Benign and Malignant Tumours of the Vulva

Question 1

What is the anatomical definition of the vulva?

Answer 1

Area between the genitocrural folds laterally, mons pubis anteriorly, and anus posteriorly.

Question 2

What are the components of the vulva?

Answer 2

Labia majora/minora, clitoris, vestibule, urethral meatus, vaginal orifice, hymen, Bartholin glands, Skene ducts.

Question 3

What types of epithelium cover the vulva?

Answer 3

Keratinised squamous epithelium, squamous mucosa, and eccrine-rich non-keratinised epithelium.

Question 4

What percentage of genital malignancies are vulvar?

Answer 4

4–5%

Question 5

How are benign vulvar tumours classified?

Answer 5

Benign cystic, solid, and vascular tumours

Question 6

Name three benign cystic tumours of the vulva.

Answer 6

Bartholin’s cyst, mucous cyst, Skene duct cyst

Question 7

Name three benign solid tumours of the vulva.

Answer 7

Fibroma, lipoma, seborrhoeic keratosis

Question 8

List two benign vascular tumours of the vulva.

Answer 8

Haemangioma, lymphangioma

Question 9

What is the typical cause of Bartholin’s cyst/abscess?

Answer 9

Blockage of Bartholin’s duct due to infection (e.g., N. gonorrhoeae, staph, anaerobes)

Question 10

How is Bartholin’s abscess treated?

Answer 10

Antibiotics, surgical drainage, marsupialisation, gland excision

Question 11

What virus types are associated with vulvar warts?

Answer 11

HPV types 6 and 11

Question 12

How are vulvar warts managed?

Answer 12

Topical trichloroacetic acid or podophyllin; excision, cryotherapy, electrosurgery, CO₂ laser

Question 13

What are the features of vulvar haemangiomas?

Answer 13

Red macules that progress to raised, soft, red lesions on labia/perineum

Question 14

What is the treatment for vulvar haemangiomas?

Answer 14

Usually regress spontaneously; corticosteroids or interferon in severe cases

Question 15

What is VIN (Vulvar Intraepithelial Neoplasia)?

Answer 15

Hyperplastic squamous lesion with atypia confined to epithelium

Question 16

What is the main viral agent in VIN?

Answer 16

HPV types 16, 18, 33

Question 17

What are the two subtypes of VIN under current ISSVD classification?

Answer 17

Usual-type VIN and differentiated VIN

Question 18

Which VIN subtype is associated with HPV?

Answer 18

Usual-type VIN (warty, basaloid, mixed)

Question 19

What symptom is seen in 60% of VIN cases?

Answer 19

Intractable itching (pruritus vulvae)

Question 20

How is VIN diagnosed?

Answer 20

Inspection, cytology, dye test (toluidine blue or acetic acid), vulvoscopy, biopsy

Question 21

What is the preferred treatment for VIN?

Answer 21

Wide local excision

Question 22

When is laser ablation appropriate in VIN?

Answer 22

When cancer is not suspected

Question 23

What medical therapy can be used for VIN?

Answer 23

Topical imiquimod 5% cream

Question 24

What is the most common histologic type of vulvar carcinoma?

Answer 24

Squamous cell carcinoma (78–90%)

Question 25

What are common risk factors for vulvar carcinoma?

Answer 25

HPV, smoking, HIV/immunosuppression, age, STIs, history of cervical neoplasia

Question 26

What are non-squamous histological types of vulvar carcinoma?

Answer 26

Basal cell carcinoma, melanoma, Paget’s disease, sarcoma, adenocarcinoma

Question 27

At what age is vulvar carcinoma most common?

Answer 27

60–70 years (6th–7th decade)

Question 28

What are the typical presenting symptoms of vulvar cancer?

Answer 28

Vulvar ulcer, lump, itching, soreness, bleeding, discharge, urinary symptoms

Question 29

What is FIGO stage IA vulvar carcinoma?

Answer 29

Microinvasive lesion <1 mm depth

Question 30

What investigations are important for vulvar cancer evaluation?

Answer 30

EUA + biopsy, FBC, RFT, LFT, USS, CXR, cystoscopy, proctoscopy

Question 31

What are the management options for vulvar carcinoma?

Answer 31

Surgery (WLE, vulvectomy ± LN dissection), radiotherapy, chemotherapy