Term
| layers of the vulvar epidermis (4) |
|
Definition
| stratum corneum (non-viable), stratum granulosum, stratum spinosum, basal cell (sterm cells) |
|
|
Term
|
Definition
| developmental, genetic, immune, hormonal, inflammation, infection, neuropathic, dietary oxylates, usually multifactorial |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 3+mo vulvar pain without cause, diagnosis of exclusion |
|
|
Term
| treatment vulvadynia (10) |
|
Definition
| vulvar care, topical anesthetics, estrogen, TCAs (amitryptline), anticonvulsants (gabapentin), intralesional (steroid/bupivicaine), pudendal nerve block, botulinum, pelvic PT, vestibulectomy |
|
|
Term
| what will the pelvic PT do for vulvydynia |
|
Definition
| electrical nerve stimulation, biofeedback, soft tissue release, trigger points, joint manipulation, ultrasound, vaginal dilation |
|
|
Term
| how is a vestibulectomy performed |
|
Definition
| limit to pain portion of hymen to hart line (lateral boundry of vulvar vestibule), must treat vaginsimus first |
|
|
Term
|
Definition
60-90% success if secondary dysparunea
40-50% success for non-surgical methods |
|
|
Term
| signs of contact dermatitis |
|
Definition
| poorly demacrated, erythematous, itchy |
|
|
Term
| signs of lichen simplex chronicus - early |
|
Definition
| scaling, lichenification, itching, sleep dysruption, atopy association, kids and late adults |
|
|
Term
| signs of lichen simplex chronicus - later |
|
Definition
| leathery, hyperpigmentation, hypopigmentation, erosions ulcers |
|
|
Term
| cause lichen simplex chronicus |
|
Definition
| end stage response to irritant (heat, sweating, products, candidia, lichen sclerosis) |
|
|
Term
| histology lichen simplex chronicus |
|
Definition
| inflammatory infiltrate, collagenization of superficial epidermis |
|
|
Term
| treatment lichen simplex chronicus |
|
Definition
| antihistamine, medium dose steroids |
|
|
Term
|
Definition
| itching, burning, dysparunea, tearing, porcealin white papules and plaques, echymosis, thin white skin, cigarette paper, introital narrowing, figure of 8, labial fusion, clitoral phimosis, reduced elasticity, fissures |
|
|
Term
| associated diseases with lichen sclerosis |
|
Definition
|
|
Term
| associated diseases with lichen simplex chronicus |
|
Definition
|
|
Term
| histology lichen sclerosis |
|
Definition
| blunting of rete ridges, chronic inflammatory dermatitis, thinned epithelium |
|
|
Term
| treatment lichen sclerosis |
|
Definition
high dose steroid (clobetasol adult, hydrocortizone kids), immune suppressants (pimerolimus, tarcolimus) second line
screen and biopsy concerning lesions q3-6mo |
|
|
Term
|
Definition
|
|
Term
| age lichen simplex chronicus |
|
Definition
|
|
Term
| lichen simplex chronic risk of cancer |
|
Definition
|
|
Term
| lichen sclerosis risk of cancer |
|
Definition
|
|
Term
| lichen sclerosis remission rate |
|
Definition
96% partial
25% complete (texture/color)
68% partial (texture/color) |
|
|
Term
|
Definition
| cell mediated immunity inflammatory disorder |
|
|
Term
|
Definition
genital and oral lesions (1% oral, 25% with oral have genital)
wickham striae - white lacy reticular
puritic shiny papules
hair loss
gingivitis |
|
|
Term
| signs of erosive lichen planus |
|
Definition
| scarring, pain, deep friable erosions in posterior vestibule often extend to labial minor causing agglutination, synechiae, vaginal obliteration, dysparunia, burning, discharge |
|
|
Term
| signs of desquamative inflammatory vaginitis |
|
Definition
| erosive form of lichen plaus but with inflammatoryr cells and parabasal and basal epithelial cells (small round, large nuclei) |
|
|
Term
|
Definition
high dose steroids
second line - PO cyclosporin, top tarcolimus, hydroxychloroquin, PO retinoids, MTX, cyclophosphamide |
|
|
Term
| signs of squamous cell hyperplasia |
|
Definition
| leathery, accentuation of skin markings red/pink vulva with overlying gray white keratin layer |
|
|
Term
| cause of squamous cell hyperplasia |
|
Definition
|
|
Term
