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69 Cards in this Set
- Front
- Back
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Typically, the vulva is diffusely involved, with very thin, whitish epithelial areas, termed “onion skin” epithelium, there are associated areas of acanthosis characterized by hyperkeratosis—an increase in the number of epithelial cells (keratinocytes) with flattening of the rete pegs.
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Lichen Sclerosus
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Lichen Sclerosus
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Typically, the vulva is diffusely involved, with very thin, whitish epithelial areas, termed “onion skin” epithelium, there are associated areas of acanthosis characterized by hyperkeratosis—an increase in the number of epithelial cells (keratinocytes) with flattening of the rete pegs.
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Typically, the vulva is diffusely involved, with very thin, whitish epithelial areas, termed “onion skin” epithelium, there are associated areas of acanthosis characterized by hyperkeratosis—an increase in the number of epithelial cells (keratinocytes) with flattening of the rete pegs.
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Lichen Sclerosus
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Treatment for lichen sclerosis includes the use of
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topical steroid (clobetasol) preparations in an effort to ameliorate symptoms
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Treatment for lichen sclerosis includes the use of
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topical steroid (clobetasol) preparations in an effort to ameliorate symptoms
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lichen simplex chornicus etiology
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In contrast to many dermatologic conditions that may be described as “rashes that itch,” lichen simplex chronicus can be described as “an itch that rashes.” Most patients develop this disorder secondary to an irritant dermatitis, which progresses to lichen simplex chronicus as a result of the effects of chronic mechanical irritation from scratching and rubbing an already irritated area. The mechanical irritation contributes to epidermal thickening or hyperplasia and inflammatory cell infiltrate, which, in turn, leads to heightened sensitivity that triggers more mechanical irritation.
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Accordingly, the history of these patients is one of progressive vulvar pruritus and/or burning
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lichen simplex chronicus
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Accordingly, the history of these patients is one of progressive vulvar pruritus and/or burning
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lichen simplex chronicus
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lichen simplex chronicus looks like?
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On clinical inspection, the skin of the labia majora, labia minora, and perineal body often shows diffusely reddened areas with occasional hyperplastic or hyperpigmented plaques of red to reddish brown
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usually a desquamative lesion of the vagina, occasional patients develop lesions on the vulva near the inner aspects of the labia minora and vulvar vestibule. Patients may have areas of whitish, lacy bands (Wickham striae) of keratosis near the reddish ulceratedlike lesions characteristic of the disease
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lichen planus
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lichen planus
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usually a desquamative lesion of the vagina, occasional patients develop lesions on the vulva near the inner aspects of the labia minora and vulvar vestibule. Patients may have areas of whitish, lacy bands (Wickham striae) of keratosis near the reddish ulceratedlike lesions characteristic of the disease
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describe lichen planus
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is usually a desquamative lesion of the vagina, occasional patients develop lesions on the vulva near the inner aspects of the labia minora and vulvar vestibule. Patients may have areas of whitish, lacy bands (Wickham striae) of keratosis near the reddish ulceratedlike lesions characteristic of the disease
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describe lichen planus
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is usually a desquamative lesion of the vagina, occasional patients develop lesions on the vulva near the inner aspects of the labia minora and vulvar vestibule. Patients may have areas of whitish, lacy bands (Wickham striae) of keratosis near the reddish ulceratedlike lesions characteristic of the disease
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Typically, complaints include chronic vulvar burning and/or pruritus and insertional (i.e., entrance) dyspareunia and a profuse vaginal discharge
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lichen planus is usually a desquamative lesion of the vagina, occasional patients develop lesions on the vulva near the inner aspects of the labia minora and vulvar vestibule. Patients may have areas of whitish, lacy bands (Wickham striae) of keratosis near the reddish ulceratedlike lesions characteristic of the disease (see Figure 42.1C). Typically, complaints include chronic vulvar burning and/or pruritus and insertional (i.e., entrance) dyspareunia and a profuse vaginal discharge
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Typically, complaints include chronic vulvar burning and/or pruritus and insertional (i.e., entrance) dyspareunia and a profuse vaginal discharge
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lichen planus is usually a desquamative lesion of the vagina, occasional patients develop lesions on the vulva near the inner aspects of the labia minora and vulvar vestibule. Patients may have areas of whitish, lacy bands (Wickham striae) of keratosis near the reddish ulceratedlike lesions characteristic of the disease (see Figure 42.1C). Typically, complaints include chronic vulvar burning and/or pruritus and insertional (i.e., entrance) dyspareunia and a profuse vaginal discharge
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The diagnosis should be suspected in all patients who present with new onset insertional dyspareunia
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Vulvar vestibulitis
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The diagnosis should be suspected in all patients who present with new onset insertional dyspareunia
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Vulvar vestibulitis
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this condition most commonly involves posterolateral vestibular glands between the 4 and 8 o'clock positions
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Vulvar vestibulitis The diagnosis should be suspected in all patients who present with new onset insertional dyspareunia. Patients with this condition frequently complain of progressive insertional dyspareunia to the point where they are unable to have intercourse. The history may go on for a few weeks, but most typically involves progressive
P.369 worsening over the course of 3 or 4 months. Patients also complain of pain on tampon insertion and at times during washing or bathing the perineal area. |
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this condition most commonly involves posterolateral vestibular glands between the 4 and 8 o'clock positions
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Vulvar vestibulitis The diagnosis should be suspected in all patients who present with new onset insertional dyspareunia. Patients with this condition frequently complain of progressive insertional dyspareunia to the point where they are unable to have intercourse. The history may go on for a few weeks, but most typically involves progressive
P.369 worsening over the course of 3 or 4 months. Patients also complain of pain on tampon insertion and at times during washing or bathing the perineal area. |
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cyst of the canal of Nuck or hydrocele.
