Podcast
Questions and Answers
Which of the following is NOT a predisposing factor for advanced tumors of the cervix?
Which of the following is NOT a predisposing factor for advanced tumors of the cervix?
What is the most common gross appearance of cervical squamous cell carcinoma?
What is the most common gross appearance of cervical squamous cell carcinoma?
Which stage of cervical squamous cell carcinoma indicates carcinoma that has reached the pelvic wall?
Which stage of cervical squamous cell carcinoma indicates carcinoma that has reached the pelvic wall?
Which of the following best describes the microscopic variant of cervical SCC characterized by keratin pearls?
Which of the following best describes the microscopic variant of cervical SCC characterized by keratin pearls?
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What complication may occur due to the spread of cervical cancer?
What complication may occur due to the spread of cervical cancer?
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Which infectious agent is responsible for causing condylomata acuminata in the vulva?
Which infectious agent is responsible for causing condylomata acuminata in the vulva?
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What is the primary characteristic of lichen sclerosus?
What is the primary characteristic of lichen sclerosus?
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What complication can arise from a Bartholin gland cyst?
What complication can arise from a Bartholin gland cyst?
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Which of the following conditions is most commonly associated with postmenopausal women?
Which of the following conditions is most commonly associated with postmenopausal women?
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What type of dermatitis is characterized by a reactive inflammatory response to exogenous stimuli?
What type of dermatitis is characterized by a reactive inflammatory response to exogenous stimuli?
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Which skin condition results from repeated scratching and rubbing in response to itchiness?
Which skin condition results from repeated scratching and rubbing in response to itchiness?
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Which infectious agent is NOT associated with vulvitis?
Which infectious agent is NOT associated with vulvitis?
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Papillary hidradenoma arises from which type of glands?
Papillary hidradenoma arises from which type of glands?
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What is clear cell adenocarcinoma primarily associated with?
What is clear cell adenocarcinoma primarily associated with?
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Which organism is NOT typically associated with infectious cervicitis?
Which organism is NOT typically associated with infectious cervicitis?
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Cervical intraepithelial neoplasia (CIN) is primarily caused by which virus?
Cervical intraepithelial neoplasia (CIN) is primarily caused by which virus?
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What is a characteristic of endocervical polyps?
What is a characteristic of endocervical polyps?
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What histological change is observed in chronic cervicitis?
What histological change is observed in chronic cervicitis?
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Which CIN grade indicates severe dysplasia?
Which CIN grade indicates severe dysplasia?
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During which age range is invasive squamous cell carcinoma of the cervix most commonly diagnosed?
During which age range is invasive squamous cell carcinoma of the cervix most commonly diagnosed?
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What can cause chronic cervicitis aside from infection?
What can cause chronic cervicitis aside from infection?
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What viral types are primarily associated with condyloma acuminatum?
What viral types are primarily associated with condyloma acuminatum?
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Which histological feature is characteristic of invasive squamous cell carcinoma?
Which histological feature is characteristic of invasive squamous cell carcinoma?
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Which neoplasm is primarily classified as carcinoma in situ in the vulva?
Which neoplasm is primarily classified as carcinoma in situ in the vulva?
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What is the main organism associated with vaginal infectious inflammation?
What is the main organism associated with vaginal infectious inflammation?
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At what age range does invasive vaginal squamous cell carcinoma typically occur?
At what age range does invasive vaginal squamous cell carcinoma typically occur?
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What distinguishes Paget’s disease of the vulva from other vulvar conditions?
What distinguishes Paget’s disease of the vulva from other vulvar conditions?
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Which condition is NOT associated with HPV infection?
Which condition is NOT associated with HPV infection?
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What is the classification of vaginal intraepithelial neoplasia based on epithelial involvement?
What is the classification of vaginal intraepithelial neoplasia based on epithelial involvement?
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Study Notes
Female Genital Diseases - Vulva
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Infectious Vulvitis: Important infectious agents include:
- Human papillomavirus (HPV): Produces condylomata acuminata (warts) and vulvar intraepithelial neoplasia.
- Herpes simplex genitalis (HSV 1 or 2): Causes a vesicular eruption.
- Gonococci: Cause suppurative infection of the vulvovaginal glands.
- Syphilis: Causes a primary chancre at the inoculation site.
- Candida: Causes an itchy rash on the vulva and surrounding skin.
Complications of Vulva
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Abscess and Bartholin Gland Cyst:
- Bartholin cysts result from the occlusion of Bartholin gland ducts.
- These cysts can become infected and turn into abscesses.
Inflammatory Dermatoses of Vulva
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Contact Dermatitis: A common cause of vulvar dermatitis, resulting from a reactive inflammatory response to exogenous stimuli.
- Irritants like urine, chemicals, or allergens can cause contact irritant or allergic dermatitis.
Non-Contact Vulval Dermatitis
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Lichen Sclerosus: A chronic inflammatory dermatosis affecting genital areas in both sexes.
- Characterized by itchy, smooth white to gray plaques.
- Primarily affects women and usually becomes most extensive in postmenopausal years.
- Microscopically shows hyperkeratosis and a thinned epidermis with a loss of rete ridges. The dermis demonstrates changes.
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Lichen Simplex Chronicus (Neurodermatitis): A chronic itchy skin condition.
- Results from thickened skin in areas subjected to repeated scratching and rubbing.
- Microscopically, acanthosis, hyperkeratosis, and inflammatory cell infiltration of the dermis are evident.
Neoplasms of Vulva—Benign Tumors
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Papillary Hidradenoma: Arises from apocrine sweat glands, often located on the labia.