| histology squamous cell hyperplasia |
|
Definition
thickened epithelium
hyperkeratosis
parakeratosis (retined nuclei at surface)
no inflammatory infiltrate
no dermal fibrosis |
|
|
Term
| treatment squamous cell hyperplasia |
|
Definition
| medium dose steroid (Triamcinolone), antihistamines |
|
|
Term
| percent squamous cell hyperplasia cancer conversion |
|
Definition
|
|
Term
|
Definition
| lateral labia majora, genitocural folds, mons, red/pink plaques, silver scales |
|
|
Term
|
Definition
mild - tar shamooo
moderate - triamcinolone, hydrocortizone
severe - clobetasol
vitamin D
phototherapy |
|
|
Term
| incidence of vulvar atrophy |
|
Definition
|
|
Term
|
Definition
| irritation, dryness, UTIs, dysparunea, pale dry thin mucosa, alkaline pH, susceptibility to irritants and trauma, bacterial overgrowth, purulent dischagre, fissuring |
|
|
Term
|
Definition
| parabasal or intermediate cells, pH 6-7.5 |
|
|
Term
|
Definition
| topical estrogen, vaginal moisturizers, maintain intercourse/masturbation |
|
|
Term
| prognosis vulvar atrophy treatment |
|
Definition
|
|
Term
| incidence of pagats of vulva |
|
Definition
|
|
Term
|
Definition
| bright red scaly plaques, frosting, can occur anywhere on milk line |
|
|
Term
|
Definition
| hyperkeratosis, large round oval cells, pale cytoplas, basophillic amphophillic, mitotic figures infrequent (signit ring cells), nest central clear areas (acinar), pigmented nucleolus, skip lesions |
|
|
Term
|
Definition
| mucarmine + acid shiff + cytoplasm mucin 79%, HE stain |
|
|
Term
| histology markers in pagets vulvar |
|
Definition
|
|
Term
|
Definition
| wide local excision or simple vulvectomy, LND if LVSI, mammogram, colonoscopy, CT abdomen |
|
|
Term
| what cancers is pagets of the vulva associated with and percents |
|
Definition
| 25% adenocarcinoma, 80% colorectal adenocarcinoma, 15% invasive adenocarcinoma of the vulva, breast, colon, urinary tract |
|
|
Term
|
Definition
|
|
Term
| risk factors vulvar melanoma |
|
Definition
| fair complexion (red/blonde hair, fair skin, blue/green eyes), sun exposure, family history, atypical nevi |
|
|
Term
|
Definition
| ABCDE, >5mm, usually asymptomatic, pruritis, bleeding |
|
|
Term
|
Definition
1 - epidermis
2 - + papillary epidermis
3 - + papillary redicular dermal interface
4 - + reticular dermis
5 - + subcutaneous tissue |
|
|
Term
| histology markers vulvar melanoma |
|
Definition
| S100, melanoma specific antigen |
|
|
Term
| management vulvar melanoma |
|
Definition
<1mm - 1cm margin
1-4mm - 2cm margin
>4mm - 3cm margin
SLN
chemo rads if advanced or recurrent disease |
|
|
Term
| prognostic factors vulvar melanoma |
|
Definition
stage and depth
not changed in pregnacy
excellent cure with complete excision
limited chemo/rads success |
|
|
Term
| most common placental metastasizinig cancer |
|
Definition
|
|
Term
| most common malignancy in fair skined people |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| basosquamous, adenoid cystic, infiltrative |
|
|
Term
|
Definition
| family history melanoma, blond/red hair, moles, sunburns as child, blistering sunburns, other BCC |
|
|
Term
|
Definition
| PMP, slow growing, brown, raised, asymptomatic, irritation, soreness, pruritis, bloody discharge, supraclavicular adenopathy, rolled ulcerated margin, smooth pearly papule |
|
|
Term
|
Definition
|
|
Term
|
Definition
wide local excision 4-5mm margin
radical vulvectomy if infiltrative
no LND unless LVSI, vascular, or deep invasion |
|
|
Term
|
Definition
poor if mets from other PCC
>2cm poor
deep invasion poor
mets poor |
|
|
Term
| recurrence rate BCC inadequate margins |
|
Definition
|
|
Term
| treatment labial adhesions |
|
Definition
| observe unless symptomatic (urinary obstruction), topical estrogen then nightly emollient to prevent readhesion 1mo, manual excision if acute urinary obstruction |
|
|
Term
| treatments of genital warts |
|
Definition
| imiquimod cream, trichloroacetic acid |
|
|
Term
| when to biopsy genital warts |
|
Definition
| PMP, failing treatment, HIV |
|
|
Term
|
Definition