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The round ligament inserts into the labium majus, carrying an investment of peritoneum. On occasion, peritoneal fluid may accumulate therein, causing a cyst of the canal of Nuck or hydrocele
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The round ligament inserts into the labium majus, carrying an investment of peritoneum. On occasion, peritoneal fluid may accumulate therein, causing a cyst of the canal of Nuck or hydrocele
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cyst of the canal of Nuck or hydrocele.
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VIN 1 occurs most often in
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condylomata acuminata
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VIN 1 occurs most often in
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condylomata acuminata
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Lesions that are condylomatous in origin do not have the features of
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attenuated maturation, pleomorphism, and atypical mitotic figures that are other forms of VIN.
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Lesions that are condylomatous in origin do not have the features of
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attenuated maturation, pleomorphism, and atypical mitotic figures that are other forms of VIN.
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VIN, usual type is subdivided into three histologic subtypes
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warty, basaloid, or mixed-depending on the features present. They all have atypical mitotic figures and nuclear pleomorphism, with loss of normal differentiation in the lower one third to one half of the epithelial layer. Full-thickness loss of maturation indicates lesions that are at least severely dysplastic, including areas that may represent true carcinoma in situ (CIS).
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VIN, usual type is subdivided into three histologic subtypes
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warty, basaloid, or mixed-depending on the features present. They all have atypical mitotic figures and nuclear pleomorphism, with loss of normal differentiation in the lower one third to one half of the epithelial layer. Full-thickness loss of maturation indicates lesions that are at least severely dysplastic, including areas that may represent true carcinoma in situ (CIS).
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characterized by extensive intraepithelial disease whose gross appearance is described as a fiery red background mottled with whitish hyperkeratotic areas.
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gross description of pagets
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characterized by extensive intraepithelial disease whose gross appearance is described as a fiery red background mottled with whitish hyperkeratotic areas.
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gross description of pagets
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gross description of pagets?
- micro: The histology of these lesions is similar to that of the breast lesions, with large, pale cells of apocrine origin below the surface epithelium (Fig. 42.4). Although not common, Paget disease of the vulva may be associated with carcinoma of the skin. Similarly, patients with Paget disease of the vulva have a higher incidence of underlying internal carcinoma, particularly of the colon and breast |
characterized by extensive intraepithelial disease whose gross appearance is described as a fiery red background mottled with whitish hyperkeratotic areas.
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gross description of pagets?
- micro: The histology of these lesions is similar to that of the breast lesions, with large, pale cells of apocrine origin below the surface epithelium (Fig. 42.4). Although not common, Paget disease of the vulva may be associated with carcinoma of the skin. Similarly, patients with Paget disease of the vulva have a higher incidence of underlying internal carcinoma, particularly of the colon and breast |
characterized by extensive intraepithelial disease whose gross appearance is described as a fiery red background mottled with whitish hyperkeratotic areas.
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The treatment for vulvar Paget disease is
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wide local excision or simple vulvectomy
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The treatment for vulvar Paget disease is
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wide local excision or simple vulvectomy
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Vulvar carcinoma accounts for approximately 5% of all gynecologic malignancies. Approximately 90% of these carcinomas are squamous cell carcinomas. The second most common variety is
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melanoma, which accounts for 2% of all vulvar carcinomas, followed by sarcoma.
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Vulvar carcinoma accounts for approximately 5% of all gynecologic malignancies. Approximately 90% of these carcinomas are squamous cell carcinomas. The second most common variety is
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melanoma, which accounts for 2% of all vulvar carcinomas, followed by sarcoma.
