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Sem 4 Mini 3 > Disorders of Vulva, Vagina, PID > Flashcards

Disorders of Vulva, Vagina, PID Flashcards

1
Q

What are the types of Non-Neoplastic Epithelial Disorders?

A
  • Lichen Simplex Chronicus (Squamous Cell Hyperplasia)
  • Lichen Sclerosus et Atrophicus
  • Lichen Planus
  • Leukoplakia
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2
Q

Lichen Simplex Chronicus

  • Age?
  • Cause?
  • Visual
A
  • Any age-usually young
  • Caused by scratching of chronic itch
  • thickening of epidermis, hyperkeratosis (may have dermal fibrosis)
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3
Q

Lichen Sclerosus et Atrophicus

  • Age?
  • Visual?
A
  • Post menopausal age
  • white plaques of confluent white patches
  • epidermal atrophy
  • dense collagenous dermal fibrosis
  • Called Balanitis Xerotica Obliterans in males
  • Occasionally progresses fo Squamous Cell Carcinoma
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4
Q
A

Lichen Simplex Chronicus

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5
Q
A

Lichen Sclerosus et Atrophicus

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6
Q

Which NNED has an hourglass appearance?

A

Lichen Sclerosus et Atrophicus

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7
Q

Lichen Planus characteristics?

A
  • inflammatory lesion
  • raised purplish plaques and patches
  • labia minora shows reddening and there is an area of erosion with red denudation of mucosa
  • Tx with topicla steroids
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8
Q

Acute (allergic) Contact Dermatits affects which vaginal regions?

A

BOTH labia majora and labia minora

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9
Q

Which inflammatory vulval disease causes pruritis, soreness, and pain??

A

Allergic Dermatitis

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10
Q

Allergic Dermatitis causes?

A
  • Topical applications like deodorants, creams, ointments (usually used for the treatment of vulval irritation and soreness)
  • Soap, detergents in shower gels and bubble baths, detergents used in washing underwear, cosmetics, perfumes…
  • rubber and latex chemicals used in contraceptives and nail varnish
  • local anesthetics and creams/ topical steroids often given as treatment
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11
Q

What are some other skin inflmmatory conditions?

A
  • Psoriasis
  • suborrheic dermatitis
  • drug rashes of various types
  • blistering diseases (eosinophil, neutrophil, lymphocyte)
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12
Q

Viruses responsible for Vulval infections?

A

HPV and Herpes Vulvitis

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13
Q
  • Thickening of labia minora skin and mucosa (Flat Condyloma)
  • Multiple protuberant warts (Condyloma Acuminata)
A

HPV 6 and 11

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14
Q

Strong link to intraepithelial neoplastic change in the vulva

A

HPV 16 and 18

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15
Q

Form initially painless blisters which subsquently break down to form a painful, sore, eroded area?

A

Herpes Vulvitis

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16
Q

Funals Vulval Infections

A

Candida and Dermatophytic fungi

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17
Q

causes vulvovaginitis, copious vaginal discharge and vulval reddening and soreness, SEEN IN DIABETICS

A

Candida Albicans

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18
Q

Causes superficial inflammation and soreness

A

Dermatophytic fungi

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19
Q

Non-Viral Causes of Vulval infection

A

Klebsiella, Chlamydia,Haemophilus, Treponema

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20
Q

Granuloma inguinale

A

Klebsiella

Ulcerating Nodules on the vulva with donovan bodies

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21
Q

Lymphogranuloma venerum

A

Chlamydia

Ulcerating vulval papules and enlarged inguinal lymph nodes

22
Q

Chancroid

A

Haemophilus

ulcerating vulval tender papules and ulcerating nodeuls with tender enlargement of the inguinal lymph nodes

23
Q

Syphillus

A

Treponema Pallidum

Small painless indurated vulval or vaginal papules in the first stage and multiple moist, warty, vulvovaginal and perineal lesions (condylomata lata) in the second stage

24
Q

Squamous Cell Carcinoma

  • Benign or Malignant?
  • Prognosis?
  • De novo or Intraepithelial formation
A
  • Malignant, usually occurs in elderly women
  • Poor Px- Extensive invasion to other pelvic organs and lymph node metastases
  • Good Px- Localized and well differentiated
  • Mostly arise de Novo, but HPV 16, 18, 31 develop VIN
25
Q

What does VIN mean?