| loss of maturation, nuclear pleomorphism, cell crowding, abnormal mitoses, no invasion of basement membrane |
|
|
Term
|
Definition
HPV/usual - warty, basaloid, mixed
Non-HPV/differentiated - associated with lichen, high risk SCC |
|
|
Term
|
Definition
| pigmented 50%, raised, papules, parakeratosis |
|
|
Term
|
Definition
| lack of keratinocyte maturation, high nucleus to cytoplasm, high mitotic rate |
|
|
Term
|
Definition
VIN 1 - observation, may treat
wide local excision - 1cm
CO2 laser
imiquiod 5%
photodynamic - not well studied
5-FU - not well studied |
|
|
Term
| side effects of local imiquiod |
|
Definition
| less effective in immune compormised |
|
|
Term
| side effects of CO2 laser ablation |
|
Definition
| pain, no tissue for histology, higher recurrence than excision |
|
|
Term
| depth of CO2 laser ablation |
|
Definition
|
|
Term
| how often in cancer found in resected VIN |
|
Definition
|
|
Term
|
Definition
| 9-50%, higher if positive margins |
|
|
Term
| VIN survellience after treatment |
|
Definition
| colpo at 6 and 12mo, visual inspection annually thereafter |
|
|
Term
| mean age of vulvar cancer |
|
Definition
|
|
Term
|
Definition
| SCC 86%, melanoma, basal cell carcinoma, adenocarcinoma, sarcomas |
|
|
Term
|
Definition
|
|
Term
| most common causes of vulvar cancer |
|
Definition
| 80% HPV, lichen sclerosis |
|
|
Term
| how is depth of invasion classified in vulvar cancer |
|
Definition
| measurment of tumor from epithelial-stromal junction of adjacent most superficial dermal papilla to deepest point of invasion |
|
|
Term
| symptoms of vulvar cancer |
|
Definition
| irritation, pain, pruritis, bleeding, un-resolving lesion, ulceration, friability, induration, discharge/necrosis, urinary symptoms, fistula |
|
|
Term
| patterns of vulvar cancer spread |
|
Definition
lymphatic: superficial inguinal > deep inguinal > pelvic > cloquets node
direct: urethra, bladder, vagina
hematogenous: liver, lung, bone |
|
|
Term
|
Definition
| deepest groin node below cribiform fascia and medial to femoral vein |
|
|
Term
|
Definition
1A - <2cm, <1mm depth
1B - >2cm, <1mm depth
2 - lower uretha, vagina, anus
3A - 1-2 nodes <5mm, 1 node >5mm
3B - 2 nodes >5mm, 3 nodes <5mm
3C - extracapsular nodal spread
4A - fixed/ulcerated nodes, upper urethra, upper vagina, rectum, bone
4B - distant mets including pelvic nodes |
|
|
Term
| treatment vulvar cancer 1A |
|
Definition
| wide local excision, if positive margins consider ERBT |
|
|
Term
| treatment vulvar cancer 1B |
|
Definition
radical local excision, ipsilateral nodes if >2cm from midline, bilateral if <2cm from midline
if positive margins consider ERBT |
|
|
Term
| treatment vulvar cancer stage 2 |
|
Definition
non visceral sparing surgery with LND
then ERBT and chemo |
|
|
Term
| treatment vulvar cancer stage 3 |
|
Definition
non visceral sparing surgery with LND
then ERBT and chemo |
|
|
Term
| treatment of vulvar cancer stage 4 |
|
Definition
|
|
Term
| survellience after vulvar cancer treatment |
|
Definition
exam q3-6mo for 2y then q6-12mo for 3-5y then annually
cytology has limited value |
|
|
Term
| what are adequate margins in vulvar cancer excision |
|
Definition
|
|
Term
| how deep to you resect vulvar cancer |
|
Definition
| to level of coplanar with the fascia over the pubic symphysis |
|
|
Term
| in vulvar cancer a negative LND on one side is associated with what risk of disease on the other side |
|
Definition
|
|
Term
| vulvar cancer stage 1A has what risk of LND involvement |
|
Definition
|
|
Term
| vulvar cancer stage 1B-2 has what risk of LND involvement |
|
Definition
|
|
Term
| what are the risks of LND in vulvar cancer |
|
Definition
30% wound comps (20% breakdown)
30% infection
30% lymphedema |
|
|
Term
| candidates for SNL rather than LND in vulvar cancer |
|
Definition
| negative groin exam, tumor <4cm, no previous vascular surgery impacting inguinal lymph flow |
|
|
Term
| 5y survival vulvar cancer with negative nodes |
|
Definition
|
|
Term
| 5y survival vulvar cancer in patients who had surgical resection |
