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75 Cards in this Set
- Front
- Back
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What are the 3 main structures found in the lower female genital tract?
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-Vulva
-Vagina -Cervix |
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Where is the predominance of pathology in the lower female genital tract seen?
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Around the cervical area
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What is the cervix?
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The opening of the uterus at the end of the vagina
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What are Gartner's cysts?
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Remnants of the mesonephric ducts found in the walls of the vagina.
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What are 4 types of pathology seen in the Vulva?
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-Cysts
-Inflammatory infections -Non-infectious dermatoses -Tumors (pre/malignant) |
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What are cysts in the vulva?
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Bartholin gland cysts
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At what age can bartholin gland cysts develop, and where in the vulva?
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-All ages
-Postero-lateral vestibule |
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What is the usual etiology of vulva cysts?
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A Staph, Strep, or GC infection causing obstruction of the bartholin gland itself, or the duct that drains it.
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What are 3 signs/sx of a bartholin gland cyst?
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-Pain
-Swelling -Regional lymphadenitis |
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How are Bartholin gland cysts treated?
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By excision
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What are the 3 most common infections causing inflammation in the vulva?
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-Herpes simplex
-Candida -HPV |
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What is submucosal inflammation of the vestibular glands of the vulva called?
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Vestibular adenitis
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What causes Vestibular Adenitis?
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Etiology is unknown
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What are 2 signs/symptoms of Vestibular Adenitis?
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-Pain
-Extreme point tendernes |
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How is vestibular adenitis treated?
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Surgical excision
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Where can HSV-2 cause inflammation in the lower GU tract?
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-Vulva
-Vagina -Cervix |
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What do we normally do when HSV2 infection is found in the lower GU tract of a pregnant woman? Why?
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Call in a pap smear because we don't want to deliver by normal vaginal delivery in which it may pass HSV2 on to the newborn
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What are the initial signs and symptoms of HSV2 infection, and when do they occur?
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-Papules, vesicles, and ulcers
-Fever -Lymphadenitis Begin 3-7 days after infection |
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What happens 1-3 weeks after the initial HSV2 lesions appear?
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The lesions heal and HSV2 takes up latency in nerve ganglia
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By what method of transmission are babies more likely to get HSV2; intrauterine or during delivery?
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During delivery
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When results in 50% of cases where the baby does acquire HSV2 in utero?
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Premature delivery
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What is the treatment for HSV2?
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Acyclovir
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So what are the top 2 most common vaginal infections?
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1. HSV2
2. Candida |
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What are 3 conditions that enhance vulval/vaginal candidiasis?
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-Diabetes
-Oral contraceptives -Pregnancy |
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What are 3 signs/symptoms of vaginal candidiasis?
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-White patch
-Pruritis -Discharge |
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How is candidiasis treated?
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Antifungal ointment
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What causes Condyloma latum?
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Treponema pallidum/Syphilis
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What are the s/sx of Chancroid and what organism causes it?
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-Tender ulcer w/ adenopathy
-H. ducreyi |
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What are the s/sx of Granuloma inguinale and what organism causes it?
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-Painless papule/ulcer
-Calymmatobacterium granulomatosis |
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What are the s/sx of Lymphogranuloma venerum and what organism causes it?
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-Ulceration and adenitis
-CHLAMYDIA!! |
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What are 4 noninfectious dermatoses that can be found in the vulva?
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-Psoriasis
-Chronic dermatitis -Lichen sclerosis -Lichen simplex chronicus |
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What types of lesions will psoriasis in the vulva produce?
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-Demarcated, Silvery Scale Papules/Plaques
-often symmetrical |
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What is Dermatitis in the vulva caused by?
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Contact allergy
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What are the signs/symptoms of dermatitis in the vulva?
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Dryness
Scaling Vesicles Erosion |
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In what age of patients can lichen sclerosis of the vulva be found?
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Children or adults
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In what condition is there increased findings of lichen sclerosis?
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Women with vulvar cancer
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Is lichen sclerosis premalignant?
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No
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What causes Lichen sclerosis?
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Thinning and whitening of the vulvar epithelium by an elastase type protease.
