Pathology - Vulval and Vaginal Flashcards
(33 cards)
Vulval intraepithelial neoplasia (2 types)
VIN
paget’s disease
VIN age groups and respective disease course
bimodal
- young women - often multifocal, recurrent or persistent causing treatment problems
- older women - greater risk of progression to invasive squamous carcinoma
VIN behaviour vs CIN
variable
less predictable than CIN
3 grades like CIN
Is VIN HPV related ?
Often, but not always
especially usual type, in younger women
What is VIN often synchronous with?
CIN and VaIN
What is usual type VIN
Younger,
HPV related,
higher risk of developing another HPV-related malignancy of anogenital tract
What is differentiate type of VIN
older, chronic dermatological conditions, greater invasive potential, shorter time between diagnosis and SCC than usual –type Vin, not HPV related
Clinical presentation of VIN (symptoms and signs)
pruritis, but some asympotomatic
Exam: white, grey, red, raised lesions
Diagnosis of VIN
visual inspection and biopsy
Management of VIN (4)
Biopsy to first confirm lesion does not contain invasive cancer
laser therapy
wide local excision +/- imiquimod
long term f/u due to close association with HPV
Management of Partial thickness VIN
most spontaneously regress, no active treatment required
What are the risk factors for high rate of recurrence in VIN?
smoking
larger lesion size
positive margin
Who gets Vulvar Invasive Squamous Carcinoma?
elderly women
How does VISC present?
ulcer or exophytic mass
Risk factors for vulvar cancer
VIN - premalignant
Lichen sclerosis - 4%
Pagets disease of vulva
con also arise from normal epithelium
What is pagets disease of Vulva
adenocarcinoma in situ - pre-invasive
How common is vulval cancer?
new case every 7 years
rare
Common sites of vulval squamous cancer?
labium majorum - 50%
labium minorum - 20%
Histology of VISC?
mostly well differentiated
keratinising
verrucous are an extremely well differentiated type
Spread of vulval invasive squamous carcinoma
Spreads slow
locally
lymphatic - inguinal nodes then pelvic nodes
what is prognosis of vulval cancer (what is the most important prognostic factor)
spread to Nodes
Node negative = 90% 5 yrs
Node postive =
Treatment of vulval cancer
surgical
radical vulvectomy and inguinal lymphadenectomy
Vulvar paget’s disease presentation
Crusting rash
Histological features of paget’s disease
tumour cells in epidermins, contain MUCIN
mostly no underlying cancer