|
Definition
|
|
Term
| tumor free margin in vulvar cancer ____ indicates good local control |
|
Definition
|
|
Term
| where does vulvar cancer recurrence have higher mortality |
|
Definition
|
|
Term
| what is the most important factor in survival and prognosis in vulvar cancer |
|
Definition
nodes - survival
margins - prognosis |
|
|
Term
| what are not risk factors for sexual function issues after vulvar cancer surgery |
|
Definition
| extent of surgery, lymphaedema, extent of cancer, comorbidities |
|
|
Term
| what are risk factors for sexual function issues after vulvar cancer surgery |
|
Definition
| age, depression, performance status, hypoactive sexual dysfunction before surgery |
|
|
Term
| most common place for vaginal IN |
|
Definition
70% upper vagina
posterior wall > anterior/lateral walls
distal 33% |
|
|
Term
|
Definition
| lack of epithelial maturation, increased nucleus to cytoplasm ratio, increased mitotic activity, irregular nuclear contours, coarse chromatin |
|
|
Term
| with vaginal IN, what percent have invasive disease after resection on path |
|
Definition
|
|
Term
| treatment options for vaginal IN |
|
Definition
| laser, vaginectomy, 5-FU, imiquimod |
|
|
Term
| what is the recurrence rate after laser treatment for vaginal IN |
|
Definition
|
|
Term
|
Definition
| 80% squamous, non-squamous often in younger patients |
|
|
Term
|
Definition
| irritation, pruritis, pain, bleeding, unresolving lesion, ulceration, friability, induration, discharge/necrosis, urinary symptoms |
|
|
Term
| pattern of vaginal cancer spread |
|
Definition
direct: parametria, bladder, rectum
lymphatic: pelvic nodes, groin nodes
hematogenous: late manifestation |
|
|
Term
|
Definition
1- vaginal mucosa
2- paravaginal but not pelvic sidewall
3- pelvic wall, pelvic/inguinal nodes
4A- adjacent organs
4B- distant organs |
|
|
Term
| management vaginal cancer |
|
Definition
best - ERBT
chemo - consider as sensitizer
if involves distal vaginal radiate inguinal nodes
surgical excision in select stage 1 patients +/- brachytherapy
distant mets chemotherapy |
|
|
Term
| survival vaginal cancer by stage |
|
Definition
1 - 70-90%
2 - 50%
3 - 40%
4 - 10-20% |
|
|
Term
| symptoms of DES exposure in-utero |
|
Definition
cervicovaginal clear cell carcinoma
congenital GU abnormalities
infertility
RPL
PTL
PTD
CIN
vaginal adenosis
breast cancer |
|
|
Term
| survellience of had DES exposure in utero |
|
Definition
annual mammogoram
annual pelvic exam with pap and colpo of upper vagina with lugols to rule out adenosis |
|
|
Term
| management of clear cell adenocarcinoma of the vagina |
|
Definition
radical hysterectomy, LND if cervical or upper vagina involved
radiation if advanced disease |
|
|
Term
| #1 pediatric vaginal tumor |
|
Definition
| vaginal sarcoma (sarcoma botryoides, embryonal rhabdomyosarcoma) |
|
|
Term
| management of sarcoma botryoides |
|
Definition
| chemotherapy VAC, radiation, surgery |
|
|
Term
| survival rate sarcoma botryoides |
|
Definition
| 30% 5y, worse in teenagers |
|
|
Term
|
Definition
| oral, ocular, and genital ulcers |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| annular lesions advancing from the labia majora to intercural folds, thighs, inguinal, butt, mons. intense pruritic, red pale rash, sharp sdemacrated scaly borders |
|
|
Term
|
Definition
| dermatophytes - trichophyton, microsporum, epidermophyton |
|
|
Term
|
Definition
| enteric fistula to the upper and lower genital tract, granulomatous salgingitis, ophoritis, vulvar inflammation, edema, granulomas, abscesses, ulcers |
|
|
Term
| which genital wart treatmetns are safe in pregnancy |
|
Definition
| cryotherapy, trihoroacetic acid |
|
|
Term
| which genital wart treatments are not safe in pregnancy |
|
Definition
| imiquimod, podophyllin, 5FU |
|
|
Term
| when do you do a CD for genital warts |
|
Definition
| only if obstructing the vaginal canal or causing bleeding |
|
|
Term
| what can the baby get if exposed to genital warts |
|
Definition
| laryngeal papillamatosis <1% |
|
|