What age group does it effect?

Predisposing factors?

A

Vulval Intraepithelial neoplasia

Effects young women

Predisposition in smokers

26
Q

Which virus is strongly associated with vulval carcinomas arising in VIN

A

HPV 16

27
Q

What evidence would be present in HPV warty change?

A

effected adjacent epithelium

28
Q

Squamous cell Carcinoma variant?

Age Group?

A

Verrocous Carcinoma

Very old women

29
Q

Describe Verrocous Carcinoma?

A

Large warty cauliflower like growth that slowly invades local tissues

Almost never metastasizes

D/D: Condyloma Accuminata

30
Q

Virus responsible for Condyloma Acuminata?

A

HPV 6/11

31
Q

Common source of derivation for benign cysts on Vulva

A

Skin or Bartholin’s glands

32
Q

Name some other neoplastic Lesions of the Vulva?

A

Benign intradermal nevus

Compound Nevus

Malignant Melanoma

Papillary Hiradenoma

Pagets Disease

33
Q

Where is Pagets Disease derived from?

A

skin appendages carcinoma

but no associated underlying malignancy

34
Q

Pagets diseas of Vulva associated with what other location?

A

20-30% associated with Breast Paget Dz

Vulva is most common extra mammary site.

35
Q

What is vaginal adenosis?

A

Remnant of columar endocervical tissue

red granular areas that have columnar mucinous epithelium

Seen in 35-90% of women exposed to DES (diethylstilbestrol) in utero –> increases RISK of CCC

BUT rarely progress to Clear Cell CA

36
Q

What is Gartner duct cyst?

A

relatively common

cyst in lateral wall of vagina

remnants of wolffian duct

37
Q

What is endometriosis vagina?

A

mullerian derived lesion

simulates malignancy

38
Q

What is Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)

A

Red polypoid mass that may protrude from vaginal orifice

1st clincal sign is spotting/bleeding

39
Q

Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)

Histology?

Age?

Prognosis?

A

Rhabdomyoblasts with cross striation

Girls < 6 yo

Px= good with surgery and chemotherapy

40
Q

Diagnostic hallmark of Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)?

A

CROSS STRIATION of Rhabdomyoblasts

-tadpole, strap, and spider cells-

41
Q
A

Arrows show a rhabdoid cell (rhabdomyoblasts) with increased eosinophilic cytoplasm that is classic for sarcoma botryoides.
The lesion in the absence of rhabdoid cells, may be confused with benign inflammatory polyp

42
Q
A

Verrocous Carcinoma

43
Q
A

Sarcoma Botryoides

44
Q

What is PID and whcih pathogens and most commonly involved?

A

PID is an ascending genital infection

N. gonnorhea, C. trachomatis, streptococci, staphylococci, clostridia, E. Coli

45
Q

What are the STAGES of PID?

A
  1. Vulvovaginitis and cervicitis
  2. Acute endometritis
  3. Acute suppurative salpingitis
  4. Salpingo-oopheritis
  5. Pyosalpinx and tubo-ovarian abscess
46
Q

Clinical presentation of PID

A
  • Lower abdominal pain
  • Vaginal discharge (if Chlamydia infection)
  • Fever and chills
  • Nausea and vomiting
  • Dyspareunia
  • Abnormal vaginal bleeding
  • Infertility: Important preventable cause
  • Cervical motion tenderness
47
Q

PID Complications?

A

Chronic salpingitis and hydrosalpinx

Scarring and tubal obstruction:

Infertility, Ectopic (tubal) pregnancy, Chronic Abdominal Pain

Pelvic peritonitis

Perihepatitis and peritoneal fibrous adhesions
(Fitz-Hugh-Curtis syndrome)

48
Q

Fitz-Hugh-Curtis Syndrome

A
  • Contrast enhancement along surface of the liver
  • Perihepatic abscess associated
  • Pericholecystic fluid associated with transient hepatic perfusion abnormality
  • Focal liver-encapsulated fluid collection
  • Gallbladder wall thickening
  • Soft-tissue bands in abundant ascites
  • Heterogeneous adnexal mass
  • Moderate chronic ascites
49
Q

Diagnostic Hallmark of Vaginal Adenosis progression to Clear Cell Carcinoma

A

Hobnail cells

50
Q
A

Sem 4 Mini 3 (7 decks)

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