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Reproductive Pathology > Lesions of the Vulva > Flashcards

Lesions of the Vulva Flashcards

1
Q

What kind of conditions usually affect the vulva and why?

A

because the vulva is largely made up of skin

  1. most inflammatory skin conditions
    - eczema, psoriasis, contact dermatitis
  2. skin infections and skin tumours
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1
Q

What lesions are peculiar to the vulva?

A
  1. Bartholin gland cyst
  2. Non neoplastic epithelial disorders
  3. Neoplasms
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2
Q

What are the non neoplastic epithelial disorders of the vulva?

A
  1. Lichen sclerosus

2. Lichen simplex chronicus

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3
Q

What are the neoplasms of the vulva?

A
  1. Benign: Condyloma acuminatum
  2. Premalignant: Vulval intraepithelial neoplasia (VIN)
  3. Malignant: SCC, Extramammary Paget’s disease
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4
Q

Describe the Bartholins gland cyst?

A
  • common
  • occur at all ages
  • Cysts can become large up to 5cm
  • Cysts are painful and cause discomfort
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5
Q

What is the cause of a Bartholin’s gland cyst?

A

Result from obstruction of Bartholin duct usually by an infection
- Sometimes an abscess can complicate the cyst

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6
Q

Describe the histology of a Bartholin’s gland cyst?

A

lined by either transitional epithelium of normal duct or by squamous metaplasia

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7
Q

What is Lichen Sclerosus?

A

chronic atrophic inflammation of the vulva

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8
Q

What is the epidemiology of Lichen Sclerosus?

A
  • Occurs in all age groups

- more common in menopause

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9
Q

What is the pathogenesis of LS?

A

unclear

- could be autoimmune

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10
Q

Describe Lichen Sclerosus?

A
  • Slowly developing, insidious and progressive

- LS is not a precancerous lesion

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11
Q

Describe the pathology of LS?

A
  1. atrophy, fibrosis and scarring of the vulva

2. Labia are atrophic and introitus (vaginal opening) is narrow

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12
Q

What are the 4 cardinal microscopic features of LS?

A
  1. Epidermal atrophy (thinning)
  2. Hydropic degeneration (oedema) of basal cells
  3. Replacement of dermis by a dense collagenous fibrous tissue
  4. A bandlike lymphocytic infiltrate
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13
Q

What is Lichen Simplex Chronicus?

A

a chronic dermatitis caused by rubbing and scratching to relieve pruritus from any cause
- it is not a precancer lesion

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14
Q

Describe the microscopic morphology of LSC?

A
  1. hyperplasia of squamous epithelium (Acanthosis)
  2. hyperkeratosis - increased thickness of the outer layer of skin
  3. variable dermal inflammation
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15
Q

What are the possible causes of pruritus?

A
  1. infectious e.g. candida, pubic lice

2. non infectious e.g. chemical irritants

16
Q

What is Condyloma Acuminatum?

A
  • Benign tumour caused by Human papilloma virus (HPV)
  • Low risk HPV 6 and 11
  • aka genital warts
17
Q

Describe the macroscopic morphology of Condyloma acuminatum?

A

Single or multiple pedunculated, papillary excrescences/projections
- There is no dysplasia

18
Q

Name malignant neoplasms?

A
  1. squamous cell carcinoma - 85%
  2. Basal cell carcinoma
  3. Melanomas
  4. Adenocarcinoma
  5. Other primary skin tumours
19
Q

Squamous cell carcinoma of the vulva is divided into what 2 groups?

A

Group 1: Associated with high risk HPV

Group 2: Arises on background of normal skin, squamous hyperplasia or lichen sclerosus

20
Q

What are the 2 groups of SCC of the vulva divided in terms of?

A
  • Aetiology
  • Pathogenesis
  • Clinical presentation
21
Q

SCC associated with high risk HPV is preceeded by?

A

classic precancerous lesion

- vulval intraepithelial neoplasm (VIN)

22
Q

What is the clinical presentation of VIN?

A

white or pigmented plaques on vulva

- frequently multicentric

23
Q

What is the epidemiology of SCC and VIN?

A

frequently seen in young patients with the advent of HIV/AIDS

24
Q

How is VIN classified?

A

VIN I, II, III (mild moderate and full thickness dysplasia)

- Invasion through basement membrane denotes invasive cancer

25
Q

Describe SCC on background of normal skin, squamous hyperplasia or lichen sclerosus?

A
  • Aetiology is unclear
  • No association with HPV
  • Associated with P53 mutations
  • Seen in elderly women
  • Rare type of vulval cancer compared to the HPV related one

Reproductive Pathology (8 decks)

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