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International Federation of Gynecology and Obstetrics 1995 Staging of Vulvar Cancer
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Carcinoma in situ; intraepithelial carcinoma I Tumor confined to the vulva and/or perineum, 2 cm or less in greatest dimension; no nodal metastasis IA Stromal invasion no greater than 1.0 mm* IB Stromal invasion greater than 1.0 mm* II Tumor confined to the vulva and/or perineum, more than 2 cm in greatest dimension; no nodal metastasis III Tumor of any size which invades any of the following: lower urethra, vagina, anus, and/or unilateral regional node metastasis IV IVA Tumor invades any of the following: upper urethra, bladder mucosa, rectal mucosa, or is fixed to bone and/or bilateral regional node metastasis IVB Any distant metastasis including pelvic lymph nodes * The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion. |
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International Federation of Gynecology and Obstetrics 1995 Staging of Vulvar Cancer
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Carcinoma in situ; intraepithelial carcinoma I Tumor confined to the vulva and/or perineum, 2 cm or less in greatest dimension; no nodal metastasis IA Stromal invasion no greater than 1.0 mm* IB Stromal invasion greater than 1.0 mm* II Tumor confined to the vulva and/or perineum, more than 2 cm in greatest dimension; no nodal metastasis III Tumor of any size which invades any of the following: lower urethra, vagina, anus, and/or unilateral regional node metastasis IV IVA Tumor invades any of the following: upper urethra, bladder mucosa, rectal mucosa, or is fixed to bone and/or bilateral regional node metastasis IVB Any distant metastasis including pelvic lymph nodes * The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion. |
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International Federation of Gynecology and Obstetrics 1995 Staging of Vulvar Cancer
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Carcinoma in situ; intraepithelial carcinoma I Tumor confined to the vulva and/or perineum, 2 cm or less in greatest dimension; no nodal metastasis IA Stromal invasion no greater than 1.0 mm* IB Stromal invasion greater than 1.0 mm* II Tumor confined to the vulva and/or perineum, more than 2 cm in greatest dimension; no nodal metastasis III Tumor of any size which invades any of the following: lower urethra, vagina, anus, and/or unilateral regional node metastasis IV IVA Tumor invades any of the following: upper urethra, bladder mucosa, rectal mucosa, or is fixed to bone and/or bilateral regional node metastasis IVB Any distant metastasis including pelvic lymph nodes * The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion. |
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International Federation of Gynecology and Obstetrics 1995 Staging of Vulvar Cancer
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Carcinoma in situ; intraepithelial carcinoma I Tumor confined to the vulva and/or perineum, 2 cm or less in greatest dimension; no nodal metastasis IA Stromal invasion no greater than 1.0 mm* IB Stromal invasion greater than 1.0 mm* II Tumor confined to the vulva and/or perineum, more than 2 cm in greatest dimension; no nodal metastasis III Tumor of any size which invades any of the following: lower urethra, vagina, anus, and/or unilateral regional node metastasis IV IVA Tumor invades any of the following: upper urethra, bladder mucosa, rectal mucosa, or is fixed to bone and/or bilateral regional node metastasis IVB Any distant metastasis including pelvic lymph nodes * The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion. |
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Gartner duct cysts arise from
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vestigial remnants of the wolffian or mesonephric system that course along the outer anterior aspect of the vaginal canal. These cystic structures are usually small and asymptomatic, but on occasion they may be larger and symptomatic so that excision is required.
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Gartner duct cysts arise from
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vestigial remnants of the wolffian or mesonephric system that course along the outer anterior aspect of the vaginal canal. These cystic structures are usually small and asymptomatic, but on occasion they may be larger and symptomatic so that excision is required.
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Gartner duct cysts arise from
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vestigial remnants of the wolffian or mesonephric system that course along the outer anterior aspect of the vaginal canal. These cystic structures are usually small and asymptomatic, but on occasion they may be larger and symptomatic so that excision is required.
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Inclusion cysts are usually seen on the
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the posterior lower vaginal surface, resulting from imperfect approximation of childbirth lacerations or episiotomy. They are lined with stratified squamous epithelium, their content is usually cheesy, and they may be excised if symptomatic.
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Inclusion cysts are usually seen on the
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the posterior lower vaginal surface, resulting from imperfect approximation of childbirth lacerations or episiotomy. They are lined with stratified squamous epithelium, their content is usually cheesy, and they may be excised if symptomatic.
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Inclusion cysts are usually seen on the
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the posterior lower vaginal surface, resulting from imperfect approximation of childbirth lacerations or episiotomy. They are lined with stratified squamous epithelium, their content is usually cheesy, and they may be excised if symptomatic.
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Inclusion cysts are usually seen on the
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the posterior lower vaginal surface, resulting from imperfect approximation of childbirth lacerations or episiotomy. They are lined with stratified squamous epithelium, their content is usually cheesy, and they may be excised if symptomatic.