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What pathologic signs/symptoms result from the thinning and whitening of the vulvar epithelium in Lichen Sclerosis?
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-Fissures
-Ulcers -Rectal bleeding -Bleeding -Strictures |
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What can the FURBS in children resemble?
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Sexual abuse
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What is the treatment for Lichen sclerosis?
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High potency topical steroids in intervals
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What is the relationship of Lichen sclerosis to malignancy?
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It is NOT form of premalignancy, though it is seen in higher amts in cases of malignancy.
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How does Lichen Simplex Chronicus differ from Lichen Sclerosis?
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Simplex chronicus causes THICKENING and RED skin
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What is the association between Lichen simplex chronicus and malignancy?
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It is increased in women with vulvar cancer, but it is NOT a premalignant state.
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What causes Lichen simplex chronicus
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Nonspecific response to irritants
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What is the treatment for Lichen simplex chronicus?
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Topical corticosteroids and antipruretics
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What are the 4 histologic features seen in LICHEN SCLEROSIS?
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-Thinned epidermis
-Hydropic degeneration of basal layer -Sclerotic stroma -Dermal inflammation |
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What are the 3 histologic features seen in Lichen simplex chronicus?
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-Thickened epidermis
-Hyperkeratosis -Dermal inflammation |
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What is the most important pathology in the lower GU tract and where is it concentrated?
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HPV - human papilloma virus; concentrated in the cervix
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What is it usually called when HPV infects the vulva?
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Condyloma accuminatum
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What are the 2 forms of HPV that primarily cause vulvar infection?
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HPV 6 and 11
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What are the 2 main signs/sx of HPV infection?
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-Warts
-Koilocytosis atypia on papsmear |
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How does HPV progress in the majority of individuals?
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Spontaneously regresses
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What is the main difference between HPV types 6/11 and 16/18?
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Types 6 and 11 are mainly benign
Types 16 and 18 are at high risk of transforming into SCC |
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Where are lesions caused by HPV types 16 and 18 primarily seen? In what age groups is this increasing?
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-Seen in the vulva
-Increasing in 20-35 y/o females |
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How is the progression of HPV toward malignancy expressed?
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In degrees of Vulva Intraepithelial neoplasia (VIN)
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What are the 3 degrees of VIN based on?
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Which layer of the epithelium is involved with dysplastic cells.
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What is VIN I?
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Involvement of lower 1/3 of the epithelium
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What is VIN II?
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Involvement of middle 2/3 of the epithelium
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What is VIN III?
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Involvement of the entire thickness of the epithelium, aka squamous carcinoma in situ
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What is squamous carcinoma in situ at risk of progressing into?
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Invasive squamous cell carcinoma
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How is VIN treated?
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By excision
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What is the defining feature of invasive SCC?
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Crossing over the basement membrane of the epithelium
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What is the most common benign tumor of the vulva?
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Papillary hidradenoma
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What does Papillary Hidradenoma appear identically to?
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Intraductal papilloma of the breast
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What is the general histologic appearance/location of a Papillary hidradenoma? What might it be confused with?
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-Sharply circumscribed nodule
-Labia majora/interlabial folds -May confuse with carcinoma |
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What is the treatment for Papillary hidradenoma?
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Just excision
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What is the most common malignant lesion in the vulva?
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Squamous cell carcinoma
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What are 2 other less common malignant lesions that can be found in the vulva?
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-Paget's (more common)
-Melanoma |
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What is the avg age at which Paget's can develop in the vulva?
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70
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How do the vulvar lesions in Paget's develop?
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By the intra-epithelial proliferation of Adenocarcinoma cells of Adnexal gland origin
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How does Paget's disease of the vulva differ from that of the breast?
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Breast usually involves an underlying tumor; there is usually NO underlying tumor in Vulvar Paget's, just confined to intraepithelial.
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What is the appearance of lesions in Paget's? How is it treated?
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-Red-pink with white scales
-Treat by excising |
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What does Paget's have to be differentiated from?
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MELANOMA
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How can you differentiate between Paget's and Melanoma?
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With special stains.
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