Non-Neoplastic and Tumors of the Vulva

Non-Neoplastic Epithelial Disorders

• Lichen Sclerosus:

  • Characterized by atrophic epithelium and dermal fibrosis.
  • Pathogenesis unclear; possible autoimmune involvement.
  • Increased risk of squamous cell carcinoma.

• Lichen Simplex Chronicus:

  • Epithelial thickening resulting from inflammatory dermatoses.
  • Expansion of stratum granulosum and surface hyperkeratosis noted.
  • Typically no increased cancer risk; can appear at margins of vulvar cancers.

Tumors

• Condylomas:
  • Two types:
    • Condylomata lata: moist, flat lesions, associated with secondary syphilis.
    • Condylomata acuminata: more common, papillary, elevated lesions on anogenital surfaces.
  • Not pre-cancerous, but found alongside low-grade vulvar intraepithelial neoplasia (VIN grade 1).

High-Grade Vulvar Intraepithelial Neoplasia and Carcinoma

• Carcinoma of the vulva accounts for approximately 3% of all genital tract cancers in women.
• 90% of vulvar carcinomas are squamous cell carcinomas, primarily HPV-related, affecting younger patients.
• Non-HPV-related cancers, typically arising in older women, associated with conditions like lichen sclerosus.

Cervicitis

• Inflammation of the cervix commonly presents with purulent vaginal discharge.
• Can result from infectious or non-infectious causes.
• Frequently linked to sexually transmitted diseases, with Chlamydia trachomatis responsible for 40% of cases in STI clinics.

Cervical Cancer

• Major cause of cancer mortality in women.
• The pap smear is an effective screening tool for early detection.
• Cervical intraepithelial neoplasia (CIN) can be identified years before invasive cancer develops, with peak CIN incidence around 30 years of age.

Proliferative Breast Disease

• Without Atypia:

  • Includes lesions such as epithelial hyperplasia, sclerosing adenosis, complex sclerosing lesions, and papillomas.

• With Atypia:

  • Includes atypical ductal hyperplasia and atypical lobular hyperplasia.

Breast Tumors

• Can originate in either epithelial or connective tissue; most breast neoplasms arise from epithelial structures.

• Fibroadenoma:

  • Most common benign breast tumor, typically occurs in women around their third decade.
  • Linked to increased estrogen activity, presents as discrete, movable masses.

• Phyllodes Tumor:

  • Less common than fibroadenomas, can be large and cystic, with possible malignant transformation.

• Intraductal Papilloma:

  • Neoplastic growth within ducts; can cause serous or bloody discharge and occasionally be associated with nipple retraction.

Breast Cancer Risk Factors

• 75% of breast cancer cases occur in women over age 50.
• Geographic variation in incidence; higher rates in North America and northern Europe.
• Family history and genetics play a significant role, with BRCA1 and BRCA2 mutations frequently implicated.
• Prolonged exposure to estrogen from hormone replacement therapy (HRT) and oral contraceptives is associated with increased cancer risk.
• Ionizing radiation exposure, obesity, alcohol, and high-fat diets also identified as risk factors.

This quiz covers non-neoplastic epithelial disorders such as Lichen Sclerosus and Lichen Simplex Chronicus, as well as various types of condylomas. It also addresses high-grade vulvar intraepithelial neoplasia and carcinoma, focusing on their characteristics and cancer risks. Test your knowledge of these important dermatological conditions.