- Microscopically composed of irregular tubular structures, dilated duct-like structures with intraluminal papillary projections.
- Structures are lined by two layers; an inner layer of columnar cells and an outer layer of cuboidal cells.
Conditionally Acuminatum
- Wart-like verrucous lesion caused by HPV types 6 or 11.
- Usually occurs on the vulva, perineum, or vagina.
- Composed of sessile or pedunculated epithelial proliferation of stratified squamous epithelial cells, some showing perinuclear cytoplasmic clearing.
Malignant Vulvar Tumors
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Vulvar Intraepithelial Neoplasia (VIN): Caused by HPV 16.
- Occurs most commonly in the 4th or 5th decades.
- May progress to invasive carcinoma in the sixth decade.
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Invasive Squamous Cell Carcinoma (SCC):
- Histologically, usually well-differentiated squamous cell carcinoma with keratin pearls or nests and prominent intracellular bridges.
- Prognosis depends on tumor size, depth of invasion, and lymph node status.
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Paget's Disease of Vulva:
- Carcinoma in situ, mostly located on the labia majora.
- Appears as a red crusty, sharply demarcated area.
- Composed of large anaplastic cells, often lying singly or in small clusters.
- There is no underlying intraductal carcinoma.
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Other Vulvar Carcinomas: Include basal cell carcinoma, adenocarcinoma of Bartholin glands or sweat glands, and malignant melanoma.
Vaginal Diseases
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Vaginal Infectious Inflammation: Common causes of vaginal discharge are usually sexually transmitted.
- Important organisms include: Gardenella vaginalis, Neisseria gonorrhoeae, Candida albicans, and Trichomonas vaginalis.
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Vaginal Intraepithelial Neoplasia (VaIN): Defined by squamous cell atypia without invasion.
- Classified by the depth of epithelial involvement; VaIN 1 and 2 affect the lower one-third and two-thirds of the epithelium respectively. VaIN 3 involves all epithelium thickness and is related to HPV infection.
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Invasive Vaginal Squamous Cell Carcinoma: Uncommon.
- Vast majority are HPV-associated and preceded by VaIN 3.
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Clear Cell Adenocarcinoma: Very rare, often in women whose mothers were treated with diethylstilbestrol.
- Composed of glands lined by vacuolated clear cells. Typically between ages of 60-70.
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Embryonal Rhabdomyosarcoma: Extremely rare, predominantly in young females.
Cervical Diseases
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Infectious Cervicitis: Extremely common, caused by Chlamydia trachomatis, N. gonorrhoeae, and Trichomonas vaginalis.
- Can be chronic or acute, acute often results in purulent discharge.
- Cervicitis can sometimes be non-infectious, caused by chemical or mechanical irritation.
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Chronic Cervicitis: Cervical tissue infiltrated by chronic inflammatory cells.
- Leads to metaplasia of endocervical columnar epithelium into squamous epithelium.
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Endocervical Polyps: Common, but can grow large.
- Composed of connective tissue stroma with blood vessels covered by endocervical or metaplastic squamous epithelium.
- Usually benign and asymptomatic.
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Cervical Intraepithelial Neoplasia (CIN): Caused by HPV.
- Usually begins at the squamo-columnar junction in adolescents.
- Characterized by squamous metaplasia, maturation, and cytologic atypia.
- Nuclear atypia includes hyperchromasia, pleomorphism, increased mitotic activity, and an increased nuclear-cytoplasmic ratio.
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CIN Grades:
- CIN I: Mild dysplasia (lower ⅓ of epithelium).
- CIN II: Moderate dysplasia (lower ⅔ of epithelium).
- CIN III: Severe dysplasia (more than ⅔ to full thickness of epithelium).
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Invasive Squamous Cell Carcinoma of Cervix:
- Peak incidence around 45 years, usually in multipara.
- Preceded by CIN 3.
- Symptoms include pain, bleeding, and painful intercourse.
- Predisposing factors include early full sexual activity, high parity, infection by HPV and herpes simplex type II, high and prolonged levels of estrogen.
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Gross Appearance of Cervical SCC: Often shows as polypoid (most common), ulcerative, or infiltrative lesions within the cervix.
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Microscopically, cervical Carcinoma: Shows keratinizing keratin pearls and abundant keratohyaline granules, intercellular bridges, large, hyperchromatic nuclei (coarse chromatin).
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Nonkeratinizing variant: Shows polygonal cells forming sheets or nests with intercellular bridges, but no keratin pearls.
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Papillary variant: Shows thin or broad papillae, with fibrovascular cores lined by multilayered epithelium.
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Basaloid variant: Shows well-defined nests of immature basaloid cells.
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Stages of Cervical SCC:
- Stage I: Confined to the cervix.
- Stage II: Reaches the upper part of the vagina.
- Stage III: Reaches the pelvic wall or lower ⅓ of the vagina.
- Stage IV: Reaches the urinary bladder or rectum, with distant metastases.
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Other Malignant Tumors of the Cervix: Adenocarcinoma (classic type), adenosquamous carcinoma, clear cell adenocarcinoma, small cell carcinoma, sarcomas, and melanomas are less common.
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Effects/Complications of Cervical Cancer: Includes spread to surrounding structures, regional lymph nodes (iliac, sacral, hypogastric), and distant sites (liver, lungs, bone), as well as vesico-vaginal and recto-vaginal fistulas and pyometria.
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Description
Test your knowledge on female genital diseases focusing on the vulva. This quiz covers infectious vulvitis, complications such as abscesses, and inflammatory dermatoses. Review key conditions and their causes, as well as associated complications in order to strengthen your understanding of vulvar health.