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VAIN I involves
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the basal epithelial layers
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VAIN I involves
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the basal epithelial layers
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VAIN I involves
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the basal epithelial layers
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VAIN I involves
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the basal epithelial layers
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VAIN 2 involves
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up to two-thirds of the vaginal epithelium
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VAIN 2 involves
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up to two-thirds of the vaginal epithelium
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VAIN 2 involves
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up to two-thirds of the vaginal epithelium
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VAIN 3 involves
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most of the vaginal epithelium (carcinoma in situ)
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VAIN 3 involves
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most of the vaginal epithelium (carcinoma in situ)
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VAIN is most commonly located in
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upper third of the vagina, a finding that may be partially related to its association with the more common cervical neoplasias
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VAIN is most commonly located in
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upper third of the vagina, a finding that may be partially related to its association with the more common cervical neoplasias
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Patients with VAIN I and II can be
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monitored and typically will not require therapy. Many of these patients have human papillomavirus infection and atrophic change of the vagina. Topical estrogen therapy may be useful in some women.
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Patients with VAIN I and II can be
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monitored and typically will not require therapy. Many of these patients have human papillomavirus infection and atrophic change of the vagina. Topical estrogen therapy may be useful in some women.
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Pap smears of the vaginal epithelium can disclose findings that are useful in the diagnosis, although colposcopy with directed biopsy is the definitive method of diagnosis, just as it is with CIN.
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vain
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Pap smears of the vaginal epithelium can disclose findings that are useful in the diagnosis, although colposcopy with directed biopsy is the definitive method of diagnosis, just as it is with CIN.
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vain
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International Federation of Gynecology and Obstetrics (FIGO) Staging of Carcinoma of the Vagina
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I
Carcinoma limited to the vaginal wall II Carcinoma involving subvaginal tissue but not extending to the pelvic wall III Carcinoma extending to the pelvic wall IV Carcinoma extending beyond the true pelvis or has involved the mucosa of the bladder or rectum; bullous edema as such does not permit a case to be allotted to Stage IV IVA Tumor invades bladder and/or rectal mucosa and/or direct extension beyond the true pelvis IVB Spread to distant organs |
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International Federation of Gynecology and Obstetrics (FIGO) Staging of Carcinoma of the Vagina
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I
Carcinoma limited to the vaginal wall II Carcinoma involving subvaginal tissue but not extending to the pelvic wall III Carcinoma extending to the pelvic wall IV Carcinoma extending beyond the true pelvis or has involved the mucosa of the bladder or rectum; bullous edema as such does not permit a case to be allotted to Stage IV IVA Tumor invades bladder and/or rectal mucosa and/or direct extension beyond the true pelvis IVB Spread to distant organs |
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International Federation of Gynecology and Obstetrics (FIGO) Staging of Carcinoma of the Vagina
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I
Carcinoma limited to the vaginal wall II Carcinoma involving subvaginal tissue but not extending to the pelvic wall III Carcinoma extending to the pelvic wall IV Carcinoma extending beyond the true pelvis or has involved the mucosa of the bladder or rectum; bullous edema as such does not permit a case to be allotted to Stage IV IVA Tumor invades bladder and/or rectal mucosa and/or direct extension beyond the true pelvis IVB Spread to distant organs |
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International Federation of Gynecology and Obstetrics (FIGO) Staging of Carcinoma of the Vagina
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Carcinoma limited to the vaginal wall II Carcinoma involving subvaginal tissue but not extending to the pelvic wall III Carcinoma extending to the pelvic wall IV Carcinoma extending beyond the true pelvis or has involved the mucosa of the bladder or rectum; bullous edema as such does not permit a case to be allotted to Stage IV IVA Tumor invades bladder and/or rectal mucosa and/or direct extension beyond the true pelvis IVB Spread to distant organs |
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rare tumor that presents as a mass of grapelike polyps protruding from the introitus of pediatric-age patients. It arises from the undifferentiated mesenchyme of the lamina propria of the anterior vaginal wall
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Sarcoma botryoides (or embryonal rhabdomyosarcoma)
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rare tumor that presents as a mass of grapelike polyps protruding from the introitus of pediatric-age patients. It arises from the undifferentiated mesenchyme of the lamina propria of the anterior vaginal wall
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Sarcoma botryoides (or embryonal rhabdomyosarcoma)
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Sarcoma botryoides (or embryonal rhabdomyosarcoma)
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rare tumor that presents as a mass of grapelike polyps protruding from the introitus of pediatric-age patients. It arises from the undifferentiated mesenchyme of the lamina propria of the anterior vaginal wall
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Sarcoma botryoides (or embryonal rhabdomyosarcoma)
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rare tumor that presents as a mass of grapelike polyps protruding from the introitus of pediatric-age patients. It arises from the undifferentiated mesenchyme of the lamina propria of the anterior vaginal wall
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