenopausal women it is secondary to contraction of the hypoestrogenic __3__ epithelium resulting in everting of the __4__ epithelium.

Answer 13

1) Small fleshy red outgrowth at the distal edge of urethra
2) Spontaneous prolapse of Urethral epithelium
3) Vaginal
4) Urethral

Question 14

1) What happens in Vulvar vestibulitis (Vestibular adenitis)
2) What is the result?
3) What are the clinical symptoms?
4) What is the treatment?

Answer 14

1) 1 or more minor vestibular gland becomes infected
2) Tender Erythematous dots
3) Dyspareunia (painful sexual intercourse) and valvular pain
4) Topical Estrogens/hydrocortisone or surgery

Question 15

What are small, smooth, nodular masses usually on inner surface of labia minora and majora due to inflammatory blockage of its ducts?

How can the material that they contain be described?

Answer 15

1) Sebaceous cyst

2) Cheesy sebaceous material

Question 16

What are the most common benign solid tumors of the vulva? They are slow growing, most range from 1-10 cm.

Answer 16

Fibromas

Question 17

What are slow growing tumors composed of adipose cells?

Answer 17

Lipoma

Question 18

What are rare lesions arising from sweat gland of the vulva?

Answer 18

Hidradenoma

Question 19

Syringoma is a(n) ____ gland tumor.

Answer 19

Eccrine

Question 20

What tumor can occur due to Von Recklinghausen’s disease?

Answer 20

Neurofibroma

Question 21

What tumor appear as multiple 2-3 mm red lesions usually in fourth & fifth decade?

Answer 21

Angioma

Question 22

What are loculated collections of blood that collect following trauma such as bike injuries (straddle injury), birth trauma or sexual assault?

Answer 22

Vulvar hematomas

Question 23

1) What is Atrophic Vaginitis due to?
2) What will exam findings show?
3) What are the treatment?

Answer 23

1) Loss of estrogen (menopause or surgery)
2) Atrophy of external genitalia and loss of vaginal rugae
3) Topical estrogen

Question 24

Local thickening of epithelium that reveals white, leathery, raised surface is diagnostic of?

What does it results from?

What will Biopsy show?

Answer 24

1) Lichen simplex chronicus (Squamous cell hyperplasia)
2) Chronic itching of the area
3) Elongated Rete Ridges and Hyperkeratosis

Question 25

__1__ reveals thin, white, inelastic skin with a crinkled tissue paper appearance that causes___2__

It is frequently found on the vulva of __3__women.

4) Biopsy will reveal what?

Answer 25

1) Lichen Sclerosis
2) Pruritus, Dyspareunia, and burning pain
3) Menopausal
3) LOSS of rete ridges, inflammatory cells lining Basement membrane, and Thin epithelium

Question 26

4% of treated women & 10% of untreated women with lichen sclerosis can develop ____ of the vulva.

Answer 26

Squamous cells cancer

Question 27

1) LICHEN SIMPLEX CHRONICUS presents with marked ____ and ____ with a prominent ____ layer.
2) What is the most striking feature of LICHEN SCLEROSIS
3) How does that occurs

Answer 27

1) Hyperkeratosis and parakeratosis with prominent Granular layer
2) Hyaline zone in superficial dermis
3) Due to edema and degeneration of collagen and elastic fibers of the dermis

Question 28

Purplish, polygonal papules that may appear in an erosive form causing vulvar burning and severe dyspareunia is diagnostic of?

Answer 28

Lichen planus

Question 29

Autoimmune blistering disease involving the vulvovaginal conjunctival areas is characteristic of?

Answer 29

Pemphigus

Question 30

What syndrome classically involves ulcerations in the genital, oral areas with uveitis?

Answer 30

Bechet’s syndrome

Question 31

Crohn’s Disease can present with what?

Answer 31

Vulvar ulceration due to fistulizations

Question 32

What ulcers can develop when chronic pressure is applied
or
Secondary to tissue being moist secondary to urinary incontinence?

Answer 32

Decubitus ulcers

Question 33

1) After birth, what bulging membrane-like structure may be noticed in the vaginal opening which can block the egress (removal) of mucus?

If it is not detected until after menarche, it can appear as a __2__ structure which entraps __3__.

Answer 33

1) Imperforate hymen
2) Thin dark bluish
3) Menstrual flow

Question 34

What type of vaginal septum is most commonly found in the upper and middle thirds of the vagina

And often a small sinus tract or perforation will be present which allows the egress of menstrual flow?

Answer 34

Transverse vaginal septum

Question 35

What type of vaginal septum creates a double vagina and can attach to the lateral wall thus creating a blind vaginal pouch?

Answer 35

Midline longitudinal vaginal septum

Question 36

Which vaginal septum are usually associated with various duplication anomalies of the uterine fundus?

Answer 36

Midline longitudinal vaginal septum

Question 37

1) Vaginal agenesis is the most extreme vaginal anomaly with total absence of the vagina except for the most distal portion (external genitalia) that is derived from?
2) What is the associated syndrome?
3) What must be true for this syndrome?

Answer 37

Urogenital sinus

2) Rokinatansky-Kuster-Hauser Syndrome (Mullerian agenesis)
3) Uterus is absent but fallopian tubes are spared

Question 38

1) Where is Adenosis located?
2) What type of cells?
3) Who gets it?

Answer 38

1) On the Vaginal wall
2) Columnar cells
3) Women exposed to DES in Utero

Question 39

1) Where are (Asymptomatic) Gartner’s duct cyst located?

2) What do they arise from?

Answer 39

1) Lateral walls

2) Arise from Wolfian Duct (Mesonephros)