Vulvar and vaginal pathology

Question 1

Presentation of lichen sclerosis

Answer 1

Postmenopausal woman, itching

Question 2

Distribution of lichen sclerosis

Answer 2

Peri-introital, perianal

Question 3

Presentation of lichen planus

Answer 3

Itching, flat plaque-like papules that are red, white, or purple

Question 4

Distribution of lichen planus

Answer 4

Vulvar skin, mucosa of lower genital tract, possible oral mucosa involvement

Question 5

Presentation of lichen simplex chronicus OR squamous cell hyperplasia

Answer 5

Itching lesion, leathery skin thickening, erythematous skin with greyish layer of keratin

Question 6

Presentation of psoriasis of vulva

Answer 6

Erythematous plaques usually without characteristic flaking found other locations

Question 7

Distribution of psoriasis

Answer 7

Lateral aspect of labia majora or labio-crural folds

Question 8

Presentation of condyloma accuminatum

Answer 8

Young, warty lesion

Question 9

Histology: thin epithelium, blunted rete pegs, chronic inflammatory infiltrate

Answer 9

Lichen sclerosis

Question 10

Histology: lymphocytic infiltrate, necrosis of basal keratinocytes

Answer 10

Lichen planus

Question 11

Histology: thick epithelium, with hyper- and para-keratosis, collagenous dermal layer, superficial inflammatory infiltrate

Answer 11

Lichen simplex chronicus

Question 12

Histology: Thick epithelium with hyper- and para-keratosis, collagenous dermal layer

Answer 12

Squamous cell hyperplasia

Question 13

Histology: stratified squamous epithelium, features of HPV infection (koilocytosis, multinucleated cells, parabasal hyperplasia)

Answer 13

Condyloma accuminata

Question 14

Treatment for most vulvar dematoses

Answer 14

Topical corticosteroids

Question 15

Second and third line treatment for lichen planus

Answer 15

Cyclosporin, retinoids; complete surgical resection

Question 16

Treatment for condyloma accuminata

Answer 16

Aldara, Condylox, Interferon alpha, excision, laser ablation, cryotherapy

Question 17

Most common skin cancer diagnosis (less common on vulva)

Answer 17

Basal cell carcinoma

Question 18

Smooth pearly papule with rolled borders

Answer 18

Basal cell carcinoma

Question 19

Treatment for basal cell carcinoma

Answer 19

Local excision

Question 20

Scaly plaque-like lesion, necrosis, hemorrhagic, hyperkeratotic

Answer 20

Squamous cell carcinoma

Question 21

Treatment for squamous cell carcinoma

Answer 21

Wide radical excision +/- LND

Question 22

Melanoma staging based on…

Answer 22

Depth of invasion (<1 mm is microinvasive)

Question 23

Treatment for VIN

Answer 23

Surgical excision vs laser vaporization (can be better for multifocal as long as not VIN3 - no specimen), occasionally imiquimod

Question 24

Treatment for VAIN

Answer 24

Surgical excision vs laser vaporization vs 5-FU cream (can cause vulvar toxicity) vs imiquimod

Question 25

Proportion of GYN cancers that are vulvar / vaginal

Answer 25

5%

Question 26

Risk factors for vulvar cancer

Answer 26

Similar to cervical cancer, HPV implicated in 40%, increasing age

Question 27

Common histology of vulvar cancer

Answer 27

Squamous cell (90%) Melanoma (5%) Others basal cell, sarcoma, adenocarcinoma, Bartholin's Paget's

Question 28

FIGO stages of vulvar cancer by location

Answer 28

I - vulva II - adjacent structures (urethra, lower vagina, anus) III - inguinofemoral LNs IV - distant

Question 29

Vulvar cancer invasion depth requiring groin LND

Answer 29

>1 mm

Question 30

Vulvar cancer treatment

Answer 30

Individualized, including resection, LND, radiation, chemoradiation (?)

Question 31

Vulvar cancer prognostic factors

Answer 31

Depth of invasion (most important), lymph node status, extent of disease (stage)

Question 32

Demographics for Paget's disease

Answer 32

Caucasian, postmenopausal

Question 33

Sharply demarcated red velvety lesion with islands of white hyperkeratosis, pruritis or pain

Answer 33

Paget's disease

Question 34

Histology: intraepithelial proliferation of glandular-like cells (large, clear cytoplasm, signet ring cells)

Answer 34

Paget's disease

Question 35

Malignancy associations with Paget's disease

Answer 35

25% associated with another primary malignancy (breast, urinary tract, cervix, or rectal cancer) 15-20% have underlying adenocarcinoma

Question 36

Treatment for Paget's disease

Answer 36

Excision, rule out additional malignancy

Question 37

Histology of Bartholin's gland cancer

Answer 37

Squamous 50% | Adenocarcinoma 50%

Question 38

Vaginal cancer definition

Answer 38

Cancer arising only from vagina, no cervical or vulvar involvement

Question 39

Risk factors for vaginal cancer

Answer 39

HPV-related probably, DES exposure in-utero (clear cell adenocarcinoma)

Question 40

Histology of vaginal cancer

Answer 40

Squamous 85% | Adenocarcinoma 10%

Question 41

FIGO stages of vaginal cancer by location

Answer 41

I - vagina II - subvaginal tissue III - pelvic sidewall, obstructed ureter IV - adjacent organs, distant organs

Question 42

Treatment of vaginal cancer

Answer 42

Radiation; surgery in selected cases; maybe chemo-RT, extrapolated from cervical cancer data